The question, "Can diabetics drink milk?", is an important one. Our answer is a qualified, “Yes.” This article discusses the dietary restrictions that are most important for the prevention and management of diabetes, and how milk fits into the optimal dietary equation. We’ll delve into the nutritional composition of milk and discuss its interaction with blood sugar levels, and how the sugar, fats and other ingredients in milk could impact metabolic and cardiovascular health. Lastly, we will examine the best types of milk, and potential milk alternatives, for individuals with diabetes or at heightened risk for the disorder.

What is diabetes?

Diabetes is a chronic disease that affects millions of people worldwide. It is characterized by high blood sugar levels over an extended period. There are two main types of diabetes: Type 1 and Type 2.

Type 1 diabetes is an autoimmune disease where the body's immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. This results in little to no insulin production, making it necessary for individuals with Type 1 diabetes to take insulin injections or use an insulin pump to regulate their blood sugar levels.

Type 2 diabetes (T2D), on the other hand, is the more common form of diabetes and is often associated with lifestyle factors such as obesity and lack of physical activity. In T2D, the body becomes resistant to insulin, and the pancreas may not produce enough insulin to meet the body's needs. Insulin is a hormone that plays a vital role in regulating the glucose from the food we eat. It helps transport glucose from the bloodstream into the cells, where it can be used as a source of energy. However, when insulin is ineffective or absent, too much glucose remains in the blood, leading to high blood sugar levels. This is why diet plays a crucial role in managing diabetes.

Common dietary restrictions for diabetics

While there is no one-size-fits-all dietary plan for diabetes, there are some common recommendations that can help individuals manage their blood sugar levels, prevent complications, and maintain a healthy weight.

• Fruits and vegetables are essential components of a diabetic-friendly diet. They are rich in fiber, vitamins, and minerals and have a low Glycemic Index score, meaning they cause a slower rise in blood sugar levels compared to high-glycemic foods. Incorporating a variety of colorful fruits and vegetables into meals and snacks can provide essential nutrients while helping to control blood sugar levels.‍
• Whole grains are another important part of a diabetic diet. They are a great source of fiber, which helps slow down the absorption of glucose into the bloodstream. Whole grains such as brown rice, quinoa, and whole wheat bread can be included in meals to provide sustained energy and promote stable blood sugar levels.‍
• Lean proteins, such as skinless chicken, turkey, fish, and tofu, are excellent choices for individuals with diabetes. They provide essential amino acids without adding excessive fat or carbohydrates to the diet. Including lean proteins in meals can help promote satiety and prevent blood sugar spikes.‍
• Dairy products, such as low-fat milk, yogurt, and cheese, can also be included in a diabetic diet. They are a good source of calcium and protein. However, milk does contain a certain amount of sugar, and (except for skim milk) a quantity of fat; we’ll delve into milk’s composition later in this report. Most clinicians continue to favor low-fat or non-fat options to avoid unnecessary saturated fats and added sugars. (Other dairy products, such as cheeses and yogurts, need to be evaluated separately.) 

While these food groups form the foundation of a diabetic-friendly diet, it's crucial to be mindful of portion sizes and individual carbohydrate tolerance. Carbohydrate counting and monitoring blood sugar levels (especially after meals) can help individuals with diabetes make informed choices about their food intake.

It's also important to note that certain foods and drinks may have a more significant impact on blood sugar levels and should be taken into account when planning meals. Foods high in refined carbohydrates — such as sugary desserts, white bread, and sugary beverages — can cause rapid spikes in blood sugar levels and should be limited or avoided.

Milk: Nutritional composition

Milk is a natural and wholesome beverage that has been consumed by humans for centuries. It is derived from mammals, primarily cows, and is known for its rich nutritional profile. The composition of milk can vary slightly depending on the source, but it typically contains a balanced combination of macronutrients and micronutrients.

• One of the primary benefits of milk is its high calcium content. Calcium is an essential mineral that plays a crucial role in maintaining strong and healthy bones. It is particularly important during childhood and adolescence when bone development is at its peak. Regular consumption of milk can help prevent conditions like osteoporosis, which is characterized by weak and brittle bones.
• In addition to calcium, milk is also an excellent source of vitamin D. This fat-soluble vitamin is essential for the absorption of calcium in the body. It is often referred to as the "sunshine vitamin" because our bodies can produce it when exposed to sunlight. However, many people do not get enough sun exposure, especially during the winter months or in regions with limited sunlight. Drinking milk can help ensure an adequate intake of vitamin D.‍
• Protein is another important component of milk. It is considered a complete protein as it contains all the essential amino acids that our bodies need for various functions. Protein is essential for growth, repair, and maintenance of tissues. It also plays a role in the production of enzymes, hormones, and antibodies.
• Milk also supplies our bodies with useful quantities of potassium and vitamin B12. Potassium is an electrolyte that helps regulate fluid balance, nerve function, and muscle contractions. Vitamin B12 is crucial for the formation of red blood cells and the proper functioning of the nervous system.

