By Ian Hayman

Alcohol has been a mainstay in human society for over 6,000 years and is essential to many aspects of culture due to it’s pain-killing, mind altering, disinfectant, and food preserving properties ^1,2. Alcohol has been instrumental in the development of numerous celebrations and traditions, ranging from the unsanctimonious ’21 run’ to celebrate a 21^st birthday, up to the development of many modern religions ¹.  Alcohol also plays a large economic role in the United States, with alcohol related industries providing millions of jobs while taxes on alcoholic beverages generate tens of billions of dollars annually ^3-6. The majority of people between 21-64 years of age regularly drink alcohol in the United States (have drank alcohol in the last month), and nearly one third of regular drinkers are binge drinkers (imbibe more than 5 drinks in a single event for men, or 4 drinks for women) (Figure 1) ⁷. The moderate use of alcohol has historically been encouraged, with studies suggesting that a glass or two of alcohol each day has minimal health impacts or could even decrease the risk of cancer, as well as chronic cardiac and vascular disease ⁸. With so many adults in the United States regularly drinking alcoholic beverages, it may be worth examining more recent evidence, which suggests alcohol consumption may be far less benign than originally thought.

More than 140,000 people die from excessive alcohol use in the United States every year ^9,10. To put this into perspective, just under 43,000 people died from car accidents in 2020 while just over 39,000 died from gun related injuries ^11,12. Alcohol is the third leading cause of preventable death in the United States, and is a leading cause of emergency room visits ^10,13,14. The total costs of excessive alcohol to the medical system use were calculated at $249 billion annually in 2010, or over $750 per citizen, and alcohol use has increased since this time ^6,10,14. Excessive alcohol is a causative agent of cancer (oral, pharyngeal, esophageal, laryngeal, gastric, colorectal, liver, pancreatic, and breast), heart disease, stroke, liver failure and cirrhosis, pancreatitis, high blood pressure, muscle wasting, dementia, and birth defects ^9,15,16. A recent study in The Lancet involving over 1.3 billion participants worldwide identified that there was no safe level of alcohol consumption for individuals under the age of 40, and only moderate benefits for those who are above the age of 40 ¹⁵.

Despite significant health concerns, it is important to recognize the popularity and very real cultural role alcohol plays in our society. Banning alcohol production or sales in the United States is unlikely to work, as seen with Prohibition in the early 1900s, and many Americans would argue that people should have the choice to imbibe alcohol in situations where it doesn’t impact others. Banning alcohol would also have significant economic impacts, as described above ^3-6. One possible way to reduce the negative impacts of alcohol consumption in the United States is to reduce individual consumption by improving education regarding the risks of alcoholic beverages ^1,15. Another rapidly growing alternative is to support industries that seek to provide substitutes to alcohol beverages, such as non-alcoholic beer and spirits, to reduce total individual alcohol intake in the United States ^17-20.

Non-alcoholic versions of beer and spirits have long had issues with quality and consumer enjoyment. For many years, non-alcoholic beers and spirits were produced by boiling the alcohol out of conventionally brewed liquids ²⁰. This dramatically impacted the taste of the resulting liquid. Recent advances in technology have developed significantly better non-alcoholic beers and spirits through two methods. First, conventional alcoholic beverages are produced as normal, then a combination of low-pressure distillation and filtration are used to generate a slurry that is largely dealcoholized but retains all of the other flavor compounds found in the original brew ^18,20. This slurry is rehydrated and sugar is added to compensate for the loss of the alcohol sweetness (Figure 2) ^18,20. Alternatively, a bioreactor system uses several added vitamins and a complex yeast growing chamber to produce fermented beverages without alcohol production ¹⁷. A compelling part of the bioreactor system is that electricity is generated inversely to alcohol production; the less alcohol generated, the more electricity is generated ¹⁷. This effect could be utilized to lower the significant carbon footprint of the alcohol industry. Current research indicates that a single 750mL bottle of spirits produces six pounds of greenhouse gases, equivalent to charging a standard cell phone 359 times ²¹ .

Despite improvements to technology, non-alcoholic beverages also struggle to recapitulate the full flavor profile of their alcoholic counterparts ¹⁹. One clear example of this is non-alcohol spirits; many commercially available options use capsaicin, the compound that makes hot peppers spicy, to replicate the burn from alcohol ¹⁹. It is likely evident to most readers that a burn from capsaicin is not a perfect analog to the burn from alcohol in spirits. On a more technical side, alcohol in even low content beverages, like beer, dramatically affects flavor and mouthfeel ¹⁹. Alcohol is more viscous than water, meaning thickening agents like complex sugars such as xanthan gum must be added to non-alcoholic beverages ¹⁹. Alcohol also impacts how different flavor compounds in alcoholic drinks interact with our taste buds, and aerosolizing alcohol in a drinker’s mouth also impacts how different flavor and scent compounds are carried into the nose ¹⁹. This is not easily replicated for non-alcoholic beverages, indicating one place where new technologies are needed.

Non-alcoholic beverages are also not the answer for everyone seeking the taste of an alcoholic beverage without the alcohol ²². Some non-alcoholic beers and spirits are termed ‘alcohol free’, meaning they have 0.0% alcohol content. Other options are ‘non-alcoholic’, meaning they contain less than 0.5% alcohol. Poor oversight of this facet of the alcohol industry means that the reported low alcohol content is not always accurate ²². A study from the early 2010s found that the majority of beers labeled as alcohol-free and non-alcoholic contained more alcohol than advertised, although they were still less than conventional beers. Alcohol-free and non-alcoholic alternatives are not safe for people sensitive to alcohol, such as people taking certain medications or who are pregnant ²². Despite the limitations, non-alcoholic and alcohol-free versions of beers, spirits, and wine can provide ways for many people to reduce or eliminate alcohol intake.

Alcoholic beverages have significant impact on the shape of our society ¹. The production of alcoholic beverages provides millions of jobs and billions in annual tax revenue, while the consumption of alcoholic beverages has led to some of the most significant cultural traditions in modern society ^1,3-6. Unfortunately, there are numerous dire health consequences associated with alcohol consumption, and even small amounts of alcohol consumption may not be safe ^9,10,14-16. New alternatives to standard alcoholic beverages may provide an alternative that is better for our health and even our planet. Next time you’re on a beer run, maybe check out the alcohol-free and non-alcoholic options. You may even find a new favorite way to unwind without the added health costs.

TL:DR

• Alcohol is culturally, socially, and economically important in the United States
• Alcohol is a leading cause of death and disease in the United States
• Education and non- or low-alcohol replacements could reduce the public health burden of alcohol

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References

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