How to build a breakfast smoothie to help your autoimmune condition - and the pitfalls to avoid
A smoothie can be a brilliant option for breakfast, particularly when we are short of time, or not particularly hungry, or just looking for a convenient way of getting a balanced breakfast.
However in clinic I regularly see people unintentionally using smoothies in a way that may be exacerbating their autoimmune symptoms.
Changing to an ‘autoimmune-appropriate’ smoothie most mornings is a good example of an ‘Atomic Habit’ that over time can make a difference to autoimmune symptoms for some people.
Smoothies can do five positive things for us at breakfast:
reduce the rate at which the natural sugars in our breakfast are released into our blood stream over the morning - improves inflammation, liver function, cravings and mood (find out more about this here)
provide plenty of protein to help with all sorts of processes, but particularly with detoxification - essential for those of us with autoimmune conditions
provide a wide variety of plant fibres to increase the health of the gut microbiome, which influences immune tolerance, inflammation, gut barrier health and blood sugar control
provide excellent hydration and fibre to assist bowel movement regularity - constipation can be a huge factor in triggering autoimmune symptoms
provide a high proportion of the daily nutrients we need for the day, which help with detoxification and energy production particularly, as well as mood
Yet smoothies can also do two negative things for us at breakfast, which can be particularly problematic in autoimmunity:
contain too many natural sugars, usually through a high content of tropical fruits like pineapple, mango, banana, as well as grapes - these high sugar foods create a blood sugar spike which, when repeated over time, lead to inflammation, an increased burden on an already struggling liver, cravings and mood swings.
contain high amounts of histamine, leading to increased inflammation and associated symptoms
Histamine
Histamine foods are important to consider in autoimmunity, because many people with an autoimmune condition will already have high levels of histamine. High histamine levels are linked to symptoms such as skin problems, including rosacea, psoriasis, acne, eczema, rashes and itchiness, various digestive problems including diarrhoea, nausea and reflux, dizziness, hayfever, headaches and migraine, nasal congestion or sinus problems, and irregular menstrual cycles.
Histamine has to be processed by the liver, which is often already overburdened with other detoxification tasks in autoimmunity. When the liver is overburdened, this is when we start to see autoimmune symptoms surface.
High histamine levels are usually caused by food intolerances, which cause mast cells in the gut to release histamine, and by suboptimal liver function, as the liver struggles to get the histamine out of our systems. However, adding high histamine foods to the mix can make things worse. Smoothies seem to be a magnet for certain high histamine foods: banana, avocado, spinach, strawberries, oranges. Having a high histamine smoothie repeatedly for breakfast over several weeks or months can exacerbate autoimmune symptoms for people already struggling with histamine and liver function.
You can read more about histamine in this histamine case study.
Building a balanced breakfast smoothie
Using the following structure to build a smoothie can be helpful:
Category One: Protein
Many of the people I see in clinic are not eating enough protein at breakfast, especially women. Protein impacts detoxification and blood sugar balance, both key functions in autoimmunity. A lack of protein, specifically an amino acid called tryptophan, can also mean we can’t produce enough serotonin, the calming hormone that combats anxiety.
We need roughly 0.75g of our body weight in protein daily, ie a person weighing 60kg would need around 45g of protein. At least one third of this should be consumed at breakfast, when we have higher stomach acid to digest the protein, and where it can most positively influence blood sugar, mood and cravings throughout rest of the day.
Here are some protein options for breakfast. Generally foods from at least two categories should be included. The amount and variety of protein sources should be increased gradually, going particularly slowly if digestion is currently poor.
Option One: Seeds
Seeds are a brilliant source of protein, as well as natural fats and fibre. They also contain essential minerals such as calcium and zinc.
Chia, flax and pumpkin seeds are good options. Consider soaking chia and flax seeds overnight first if you know you struggle with seeds, although blending them will make them easier to digest anyway. Tahini can be a great option as it is already blended, making it easier to digest and absorb the nutrients (tahini is blended sesame seeds).
Option Two: Beans
Beans are also a great source of protein, fats, fibre and essential minerals and B vitamins. B vitamins essentially support the liver to manage a higher toxic burden, as well as to support better energy metabolism. B vitamin levels are often low in autoimmunity because demand for them is higher than average.
Cannelini beans are probably the easiest bean to start with as they add creaminess without really affecting the flavour. Build up the amount gradually if you are not used to eating beans. Butter beans are also high in B6, commonly a deficient nutrient for people with autoimmunity, partly because it is needed to process histamine.
Option Three: Quinoa or Millet flakes
These flakes act like oat flakes to add creaminess and thickness to the smoothie. Again they are a great blend of protein, fat, fibre and B vitamins. I recommend them rather than oats, as oats contain a protein which is very similar to gluten. We know that many people with autoimmunity react to gluten, and therefore often react to oats too. Quinoa is a complete protein, meaning it contains all the amino acids needed from the diet, so it’s particularly useful for people on vegan diets.
