Independent report

SACN and COT assessment of the health benefits and risks of consuming plant-based drinks: summary

Published 16 July 2025

Introduction

Plant-based drinks are widely used as alternatives to animal milks such as cows’ milk. They include drinks made from beans, peas, cereals, nuts and seeds.

While availability and use of plant-based drinks in the UK have increased in recent years, they are still much less popular than cows’ milk. Around 10% of people in the National Diet and Nutrition Survey 2019 to 2023 reported that they consumed plant-based drinks during the survey period.

Oat drinks are currently the most popular plant-based drink in the UK, followed by soya and almond drinks.

Cows’ milk is an important contributor to intakes of calcium and other minerals and vitamins (‘micronutrients’). For children aged 1 to 5 years, cows’ milk is also a major contributor to energy, protein and saturated fat intakes. Cows’ milk is not an essential component of young children’s diets (or the diets of other age groups). But if it is not part of their diet, other foods and drinks are needed to replace the nutrients that it provides.

Whole, semi-skimmed and skimmed cows’ milk vary in the amount of energy, saturated fat and vitamin A they contain. The nutrient content of plant-based drinks also varies considerably (there are no specific legal or minimum standards governing nutrient composition of these products). Plant-based drinks tend to:

• contain free sugars (sugars added as an ingredient or present as a result of the manufacturing process)

• vary in the type and amount of micronutrient fortification, with some:

  • not fortified
  • only fortified with calcium
  • fortified with calcium, riboflavin, vitamin B12, vitamin D, and increasingly iodine

Very few products are fortified with vitamin A. Plant-based drinks in the UK that are labelled as ‘organic’ are not allowed to be fortified with any nutrients.

Most plant-based drinks would be classified as ‘ultra-processed’ according to the NOVA classification.

Both cows’ milk and plant-based drinks may contain chemical contaminants or naturally occurring components. Chemical contaminants can be harmful if they are present at high levels. Chemical contaminants include organic chemicals, heavy metals and mycotoxins. Naturally occurring components include glycosides, isoflavones and naturally occurring oestrogens. Some of these components may have positive or negative health effects.

In England and Wales, the Nursery Milk Scheme allows childcare settings to reclaim the cost of providing one-third of a pint of milk per day to children in their care. Also, the Healthy Start scheme provides its recipients with weekly payments that can be spent on healthy foods, including cows’ milk. To inform considerations about plant-based drinks in these schemes, the Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) agreed to undertake an assessment of the nutritional and toxicological aspects of plant-based drinks.

Approach to the assessment

SACN and COT carried out a benefit-risk assessment comparing cows’ milk with almond, oat and soya drinks, which were the most popular plant-based drinks in the UK at the time of the assessment. They also compared milk with water.

The assessment considered the impact of both nutritional intake and toxicological exposure on health outcomes. The full report includes details of the methods and processes for the assessment.

The assessment had a specific focus on children aged 1 to 5 years (children up to their fifth birthday). However, given the increasing availability and consumption of plant-based drinks, the assessment was expanded to also cover adults and children aged 5 years and over.

The assessment did not cover individuals or groups of people with specific dietary or nutrient requirements, except for those following a vegan diet (or a diet that is mostly free from animal products). Wider issues (such as those relating to food allergies, food additives, sustainability or the environment) were outside the scope of this assessment.

SACN and COT used the Benefit Risk Analysis for Foods approach to compare cows’ milk with almond, oat and soya drinks.