The benefits of milk

Given its rich nutritional composition, milk offers numerous health benefits. Regular consumption of milk has been associated with improved bone health, reduced risk of osteoporosis, and proper muscle function. It is particularly important for children and adolescents who are still growing and developing.

Milk is also a popular choice for athletes and individuals looking to build muscle or recover from intense physical activity. The protein content in milk helps support muscle growth and repair, making it an excellent post-workout beverage.

Furthermore, milk is often recommended for pregnant women, breastfeeding mothers, toddlers and children due to its high nutrient content. It provides essential vitamins and minerals that are crucial for healthy development.

Potential risks of consuming milk

While milk offers numerous benefits, it is important to be aware of potential risks associated with its consumption, especially for those with diabetes or at high risk for the disorder. 

The sugar in milk

See our report, Is there sugar in milk?, for a detailed analysis of milk’s sugar content and potential health impacts. Summarizing:

• The sugar in milk, lactose, can lead to digestive issues (such as bloating, gas, and diarrhea) amongst individuals who are “lactose-intolerant” because they lack the enzyme lactase, which is needed to digest lactose. ‍
• Since milk (including lactose-free milk) does contain sugar, a type of carbohydrate, milk can potentially raise blood sugar levels. As such, diabetics need to consider the type and amount of milk they consume. Even though milk also contains a good amount of protein, as well as fat, the American Diabetes Association categorizes milk as a carbohydrate — which is a clear indication that this organization believes in evaluating milk as a possible blood-glucose-raising carb source. However, milk’s impact on blood sugar is relatively modest compared to other carb-containing foods, thanks in part to its fat and protein content. These slow down digestion and absorption, resulting in a slower increase in blood sugar. Plus, there are low- or no-sugar milk alternatives: see our article on "Is there sugar in milk" for comparisons.

The protein in milk

While milk’s high level of protein is generally considered a positive, too much of a good thing isn’t advised, either. And most Americans consume plenty of protein from a variety of sources. As the American Diabetes Association (ADA) has stated, research is inconclusive regarding the ideal amount of dietary protein to optimize either glycemic control or cardiovascular disease (CVD) risk. While much research has found successful management of T2D with meal plans including slightly higher levels of protein (20–30%), which may contribute to increased satiety, excessive protein combined with very low carbohydrate intake (as in the “Keto Diet”) can result in diabetic ketosis and ketoacidosis: read more in our Protein and diabetes report. Furthermore, for individuals with prediabetes, too much animal protein may be ill-advised: this 2016 Harvard study found that those who consumed a diet high in animal protein had a 13 percent higher risk of developing T2D compared to those who consumed the least amount of animal protein. (Vegetable sources of protein, on the other hand, gave them a bit of protection from the disease.) 

The fats in milk

Milk, being an animal food source, does contain saturated fat — the kind of fat that the American Heart Association recommends limiting (to no more than 7% of calories in your overall diet) due to its association with heart disease, stroke, and metabolic disorders such as diabetes. Whole milk contains approximately 3.5% fat, while low-fat types have less, and skim milk’s fat content is negligible. (Soy and almond milks contain about 2 to 4 grams of fat per cup, but those fats are predominantly healthy, monounsaturated and polyunsaturated fats: learn more.) 

On the other hand, the pros/cons of milk fat remain controversial and are still under study. A growing body of research finds that the saturated fats in milk — even in whole cow’s milk — may be less harmful for adults than previously thought. A 2020 review in the Journal of Cardiology concluded that “several foods relatively rich in saturated fatty acids (SFAs), such as whole-fat dairy … are not [our emphasis] associated with increased CVD or diabetes risk.” The authors went on to argue that while “SFAs increase low-density lipoprotein (LDL) cholesterol, in most individuals, this is not due to increasing levels of small, dense LDL particles, but rather larger LDL particles, which are much less strongly related to CVD risk.” Future research will hopefully shed more light on the validity of this distinction between small and larger LDL cholesterol particles.

In other dairy fat research:

• A 2018 study concluded whole milk actually increases HDL (the “good cholesterol”) while having no different impact than low-fat milk on measures of total cholesterol, LDL (the “bad cholesterol”), insulin or glucose concentrations.
• A 2016 cohort study measured circulating blood biomarkers and found that higher consumption of dairy fat actually lowered T2D incidence modestly.
• A 2019 clinical review found that “very little evidence exists on the adverse impact of high-fat compared with low-fat dairy consumption on T2D risk.”
• A 2020 study formed a similar conclusion, that while “in some high-fat dairy products, the high lipid composition may offset the potential protective benefits of dairy ingredients, the medium-chain unsaturated fatty acids in milk and other dairy products may have a positive effect on reducing the risk of T2D.” 
• A 2019 case-cohort study opined that certain dairy products may have “protective components” such as whey proteins, odd-chain fatty acids, and the high nutrient density of dairy, and/or that “interactions within the dairy food matrix may modify the metabolic effects of dairy consumption.” 
• A 2019 European narrative review formed this conclusion: “Most of the meta-analyses and systematic reviews of the cohort studies point to a reduced risk of T2D with dairy intake of 3 servings per day. This effect was mainly attributed to low-fat dairy, particularly yogurt and cheese. However, there is no evidence in cohort studies that high-fat dairy intake poses any harm. 