Option Four: Protein powders
This is a tricky category, as many protein powders are ultra processed foods with lots of additives, thickeners, etc which damage the delicate lining of the gut barrier, increasing the risk of inappropriate substances passing into the blood stream. This triggers the immune system, increasing inflammation and increasing the burden on the liver, which then raises the risk of autoimmune symptoms surfacing.
Look for organic protein powders that do not contain whey. Whey is generally very inflammatory in autoimmunity, so I recommend choosing an organic, vegan protein powder to avoid whey. Always read the ingredients list and make sure you recognise all of the ingredients. Even clean protein powders can irritate the gut if you are not used to high amounts of fibre, so I recommend being extremely cautious with protein powders, as they are not right for everyone.
Here are two examples of protein powders which I tend to recommend at the moment as they are organic, contain a balanced array of amino acids and do not contain whey:
Indigo Herbs Organic Vegan Protein Powder
BodyMe Organic Vegan Protein Powder Blend
Category Two: Fibre variety
When our gut lining is covered by beneficial microbes, we are significantly less vulnerable to incoming viruses, Candida, mould, and other non beneficial microbes such as clostridia species. This is highly relevant in autoimmunity because most people’s test results show that their guts have high levels of at least one of these groups of microbes, which impacts inflammation, anxiety, the manufacture of B vitamins for energy and detoxification, and the function of the gut barrier.
To encourage beneficial microbes to flourish in our guts, we need a wide variety of fibre intake. This does not mean eating ‘high fibre’ highly processed breakfast cereals as highly processed foods promote the growth of non beneficial microbes. (Dried fruits also feed non beneficial microbes due to their high sugar content.) Instead it simply means eating lots of different plant foods, ranging from herbs and spices, to seeds, greens, legumes, grains and as many unusual vegetables as we can find! Diversity is the keyword here.
A smoothie is an ideal way to increase diversity easily as small amounts of new ingredients can disappear into the mix without having to affect the taste. Here are some ideas:
frozen mixed berries and cherries (low in histamine and natural sugars), kale, watercress, spriulina, goji berries, beans, sunflower or pumpkin seeds, cabbage, tahini, cinnamon, walnuts, turmeric and microgreens . See also the foods in the ‘Greens’ category below. You could also consider using additional parts of the plants such as the peel or the pips where appropriate.
Consider just adding small amounts of these to avoid overly affecting the taste of the smoothie and chopping and freezing the remains to use another day. Diversity is the focus here, rather than quantity.
Category Three: Greens
Many people don’t include enough greens in their diet, meaning they are low on nutrients such as iron, calcium, zinc, magnesium, beta carotene and folic acid. Consider adding celery, kale, cucumber, parsley, coriander, carrot or beetroot tops (leaves), spirulina, matcha, algae, watercress, chard, etc. You can also buy powdered organic greens mixes which can work well.
As before, build the quantity up very slowly if you are not used to lots of fibre. You may notice an increase in bloating initially, but this should dissipate after two or three weeks.
Example smoothie recipe
Three tbsp quinoa flakes
One tbsp chia seeds
One tbsp pumpkin seeds
One tbsp protein powder
One tps tahini
Two handfuls mixed frozen berries and cherries
One tsp powdered organic greens
One handful parlsey
One tps cinnamon
Optional (to improve creaminess and taste) - one quarter of a banana (freeze the rest to use another day - bananas are high in histamine and sugar).
Roughly 500-750ml water
Appetite
Notice whether having a smoothie to start your day whets your appetite for more food at breakfast. This can be helpful for people who struggle to eat in the mornings. Generally, eating more at breakfast, as long as it is more protein and healthy fats rather than more sugar and highly refined carbs, regulates appetite for the rest of day and is a positive thing to do.
Bowel movements
Also notice whether the increased hydration and fibre regulate bowel movements, if you struggle with constipation. Not only do you ideally want at least one bowel movement daily, but ideally the first bowel movement should be within an hour or so of waking. When stools hang around in the gut for too long, they negatively affect the microbes that live there, promoting the growth of certain non beneficial microbes mentioned earlier, as well as increasing unwanted symptoms such as bloating. Tackling constipation can be the one of the most effective ways to reduce autoimmune symptoms.
Monitor mood and energy dips
Generally speaking, the more you build up the quantity of protein in the smoothie relative to the natural sugars, the more consistent your mood and energy will be throughout the day. Notice whether you have fewer afternoon slumps and cravings and whether you have less need for snacks. If you do have crashes, always look back to what happened earlier in the day. Did you eat sufficient amounts of protein, fat and fibre at breakfast? Also note that high amounts of stress earlier in the day make energy and mood slumps more likely.
Everyone is different…
Lastly, remember we are all unique and react to foods differently. These are just some ideas to give you a starting structure.
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