Smoothies for People Living with ALS

Angela Loewen, MS, RDN, LDN, CNSC, Clinical Dietitian, UChicago Medicine

Smoothies offer a delectable and nutritious option to address the dietary needs of people living with ALS. As ALS progresses, patients often face difficulties in consuming sufficient calories and protein due to challenges with swallowing and muscle weakness. Incorporating smoothies into your diet can be a valuable strategy to overcome these obstacles for optimal nutritional intake.

Smoothies offer a convenient and time-saving solution for those who may experience fatigue and limited energy for meal preparation. They can be prepared in advance and stored, allowing for frequent, small, and manageable meals throughout the day. Plus, the abundant vitamins, minerals, and antioxidants found in fruits and vegetables make smoothies an excellent source of essential nutrients, supporting your overall health and well-being.

The texture of smoothies can be adjusted to accommodate swallowing difficulties. Blending ingredients into a smooth consistency not only eliminates the need for strenuous chewing but also can reduce the risk of aspiration and enhance overall safety during eating. Adjust the liquids or add thickening agents as needed to achieve nectar or honey-thick consistencies. (Caution with adding ice cubes. As the ice melts, it will thin the consistency of the smoothie.)

Smoothies are easily customizable to suit individual preferences and dietary requirements. Choose high-calorie ingredients like avocados, nut butters, coconut oil, or full-fat dairy to boost calories without increasing meal volume. Include protein powders or high-protein ingredients like Greek yogurt, chia seeds, or hemp seeds to help maintain muscle mass. There are limitless combinations when building a smoothie. Enjoy being creative with your recipes!

Follow this order for layering ingredients for easier blending:

1. Start with a liquid base: whole milk, coconut milk or coconut water, non-dairy milk alternatives (almond, oat, rice, hemp, soy, chickpea, barley–look at nutrition label as the calorie and protein contents vary widely), kefir, fruit juice, tomato juice, coffee, chai tea, Ensure or other nutritional supplement drink
2. Add syrups, oils, powders, nuts, and seeds: honey, maple syrup, agave syrup, brown rice syrup, granulated sugar, jelly or jam, chocolate syrup, coconut oil, avocado oil, cocoa powder, protein powder, fiber powder, spices, chia seeds, flaxseed, pistachios, cashews
3. Add leafy greens: spinach, kale, arugula, spring mix, parsley, mint, basil (mostly any lettuce or herb works well)
4. Add creamy ingredients: yogurt or non-dairy alternative, nut butters, avocado, silken tofu, cottage or ricotta cheese, chia seed pudding, pumpkin puree
5. Add fruits, vegetables, and grains: frozen, canned, raw, and cooked…all can work in smoothies and can change the consistency. Grains (oats, cooked quinoa, barley, or rice) can thicken while also increasing protein and fiber.

A Delicious Example: The Oatmeal Cookie Smoothie

(Approximately 800 calories, 60 grams protein and 6 grams fiber)

• 1 cup whole milk
• 1 tablespoon honey
• ½ teaspoon ground cinnamon
• 1 scoop protein powder (vanilla or unflavored)
• 1 tablespoon almond butter
• ½ cup rolled oats
• 1 cup whole Greek yogurt (vanilla or coffee)