DEAR DR. ROACH: Everyone in my family except for me has converted to using almond milk instead of cow’s milk. I just saw something on the internet that says almond milk is possibly the worst plant-based milk substitute. I trust your opinion and research. Can you please educate me on what is best? Are plant-based milks really better than cow’s milk, and which plant-based milk is best? — D.G.

ANSWER: When trying to compare plant-based milk substitutes with each other and with animal milks in their health impact, it’s important to look at what each of them have in terms of macronutrients and micronutrients.

Cow’s milk, like other animal milks, contains macronutrients like protein, sugars and fats as well as micronutrients like calcium. (Most cow’s milk is fortified with vitamin D.) While most North Americans consume adequate protein, many people try to increase their protein intake through cow’s milk.

Similarly, although the data are mixed, most experts agree that saturated fat, which is found in cow’s milk, increases heart disease risk. (Cow’s milk can be whole, low-fat, reduced fat or skim, varying in their percentages of overall fat.) However, cow’s milk contains beneficial fats like conjugated linoleic acid and methyl-branched-chain fatty acids. Most North Americans consume much more simple sugar than what is optimal with cow’s milk.

Almond milk has much less protein than cow’s milk (1 gram versus 8 grams), and the quality of the protein based on the amount of essential amino acids is less. Soy milk is much higher in protein than almond milk — almost as much as cow’s milk, about 7 grams. Coconut milk has almost none.

However, almond and soy milk have no saturated fat (or almost none) and more monounsaturated fats. Coconut milk has about the same amount of saturated fat as cow’s milk. Almond, soy and coconut milks are typically fortified with calcium to match what is found in cow’s milk, but the calcium in plant milks is not absorbed as well.

Almond milk can be bought unsweetened or sweetened with typically 7-8 grams of sugar per cup, compared to 12 grams per cup in cow’s milk. Cow’s milk has multiple other micronutrients naturally, while plant-based milk is fortified with vitamin A and D.

So, is your family right that almond milk is the worst? No, I don’t think so. In my opinion, the nonexistent protein and high saturated fat content of coconut milk makes it the least acceptable from a health perspective. Soy and almond milk seem like the better alternatives, but neither of them is really comparable to cow’s milk in terms of other micronutrients.

The choice of almond versus soy milk is not clear from a health perspective, so your taste preference should be your guide. In all cases of plant-based milks, I recommend unsweetened and unflavored products.

DEAR DR. ROACH: I get regular pedicures. I never go for gel, but I often use a bright color. When the polish comes off, almost every single one of my nails is quite mottled with brown and white spots. Of course, I thought about not wearing polish and allowing the new nails to slowly grow out, but I can’t stand the look of my toes.

I know this is just a cosmetic problem. My pedicurist seems to know nothing about it. The real question is, what causes such gross discoloration in some people but not in other others? — N.W.

ANSWER: I’ll bet you have keratin granules, which represent damage to the nail. They are often described to be chalky white and happen in many people if nail polish is left on too long (more than 7-10 days). Experts recommend an acetone-free remover when it’s time to remove them. You can also use a base coat to protect the nail. Let the nails go without polish periodically.

Fortunately, keratin granules are not dangerous and will grow out. They can be mistaken for toenail fungus, so your regular doctor or a dermatologist can help if these tips don’t stop them from developing.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc.

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