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The health implications of low alcohol and alcohol-free drinks are complex and multifaceted. While low alcohol consumption may offer certain cardiovascular benefits, these must be weighed against the associated risks, including increased cancer risk and the potential for developing AUD. Alcohol-free drinks present a promising alternative, but their effects on health, particularly in individuals with AUD, require further investigation. As the evidence base continues to grow, it is crucial for public health guidelines to be informed by robust and comprehensive research.

The consumption of alcohol has long been a topic of debate in the context of public health. While moderate alcohol consumption has been associated with certain health benefits, excessive intake is known to have detrimental effects. Recently, low alcohol (NoLo) and alcohol-free drinks have gained popularity as potential healthier alternatives. This article explores the health implications of these beverages based on current research.

Health Benefits of Low Alcohol Consumption

Several studies have suggested that low to moderate alcohol consumption may confer certain health benefits, particularly in relation to cardiovascular health. For instance, light to moderate alcohol intake has been associated with decreased risks for coronary artery disease, diabetes, and stroke4 5. These benefits are thought to arise from improvements in insulin sensitivity and high-density lipoprotein cholesterol4. However, it is important to note that these findings are not universally accepted. Some researchers argue that the observed benefits may be due to confounding factors, such as healthier lifestyles among moderate drinkers10. Moreover, the potential benefits must be weighed against the risks of alcohol consumption, including the development of hypertension, atrial fibrillation, and liver disease5 6 7.

Risks Associated with Low Alcohol Consumption

Despite the potential benefits, low alcohol consumption is not without risks. Studies have shown that even low levels of alcohol intake can increase the risk of certain cancers, including liver cancer6. Additionally, alcohol consumption, regardless of the amount, can lead to the development of alcohol use disorders (AUD) and other health complications2 7. A systematic review and meta-analysis found that low-volume alcohol consumption does not significantly reduce mortality risk when compared to lifetime abstention or occasional drinking1. This finding challenges the notion that low alcohol consumption is inherently beneficial and suggests that the health risks may outweigh the benefits.

Health Implications of Alcohol-Free Drinks

Alcohol-free drinks have been proposed as a healthier alternative to traditional alcoholic beverages. These drinks are particularly appealing to individuals with AUD or those seeking to reduce their alcohol intake. However, the evidence on the health effects of alcohol-free drinks is limited and mixed.

A systematic review found that alcohol-free drinks could increase cravings and desire to drink in individuals with AUD, potentially leading to relapse2. Additionally, heavy drinkers may use alcohol-free drinks in conjunction with their usual alcohol consumption, rather than as a replacement, thereby negating any potential health benefits2. On the other hand, some studies suggest that switching from higher strength to alcohol-free products could reduce overall ethanol consumption, potentially leading to health benefits3. However, the evidence base is currently inadequate to inform policy, and further research is needed to fully understand the health implications of alcohol-free drinks3.

Are low alcohol or alcohol-free drinks healthy?

Tim Crowe has answered Likely An expert from Thinking Nutrition in Nutrition When it comes to alcohol, it is a major risk factor for many types of cancer and is the second leading global risk factor for cancer after smoking. As the amount of alcohol a person drinks increases, so too does their risk of cancer. Combine that with other health effects on the liver, brain and heart plus the societal issues of violence and injuries, then drinking less can be an important health priority for many people. Changing to low-alcohol or non-alcoholic alcohol drinks is a good way for a person to reduce how much they drink. But it is important to realise that it can be easy to overconsume non-alcoholic drinks (many of which are still a source of energy) as they don’t fill you up in the same way that food does, meaning that we can easily drink a lot of kilojoules without realising it. For someone carrying too much weight that can compound health issues linked to that.

Are low alcohol or alcohol-free drinks healthy?

