DEAR DR. ROACH: I’m vegan, primarily for ethical reasons, but I also enjoy the health benefits. There are so many more nondairy milks on the market now than when I went vegan, 23 years ago. I especially enjoy the taste of soy, coconut and almond milks, but from a health perspective, which is best? — I.M.

ANSWER: From a health perspective, there are pros and cons to all. Let me start off by saying these recommendations are for adults: Infants and young children need the many nutrients that are ideally in human milk.

Soy milk has lots of protein, and diets with high amounts of soy protein may reduce heart disease risk. As I have mentioned before, the isoflavones in soy act as weak estrogens, and women with a history of estrogen-receptor-positive breast cancer should be cautious. Soy milk has little calcium unless it’s fortified.

Almond milk (like cashew, hazelnut and walnut milks) has much less protein than soy, but the unsweetened version has no sugar. It does have some calcium and vitamin D. Coconut milk has a lot of saturated fat; however, preliminary data show that the saturated fat in coconut is not as likely to cause damage to arteries as saturated fat from cow’s milk.

None of these milks is a complete source of nutrition, so I would say any of the unsweetened versions of the milk alternatives you mention are reasonable for cooking, for eating with cereal or for drinking, but not as a major calorie source. Sweetened versions of any of these add 8-20 grams of sugar per 1-cup serving, which is a substantial proportion of your recommended intake for the day.

DEAR DR. ROACH: I was shocked this morning to read your response about prostate cancer, where you stated, “Approximately 70 percent to 80 percent of the men your age have prostate cancer”! I was totally flabbergasted by your comment and decided to check it out on the Centers for Disease Control and Prevention website.


It states that if a man is 70 years old, he only has a little more than 7 percent chance of getting cancer within 10 years. — R.D.

ANSWER: Shocking it may be, but I assure you that the prevalence of prostate cancer in older men is very high. In re-reviewing the many studies on this, I find estimates of 40 to 80 percent of men in their 70s, with no known history of prostate cancer, will at autopsy be found to have had prostate cancer. The difference from what I said and what the CDC site is telling you is the likelihood of being diagnosed with prostate cancer. There are thus many men with undiagnosed prostate cancer, the vast majority of whom will never be bothered by their prostate cancer and will eventually die of something unrelated. For those men, the process of screening can lead to a diagnosis of prostate cancer, treatment of which can lead to significant side effects but with no benefit to them. We can’t tell with certainty which cancers are destined to spread out of the prostate to the bones, and which are destined to remain in the prostate, never to cause problems.

The booklet on the prostate gland discusses enlargement and cancer. Readers can obtain a copy by writing: Dr. Roach — No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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 or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

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