North Americans are spending just short of $3 billion per year on plant-based yogurt. A study from the University of Massachusetts, Amherst, found that plant-based yogurts may be more healthful than dairy yogurts because they contain less sugar, salt and saturated fats, and more fiber (Front Nutr, May 25, 2023;10:1195045). Almond and oat yogurts had significantly higher concentrations of nutrients than other plant-based or dairy yogurts.

Most people eat way too much salt and sugar because food manufacturers know that sugar and salt make their foods taste good, so they add them to all kinds of processed foods (BMJ, Aug 31, 2022;378:e068921). Excess sugar increases diabetes risk, excess salt can lead to high blood pressure, and saturated fats raise blood levels of LDL cholesterol to increase heart attack risk.

Limitations of Plant-Based Yogurts
Plant-based yogurts contain no vitamin B12, and less protein, calcium and potassium than dairy yogurts. Vitamin B12 is found only in animals, and lack of B12 causes an increased incidence of dementia in older people because aging causes loss of stomach acidity which is necessary for absorption of B12 from food. One study found that most people prefer blended yogurts that contain both plant-based and dairy yogurt over just plant-based yogurts (Food Quality and Preference, Dec 2020;86:104019). Adding dairy yogurt to plant-based yogurt causes the mixture to form a gel that tastes better and would not form in a yogurt that is only plant-based.

Benefits of Fermented Foods
People who ate primarily fermented dairy products such as cheese and yogurt were significantly less likely to suffer heart attacks than those who drank milk (Journal of Nutrition, January 9, 2020). It made no difference whether the milk was whole or reduced fat. Fermented dairy products were also associated with reduced risk for heart attacks in Australians (Journal of Nutrition, Oct 2019;149(10):1797-1804) and Finns (British Journal of Nutrition, Oct 29, 2018). A review of 15 prospective studies showed that fermented dairy products were associated with reduced heart attack risk (Eur J Nutr, Dec 2017;56(8):2565-2575), and other studies showed reduced levels of inflammation (Br J Nutr, Apr 2015;113 Suppl 2:S131-5) and LDL cholesterol (Am J Clin Nutr, 2000 Mar;71(3):674-81).

Galactose, the Inflammatory Sugar in Milk
Milk is a high-sugar drink and sugared drinks are associated with increased risk for heart attacks, obesity, diabetes, and premature death (Circulation, March 18, 2019). Milk and other unfermented dairy products are full of the sugar, galactose, that is one of the four pro-inflammatory sugars that can pass from the intestines into the bloodstream — glucose, fructose, mannose and galactose (Cytokine, Sept 2014;69(1):150-153). Inflammation means that your immune system is overactive. When you are infected by germs, your immune cells and proteins try to kill the invading germs, but as soon as the attacking germs are gone, your immune system is supposed to dampen down. If it stays active, it can use the same cells and proteins to attack you and damage your own cells, including the cells that line your arteries.

Fermented dairy products (such as yogurt, kefir, and many cheeses) are made by adding live bacteria that “eat” the galactose and break it down. Milk, butter and cream contain large amounts of galactose, while aged cheeses and yogurt made from these products contain very low amounts of galactose because it has been destroyed in the fermentation process (Nutrition, Metabolism and Cardiovascular Diseases, May 21, 2018). Cheese and yogurt (with no added sugars) lower high blood sugar and insulin and are not associated with increased risk for heart attacks or diabetes (Nutr Rev, 2015;73(5):259-275) or with gaining weight (BMC Med, 2014;12:215).

My Recommendations
These studies do not prove that milk causes heart attacks or diabetes, or that yogurt or cheese help to prevent them. They suggest that you should limit the amount of milk that you drink, and that cheese, yogurt and other fermented dairy products may be more healthful choices. Furthermore, plant-based yogurts contain extremely small amounts of saturated fats and sugar and therefore may be more healthful as long as you don’t add sugared flavorings.