The assessment considered the impact of replacing cows’ milk with almond, oat and soya drinks from a nutritional and toxicological perspective. The assessment was mainly informed by:

• previous evaluations undertaken by SACN on nutrition and by COT on toxicology and health outcomes
• UK dietary survey and purchasing data for information on total volumes of cows’ milk consumed and the types of plant-based drinks available in the UK
• a nutritional substitution analysis to consider the potential impact on nutrient intakes of replacing cows’ milk with plant-based drinks or water

The assessment aimed to reflect the range of nutritional contents of almond, oat and soya drinks sold in the UK in January 2022. For each drink type, 3 theoretical nutrient profiles were developed, which provided a sliding scale of nutritional impact. The nutrient profiles were:

• typical
• enhanced
• unfortified and/or sweetened

The ‘typical’ nutrient profiles were based on the nutrient content of the most popular almond, oat and soya drinks sold in the UK in January 2022. These drink profiles tended to contain free sugars (sugars added as an ingredient or present as a result of the manufacturing process). They were fortified with riboflavin, vitamin B12 and calcium (but not vitamin A or iodine) at comparable levels to cows’ milk. These drink profiles were also fortified with vitamin D (there is very little vitamin D naturally present in cows’ milk).

The ‘enhanced’ nutrient profiles were based on the most nutritionally beneficial values for relevant nutrients in almond, oat and soya drinks sold in the UK in January 2022. These drink profiles were unsweetened (did not contain free sugars) and fortified with vitamin A, riboflavin, vitamin B12, calcium and iodine at comparable levels to cows’ milk. The drink profiles were also fortified with vitamin D.

‘Unfortified and/or sweetened’ nutrient profiles were based on the least nutritionally beneficial values for relevant nutrients in almond, oat and soya drinks sold in the UK in January 2022. These drink profiles were not fortified with any vitamins or minerals and/or contained sugars added as an ingredient.

The draft report was made available for peer review from 23 July to 19 September 2024 on the SACN web page.

Benefit risk assessment

SACN identified nutrients for inclusion in the benefit-risk assessment based on:

• their function
• current dietary advice on nutrient requirements
• current nutrient intakes compared with requirements for different population groups, based on data from UK dietary surveys
• how cows’ milk contributes to nutrient intakes for different population groups
• findings from the nutritional substitution analysis
• evidence on health outcomes and whether changes in nutrient intakes would be a public health concern

SACN considered the following nutrients:

• energy
• protein
• saturated fat
• free sugars
• fibre
• vitamin A
• riboflavin
• vitamin B12
• vitamin D
• calcium
• potassium
• iodine
• zinc

SACN also considered salt.

COT considered a number of chemical contaminants and naturally occurring components and identified those for inclusion in the benefit-risk assessment based on:

• their likely occurrence in cows’ milk and plant-based drinks
• whether exposure was close to the relevant Health Based Guidance Value (the amount of chemical in food that a person can consume on a regular basis usually over a lifetime without any significant risk to health)
• evidence on health outcomes and whether changes in exposure to chemical contaminants or naturally occurring components would likely be a public health concern

COT included the following chemical contaminants or naturally occurring components in their assessment:

• isoflavones
• lead
• dioxins and dioxin-like polychlorinated biphenyls (PCBs)
• non-dioxin like PCBs
• per- and polyfluoroalkyl substances
• perchlorate
• mycotoxins (aflatoxin and ochratoxin A)
• deoxynivalenol
• naturally occurring oestrogens (such as oestradiol)

Findings

At the time of the assessment, almond, oat and soya drinks available in the UK were not nutritionally equivalent to cows’ milk. Replacing cows’ milk with almond, oat or soya drinks would result in potential benefits and risks from both a nutritional and a toxicological perspective.

Nutritional benefits and risks

Replacing cows’ milk with ‘typical’ nutrient profile drinks may have some nutritional benefits.

‘Typical’ almond, oat and soya drinks may contribute to:

• lower intakes of energy and saturated fat - this would be beneficial in all age groups, except for people, particularly children, living with underweight, for whom lower energy intakes would not be beneficial
• higher intakes of dietary fibre and vitamin D, which would be beneficial in all age groups

Average protein intakes are above requirements in all age groups in the UK. Evidence suggests that higher protein intakes in children aged 1 to 5 years may be associated with increased body mass index in later childhood. ‘Typical’ almond and oat drinks may contribute to lower intakes of protein (soya drinks are more similar to cows’ milk in terms of protein quantity and quality). People, especially children aged 1 to 5 years, who follow a vegan or vegetarian diet may have lower protein intakes if they consume almond or oat drinks rather than soya drinks. So, soya drinks are preferable for children aged 1 to 5 years who may be at risk of lower protein intakes.