Dairy, milk and the weight gain potential

Most studies show that moderate consumption of dairy foods, milk included, can actually help you manage your weight, and getting and keeping your weight in a healthy range is of paramount importance for preventing as well as optimally managing diabetes.

• In a 2016 meta-analysis, increased consumption of total dairy and milk alone were both associated with a decreased risk of obesity. Similarly, a 2016 prospective cohort study found that a greater intake of dairy foods was associated with less weight gain; (but, interestingly, only high-fat dairy products, and not low-fat dairy products, were associated with less weight gain).
  
• As a 2019 meta-analysis noted, dairy may only have an additive (positive) effect on weight loss when an individual adheres to an overall energy-restricted (total calories) diet. Dairy foods, with their protein and fat content, can, it’s theorized, help induce a feeling of fullness and reduced hunger, which might contribute to easier avoidance of more calorically high and nutrient-weak carbohydrates, such as cookies and other highly-processed foods that contain added sugars and saturated fats. 

Consensus recommendation for those with diabetes

Before concluding the recommendation for or against milk, it’s important for context to understand the ADA’s position (in the 2022 Standards of Care in Diabetes) about overall nutritional therapy: “There is no macronutrient pattern for people with diabetes.” Rather, ADA thinks that “meal plans should be individualized while keeping total calorie and metabolic goals in mind.” This philosophy embraces what medical researchers have found studying T2D: “The pathophysiology of type 2 diabetes (T2D) is complex and not the same for each individual” (2019 clinical review).

Regarding dairy generally, which the ADA places in its carbohydrate discussion, they simply state [with our added bold emphasis] the following:

“As for all individuals in developed countries, both children and adults with diabetes are encouraged to minimize intake of refined carbohydrates and added sugars and instead focus on carbohydrates from vegetables, legumes, fruits, dairy (milk and yogurt), and whole grains. The consumption of sugar-sweetened beverages (including fruit juices) and processed “low-fat” or “nonfat” food products with high amounts of refined grains and added sugars is strongly discouraged.” 

As to the high-fat vs. low-fat milk/dairy debate, the consensus medical recommendation for those individuals with diabetes remains avoidance of any foods high in saturated fats, due to their potential contribution to the development of heart disease and other cardiovascular conditions — the common comorbidities of diabetes as it progresses. Thus, diabetics are typically advised to select low-fat or skim milk options. That advice notwithstanding, the American Heart Association states: “The more important thing to remember is the overall dietary picture. Saturated fats are just one piece of the puzzle. In general, you can’t go wrong eating more fruits, vegetables and whole grains – and taking in fewer calories.”

Thus, the decision about diary and diabetes, and whether to include milk and other dairy products in your diet, truly boils down to your preferences and what works for your body. Most dairy products, including milk, seem slightly to moderately beneficial relative to cardiometabolic outcomes — assuming the overall diet is healthy and balanced, calorie-restricted, relatively low-carb overall and containing only low amounts of processed carb foods high in added sugars and fats.

Amongst the various types of dairy foods, all of which are nutrient rich (and particularly high in calcium), yogurt appears particularly beneficial, even if the exact mechanisms continue to be debated. Learn more: Dairy and diabetes.

Remember, food impacts are highly individualized. How each of our bodies reacts to various milks — and to the sugars, fats and other ingredients in those milks — may vary considerably. Monitoring your food intake while wearing a continuous glucose monitor (CGM), together with an app (such as the January AI platform) that allows you to leverage heart rate and glucose data, may help you to align your health habits in precisely the way your body needs — especially for individuals with diabetes or those at elevated risk for the disorder, as it is crucial for this population to monitor their sugar intake, including the consumption of milk. 

Addendum: Pros and cons of various milk types

Skim milk: In comparison, skim milk contains all the nutrients found in whole milk but has fewer calories and less fat. It's often recommended to diabetics, given that obesity is a common issue. However, the lack of fat may result in a quicker spike in blood sugar levels. As such, it is important to monitor your blood sugar levels when consuming skim milk.

Lactose-free milk: It’s essentially the same as regular milk, but the lactose has been broken down. It provides all the same nutrients, but without risking lactose-related digestion problems. 

However, having the lactose pre-digested might result in a larger blood sugar spike. People with diabetes are advised to be careful when introducing it to their diet and monitor their blood sugar levels carefully.

Almond milk: A popular non-dairy alternative that contains minimal carbs, meaning it's unlikely to significantly impact blood sugar levels, almond milk is, however, lower in protein compared to dairy milk. A single cup of unsweetened almond milk contains just 30-50 calories and 1-2 grams of carbs, making it a great low-calorie, low-carb option for diabetics.

Soy Milk: Although it contains more carbs than almond milk, soy milk is also significantly higher in protein and fiber, which can help control blood sugar levels.

Read more about cashew, oat, coconut and other alternative milks in What are the healthiest milk alternatives? And remember: whichever alternative you choose, make sure to go for the unsweetened versions to avoid any unnecessary sugar intake.