Duane Mellor has answered Likely An expert from Aston University in Nutrition It is often said that weak beer was drunk in preference to dirty water in European towns during the middle ages. This fact is probably overstated, but the idea that beer was nutritionally important in the medieval period seems more likely. Weaker, so-called “small beers” would have been low in alcohol but a valuable source of energy and nutrients, helping medieval labourers meet their high energy requirements of 3,000 calories a day. The industrialisation of brewing led to higher alcohol levels in modern beers, which together with their energy and carbohydrate content means beer is now associated with poor health and disease. Growing concerns about the health effects of excessive beer consumption has driven increased interest in no-alcohol and low-alcohol (“nolo”) beers, especially in adults under 30. The acceptability of these beers has increased recently, in part due to brewing developments that require less heat and so retain more of the original flavours. Research shows that moderate beer intake, as with wine, is associated with a reduced risks of heart disease. So it’s plausible that nolo beers could also offer these health and nutritional benefits, but without the negative effects linked to the alcohol and calorie content. In a recent review, we set out to determine the health benefits of nolo beers and whether they could find a place as nutritious drinks with everyday uses, rather than being drunk typically only by teetotallers and designated drivers. Antioxidants and gut health are areas about which there is considerable interest among the health-conscious and among food producers, and nolo beers can provide for both.

Probiotics

Many people think probiotics are the bacteria in yoghurts and perhaps kombucha, but beer can be probiotic too – that is, it contains live, beneficial bacteria – due to its yeast. A number of yeasts such as Saccharomyces boulardii have been found to play a role in managing gastrointestinal disorders, and although this type of beer is yet to be tested to see if it improves gut health, a number of studies are in the pipeline. A beer using alternative yeasts such as this also could reduce the beer’s sugar content, or through slow fermentation, produce less alcohol. Other styles of beer such as sour beers and lambics use bacteria similar to those you would find in live yoghurt. But, as with yoghurts, it may not be possible to get an approved health claim, and many products are treated to extend shelf life and in doing so reduce or remove any potential probiotic microorganisms. To contain any live probiotics linked to maintaining a healthy gut and immune system, the beer needs to be fresh, not pasteurised and unfiltered. But this would reduce its shelf-life and risk the production of “off” flavours.

Polyphenols

Polyphenols are a large group of compounds found in hops and grains that have been linked to a reduced risk of disease. They have been shown in laboratory tests to be powerful antioxidants, which can mop up dangerous free radicals in the body’s cells, which if left unchecked can increase the risk of diseases, such as heart disease and cancer. While there is doubt about whether this is the mechanism by which antioxidants keep us healthy, what is clear is that diets rich in a variety of these compounds are a good thing. Beer and nolo beer are rich in polyphenols due to the barley and hops, which means beer can contain over 50 different compounds that could provide benefits from affecting gastrointestinal health to controlling bacteria growth. Beers containing more hops, such as IPAs, tend to contain even more of these potential health-promoting polyphenols than lagers. There is now recognition that nolo beers can potentially be marketed as health products. German brewer Erdinger’s alcohol-free wheat beer contains electrolytes that can aid the absorption of water to help digestion – something often referred to as “isotonic” when found in a sports drink. The beer is also a source of folate and vitamin B12 due to the action of the yeast in the bottled beer (particularly important for vegans, for whom there are few natural sources of vitamin B12 available). Erdinger market this beer as “isotonic” and “a sporty thirst quencher”, which suggests it has identified that the beer is both suitable for, and is of interest to, groups beyond those wishing to avoid alcohol. The sports drink potential of nolo beers has been tested in the lab too, with low alcohol beers being almost as good as sports drinks for rehydrating, especially if a pinch of salt is added. While nolo beers are growing in popularity, it may be that traditional beer fans may struggle to accept them as “real ales”, given the poor reputation of low-alcohol beers in the past. But with improving brewing and alcohol-removal methods, the flavour and potentially the health benefits of low alcohol beers can be retained, while reducing the negatives of excess alcohol and calories. Even the most ardent beer fans may yet be won over. This article was originally published in The Conversation

Are low alcohol or alcohol-free drinks healthy?