Replacing cows’ milk with ‘typical’ nutrient profile plant-based drinks may have potential nutritional risks by contributing to:

• higher intakes of free sugars in all age groups
• inadequate intakes of some micronutrients, especially in children aged 1 to 5, who get a higher proportion of their micronutrient intake from cows’ milk

Nutritional concerns may be lessened if almond, oat and soya drinks met the ‘enhanced’ nutrient profile. That is, if they were unsweetened (without free sugars) and fortified with vitamin A, riboflavin, vitamin B12, calcium and iodine at similar levels to those in cows’ milk, and also with vitamin D. However, it is uncertain whether micronutrient fortificants are as ‘bioavailable’ (as easily digested and absorbed) as micronutrients that are naturally present in cows’ milk.

Replacing cows’ milk with the ‘unfortified and/or sweetened’ nutrient profile drinks has nutritional risks for all population groups. It may contribute to:

• higher intakes of free sugars
• inadequate intakes of some micronutrients

For children, particularly children aged 1 to 5 years, replacing cows’ milk with water may contribute to increased risk of inadequate micronutrient intakes.

Toxicological benefits and risks

For most toxicological chemical contaminants and naturally occurring components considered in the assessment, there was no clear difference between cows’ milk and almond, oat or soya drinks. This was because either the chemical contaminants or naturally occurring components were not present in either cows’ milk or plant-based drinks or were present at levels that posed little or no risk.

The only potential toxicological concern clearly identified  relates to isoflavones from soya drinks in children aged 1 to 5 years following a vegan diet. This is because children are more highly exposed on a body weight basis than adults because of their smaller body size. Children following a vegan diet may consume a higher amount of soya than other children. This risk could be partially mitigated by ensuring that children following a vegan diet consume a variety of non-animal protein sources rather than relying solely on soya products.

The ingredients used to make plant-based drinks may be at risk of fungal contamination, which can result in the presence of mycotoxins (naturally occurring toxins produced by fungi that can contaminate food and cause health problems). The limited data available suggests that this may not be a major concern in the UK, but it will be important to monitor the possible presence of these naturally occurring contaminants.

Limitations

This assessment is based on the available data on plant-based drinks in the UK up to January 2022. Only almond, oat and soya drinks were considered. SACN and COT were aware that the nutritional composition of plant-based drinks sold in the UK continued to change while this assessment was being conducted. This limitation is mitigated by the use of hypothetical versions of each plant-based drink in the assessment, instead of actual products. Three versions of almond, oat and soya were considered.

There is currently limited evidence on population consumption of plant-based drinks and the impact of their use on nutrient intakes, toxicological exposures and related health outcomes.

The bioavailability of micronutrient fortificants in plant-based drinks is uncertain.

The nutritional substitution analysis did not consider the impact of separately replacing whole, semi-skimmed and skimmed cows’ milk with almond, oat or soya drinks. It was based on total volumes of all types of cows’ milk consumed by the UK population. In the UK, the mostly commonly consumed milk is semi-skimmed. If skimmed milk replaced whole or semi-skimmed milk for children aged 5 and over and adults, some of the potential nutrition-related benefits identified for almond, oat or soya drinks would be lessened. This is due to the lower energy and saturated fat content of skimmed milk.

The substitution analysis assumed that there were no changes to the wider diet.

There was limited information for the toxicological assessment of almond, oat or soya drinks. In particular, there was very little information on the amount and type of chemical contaminants and naturally occurring components in almond, oat and soya drinks.

