What to drink with breakfast: coffee, tea, plant-based drinks and smoothies

Is it healthy to have coffee with breakfast?

Yes, for most healthy adults. A review analysing more than two hundred meta-analyses concluded that moderate coffee consumption is safe and is associated with lower mortality and less cardiovascular disease [2]. It notes two exceptions: pregnancy and women at high risk of fracture [2]. These are observational studies: they show an association, not that coffee itself is protective. Based on current evidence, coffee is not something you need to compensate for or routinely avoid.

How much caffeine is in a cup of coffee?

It depends on how it is prepared and the type of bean. As a guide, the European Food Safety Authority (EFSA) estimates that a 60 ml espresso contains about 80 mg of caffeine [3]. A 200 ml cup of filter coffee contains about 90 mg, and a 220 ml cup of black tea about 50 mg [3]. Chocolate and cola drinks also contribute caffeine, in smaller amounts [3]. Decaffeinated coffee retains only a minimal amount.

How many coffees can you have a day?

For healthy adults, up to 400 mg of caffeine a day, spread throughout the day, does not raise safety concerns, according to EFSA [1]. Nor do single doses of up to 200 mg [1], or about two and a half espressos [3]. In practice, that is around four cups of filter coffee or five espressos a day [3].

The same scientific opinion warns that around 100 mg close to bedtime may delay sleep and shorten it in some people [1]. If you sleep poorly, first consider what time you have your last coffee before focusing on how many you drink.

Who should limit coffee?

In some situations, it may be advisable to have less or switch to decaffeinated coffee. This is not an exhaustive list, and the decision should be made with your doctor.

• Pregnancy and breastfeeding. During pregnancy, the reference is to stay below 200 mg of caffeine a day from all sources [1], or around two cups of filter coffee [3]. During breastfeeding, up to 200 mg of caffeine a day is also not considered a concern for the baby [1]. Pregnancy is also one of the two exceptions noted in the review on coffee and health [2].
• Uncontrolled high blood pressure. Caffeine can temporarily raise blood pressure, especially in people who do not drink it every day. If your blood pressure is not controlled, talk to your doctor before continuing or increasing your coffee intake. For the rest of your eating plan, see our guide to eating with hypertension.
• Reflux. The American reflux guideline advises avoiding foods that trigger symptoms [4]. Coffee is often among those mentioned [4]. If you have reflux, avoid coffee.
• Anxiety or nervousness. If you notice palpitations, trembling or increased restlessness after coffee, reduce the amount or switch to decaffeinated coffee.
• Children and teenagers. Coffee is not a suitable breakfast drink for them. As a cautious reference, they should stay below 3 mg of caffeine per kilogram of body weight per day, counting cola drinks, chocolate and energy drinks [1].

If you take medication, ask your pharmacist or doctor whether coffee interacts with it; do not change your medication on your own.

How to have coffee as part of a balanced breakfast

What often takes away from coffee is what goes into it. The World Health Organization (WHO) recommends that free sugars provide no more than 10% of daily energy, and ideally no more than 5% [5]. These include sugars added to foods and drinks, as well as those in honey, syrups and fruit juices [5]. Two or three coffees with two sachets of sugar each already use a substantial part of that allowance.

Many capsules and powdered-milk coffee mixes already contain sugar even if you do not add any yourself; check the ingredients list.

If you do not want coffee: tea, herbal infusions or milk

Black, green and red tea all come from the same plant and contain caffeine, traditionally called theine in tea. A cup of black tea provides a little over half as much caffeine as a cup of filter coffee [3]. Mild infusions, such as chamomile, lemon balm or lemon verbena, are a good option if you want a hot drink without caffeine. Have them without sugar, just like coffee.

Milk can also be part of breakfast, on its own or flavoured: warm it without bringing it to the boil, with a cinnamon stick and orange peel or a vanilla pod. If you do not have dairy, in consultations we recommend soy drink, or a plant-based drink with at least 3 g of protein per 100 ml and added calcium. Bear in mind that soy is an allergen. We explain what else to look for on the label in plant-based drinks: which one to choose.

Fruit smoothie, juice or cocoa: which is better at breakfast?

Whole fruit, eaten and chewed, is the best way to have fruit. A homemade smoothie made by blending whole fruit retains its fibre and, with milk, yoghurt or kefir, can make a complete breakfast. There is one limitation: it is quicker to drink and less filling than chewed fruit, so it should not replace all the fruit you eat during the day.

Juice is different. WHO counts the sugars in fruit juice, including fresh-squeezed juice, as free sugars, just like table sugar [5]. You do not need to eliminate it; simply avoid making it your everyday morning fruit.

Sugared cocoa powder usually lists sugar as its first ingredient; check the label. Water is the drink of choice as part of a healthy diet [6].

Common mistakes we see in consultations

Three things we often hear, and what may be behind them.

• “I only have two coffees.” A milky coffee in a large cup may contain a double espresso. To work out how much caffeine you have, count the espresso shots in each cup, not just the cups.
• “I switched to tea to have less caffeine.” That is fine, as long as you are not having five cups a day: at around 50 mg each [3], they add up to almost as much as three filter coffees.
• “Coffee keeps me going until midday.” That can work, but it leaves out the rest of breakfast. If you do not feel like eating when you get up, have breakfast later. Start with something small, such as a yoghurt or a piece of fruit, and add more when you feel like it. Find ideas in how to put together healthy, balanced breakfasts.