Cornelie Nienaber-Rousseau has answered Likely An expert from North-West University in Nutrition Alcohol or ethanol containing drinks made by fermenting and distilling maize, cornstalks, sorghum, potatoes, wheat, grapes and other fruits, sugar cane and vegetable waste are of the most consumed beverages worldwide. Breweries have expanded their products to include low alcohol content versions by removal of alcohol from regular beer or by limiting ethanol formation during the beer fermentation (Brányik et al., 2012). Besides beer, no-alcohol or low-alcohol (NoLo) drinks (up to 1.2% alcohol by volume(ABV)) also include alcohol-free, non-alcoholic, de-alcoholized, and low-strength wines, ciders and spirits. Due to climate change wine’s alcoholic content has been increasing with approximately 1% ABV per decade. This increase has forced the wine industry to come up with solutions such as de-alcoholizing their wines (Anderson et al., 2021). Classification of the low alcohol content alternatives vary. Low alcohol content beers are divided into alcohol-free beers (AFBs) also called non-alcoholic beer or “near-beer” (in Europe ≤0.5% ABV; in America no alcohol), and low-alcohol beers (LABs; in Europe less than 1.2%; in America ≤0.5% ABV) (Montanari et al., 2009). For wine the International Organisation of Vine and Wine classifies dealcoholized wine as containing ≤0.5% ABV, partial dealcoholized wine 0.5–8.5% ABV. However, these products are also defined in the literature as having an ABV of up to 11.0% (as reviewed by Anderson et al. (2021)). NoLo products have increased the alcohol industry’s production and markets where alcohol consumption is forbidden for religious reasons (Brányik et al., 2012). However, overall NoLo drinks’ sales are limited compared to the high alcohol content versions (Brányik et al., 2012; Caballeria et al., 2022). For consumers the hope is that NoLo products would replace those with higher alcohol content thereby reducing the overall alcohol consumed, facilitate cutting back on alcohol without standing out at social events and provide alternatives when driving vehicles or operating machinery or when pregnant or using certain medications (Anderson et al. 2021; Brányik et al., 2012; Caballeria et al., 2022). Alcohol abuse is a major issue and ethanol, which is metabolized to highly toxic acetaldehyde, is the most used recreational drug worldwide (Pisa et al., 2010; Murray et al., 2020). Adverse health effects of alcohol can be divided into biological health hazards (alcoholic liver disease, alcoholic pancreatitis, cancers, malnutrition, cardiac disorders, gastric complications, neurological disorders), fetal development or teratogenic effects (alcohol-related birth defects, alcohol related neurodevelopmental disorders and fetal alcohol spectrum (FAS) defects) and accidents or injuries (Pisa et al., 2010). Reducing alcohol consumption by reducing the amount of alcohol a drink contains could ultimately reduce the risk of dying prematurely and the prevalence of these conditions. Simultaneously, there are evidence of a U-shaped association between alcohol intake with all-cause, non-cancer and cardiovascular disease mortality (Neumann et al., 2021; Schaefer et al., 2022). Therefore, moderate alcohol consumption has better long-term health outcome than excessive alcohol consumption and is slightly better than abstaining. The health benefits of alcohol containing beverages are partly attributed to substances other than the alcohol found in these products. Beer contains no fat or cholesterol, and has no added sugars, is high in antioxidants (polyphenols, flavonoids), contains some essential vitamins and minerals and some soluble fiber (Bamforth, 2002). Similarly, wine does not contain fat or cholesterol or added sugars but contains carbohydrates, organic acids, minerals and polyphenols (resveratrol, anthocyanins, and catechins) (Snopek et al., 2018). Therefore, NoLo products could give the nutritious benefits without the energy (alcohol has a relatively high energy value of 29.2 kJ/gram or 7.1 kilocalories/gram) and other negative impacts provided by ethanol. Unfortunately, when the %ABV or verbal descriptors indicate lower alcohol, studies showed that consumption increased leading to the high consumption of these products and high overall alcohol intake (Vasiljevic et al., 2018 and 2021). Furthermore, those with alcohol use disorders should steer clear from these beverages, because they can increase cravings and desires to drink (Caballeria et al., 2022). Caballeria and colleagues observed, in their survey of the literature, that heavy drinkers tend to use no-and low-alcohol drinks on top of their usual alcohol consumption rather than as substitutes. I, therefore, recommend that for the general population if you drink, drink sensibly and use NoLo beverages judiciously as substitutes rather than adding to your intake and for pregnant women or those with alcohol use disorders to steer clear from NoLo drinks to diminish any cravings.