SACN and COT were also aware of the limitations in the wider evidence base on the dietary intakes and nutritional status of children following a vegan diet (or a diet that is mostly free from animal products).

Conclusions

SACN and COT noted that, based on the data available at the time of publication of the report, no almond, oat or soya drink available in the UK is nutritionally equivalent to cows’ milk.

The most appropriate alternative to cows’ milk varies by age group and people’s wider dietary intakes and health concerns.

There are potential nutritional and toxicological concerns related to plant-based drinks, and these particularly apply to children aged 1 to 5 years, especially those who are following a vegan diet.

There are potential nutritional concerns related to higher intakes of free sugars and inadequate intakes of certain micronutrients (for all 3 plant-based drinks) and lower intakes of protein (for almond and oat drinks). These risks may be mitigated by:

• drinks being unsweetened
• fortifying drinks with vitamin A, riboflavin, vitamin B12, calcium and iodine at levels comparable to those found in semi-skimmed cows’ milk
• people following a vegan diet consuming a variety of protein sources across the diet to make up for the potential lower protein intake associated with consuming almond or oat drinks

The only potential toxicological concern clearly identified relates to isoflavones among children aged 1 to 5 years who are high consumers of soya. The potential risks of isoflavones may be mitigated by people choosing a variety of protein sources (including non-animal sources) and not restricting their protein source to soya products (in both drinks and foods).

SACN and COT considered cows’ milk consumption (mainly whole or semi-skimmed milk) in the benefit-risk assessment rather than separately examining different types of cows’ milk. However, they were aware that current advice is that people should choose lower-fat dairy products to reduce saturated fat intake, and semi-skimmed milk is suitable as a main drink from aged 1 year and over and skimmed milk from aged 5 years and over.

For children aged 1 to 5 years who consume animal products, whole or semi-skimmed cows’ milk are preferable to plant-based drinks. For older children and adults, the relative benefits and risks of different types of cows’ milk (whole, semi- or skimmed) and plant-based drinks will vary by the diet that people follow and whether they have any health concerns. The most appropriate product will depend on a variety of individual factors.

‘Typical’ nutrient profile plant-based drinks are lower in energy and saturated fat than whole and semi-skimmed milk. SACN and COT noted that if skimmed milk replaced whole or semi-skimmed milk, this would reduce intakes of energy, saturated fat and fat-soluble vitamins (vitamin A). As a result, the nutritional differences associated with replacing cows’ milk with almond, oat and soya drinks would be reduced. However, skimmed milk is not recommended as a main drink for young children under the age of 5 years due to its low vitamin A content.

While this assessment focused on almond, oat and soya drinks, SACN and COT noted that many of their conclusions, and as a result the recommendations, would apply to all plant-based drinks.

Although it is beyond the scope of this assessment, SACN and COT noted that there are no minimum nutritional composition requirements for these products.

It is also important to note the uncertainties in the data considered in the benefit-risk assessment, particularly:

• whether the bioavailability of micronutrients added to plant-based drinks is equivalent to the bioavailability of micronutrients that are naturally present in cows’ milk
• the protein quality (meaning the amino acid composition and the digestibility of the protein found in drinks) is also unclear for specific almond, oat and soya drinks sold in the UK

Recommendations

The following recommendations are for adults and children aged 1 year and over. They are made in the context of existing UK population advice. This includes existing SACN and COT recommendations on:

• non-sugar sweeteners (2025)
• processed foods (2025)
• feeding young children aged 1 to 5 (2023)
• rice drinks, in the Food Standard Agency Arsenic in rice advice (2018)

In the recommendations, the term ‘vegan diets’ extends to diets that are mostly free from animal products. ‘Children aged 1 to 5 years’ covers children up to their fifth birthday. Where recommendations state ‘plant-based drinks’ this refers to all types, not just almond, oat and soya.

The full report also includes research recommendations.

Fortification of plant-based drinks

Plant-based drinks should be fortified with vitamin A, riboflavin, vitamin B12, calcium and iodine at levels comparable with those found in semi-skimmed cows’ milk.

Plant-based drinks should also be fortified with vitamin D, which is already common practice and should be encouraged.

Recommendations for the general population

All children aged 1 to 5 years

For children aged 1 to 5 years, SACN and COT recommend that:

• whole or semi-skimmed cows’ milk are preferable to plant-based drinks for children aged 1 to 5 years who consume animal products
• fortified and unsweetened (without free sugars or non-sugar sweeteners) almond, oat and soya drinks are an acceptable alternative to cows’ milk
• unfortified or sweetened (with free sugars or non-sugar sweeteners) plant-based drinks are not an acceptable alternative to cows’ milk
• there is no need for drinks specifically marketed for children aged 1 to 3 years, including plant-based follow-on formula, ‘growing up’ and other ‘toddler’ drinks
• they are ideally breastfed into the second year of life or beyond

Children aged 1 to 5 years following a vegan diet

For children aged 1 to 5 years following a vegan diet, SACN and COT recommend that:

• fortified and unsweetened (without free sugars or non-sugar sweeteners) versions of almond, oat and soya drinks are preferable to water in meals and snacks where other children would usually consume cows’ milk
• fortified and unsweetened (without free sugars or non-sugar sweeteners) soya drink is preferable as their main alternative to cows’ milk, because it usually contains higher amounts of protein than either almond or oat drink
• they are offered a variety of suitable alternatives to animal-based food and drinks, rather than mainly consuming soya products, to avoid high intakes of isoflavones

All children aged 5 years and over and all adults

For the general population of children aged 5 years and over and all adults, SACN and COT recommend that:

• fortified and unsweetened (without free sugars or non-sugar sweeteners) almond, oat and soya drinks are an acceptable alternative to cows’ milk
• unfortified or sweetened (with free sugars or non-sugar sweeteners) plant-based drinks are not an acceptable alternative to cows’ milk

Recommendations for the government to consider

SACN and COT recommend that government considers:

• collecting detailed, nationally representative dietary data with a sufficient sample size to monitor the consumption of plant-based drinks and enable assessment by population subgroups including:
  • racially and ethnically diverse groups
  • socially disadvantaged groups
  • individuals, particularly children, who follow a vegan or vegetarian diet
• monitoring the nutritional impact of a possible population shift towards greater adoption of vegetarian, vegan and diets that are mostly free from animal products, particularly in children
• collecting data on the nutritional composition of plant-based drinks
• monitoring industry data on the nutritional composition and the levels of contaminants of toxicological concern in plant-based drinks
• establishing minimum requirements for the vitamin A, riboflavin, vitamin B12, calcium and iodine content of plant-based drinks at a comparable level to (and assuming equivalent bioavailability from) semi-skimmed cows’ milk
• encouraging industry to continue to fortify plant-based drinks with vitamin D
• establishing minimum toxicological standards for chemical contaminants in plant-based drinks, particularly those marketed to young children
• options to help consumers make informed choices about the suitability of plant-based drinks compared with cows’ milk

Recommendations for industry

SACN and COT recommend that industry:

• reduces the free sugars content of plant-based drinks (whether these are sugars added as an ingredient or present due to the manufacturing processes)
• aims for plant-based drinks to be nutritionally equivalent to semi-skimmed cows’ milk for levels of vitamin A, riboflavin, vitamin B12, calcium and iodine
• fortifies plant-based drinks with vitamin D
• avoids adding non-sugar sweeteners to plant-based drinks
• minimises the toxicological risks associated with plant-based drinks, including minimising the presence of chemical contaminants and undesirable naturally occurring components (such as isoflavones and mycotoxins)
• makes data on the nutritional composition of plant-based drinks and the levels of substances of toxicological concern publicly available