Medical groups warn against trace alcohol in nonalcoholic drinks

The Adult Non-Alcoholic Beverage Association, whose members include Athletic Brewing, Diageo North America and Ritual Zero Proof, is advising members to drop “alcohol-free” and “zero-proof” claims on any beverage containing trace alcohol. Chief executive Marcos Salazar said some marketing strategies are built around loose terminology that can leave consumers confused. “We recommend ‘nonalcoholic’ because we don’t want anybody to be confused,” he said.

The recommendation comes amid growth in the category. Dollar sales of nonalcoholic beer, spirits and wine in the United States grew more than 14% in the 52 weeks ended July 18 compared with the prior year, according to NielsenIQ. Sales of nonalcoholic beer alone climbed to nearly $235 million for the three months ended June 27.

Bill Shufelt, co-founder and chief executive of Athletic Brewing — the largest dedicated nonalcoholic brewer in the United States by sales — said the distinction between zero alcohol and a trace amount has become a nonissue for many customers. He said most top nonalcoholic beer brands in the United States contain under 0.5% alcohol by volume rather than zero. “It takes a lot of extra processing to get down to 0.0,” Shufelt said. “There’s a major cost moat.”

Methods for producing nonalcoholic and zero-proof drinks vary. Some brands skip fermentation — which naturally produces alcohol — and instead mix ingredients such as herbs and spices in hot water before distilling the mixture. Others control fermentation, dilute the original formulation to reduce alcohol content, or remove alcohol through vacuum distillation or filtration. Trace amounts of alcohol may remain after those steps, and advanced distillation or filtration that strips out the rest can also strip out flavor, according to industry executives.

Under federal regulation, beverages labeled “alcohol-free” must contain no trace of alcohol, while those containing less than 0.5% alcohol by volume may be labeled “nonalcoholic.” Some brands use terms such as “0% alcohol” or “zero-proof” interchangeably with “nonalcoholic,” leaving the trace amount to the fine print.

Some consumers have gone to court over the labeling. A federal lawsuit filed in Louisiana in 2021 alleged Heineken USA misled buyers by marketing Heineken 0.0 as alcohol-free despite the beverage containing less than 0.03% alcohol by volume. The case was settled in 2022; Heineken 0.0 remains on sale. Heineken USA said the formulation had been reviewed by the Alcohol and Tobacco Tax and Trade Bureau and classified as alcohol-free, and that the formula had not changed since the product was introduced in 2017.

Other major brands say they have reached absolute zero. Budweiser Zero and Michelob Ultra Zero both advertise no alcohol content. CleanCo, which sells alcohol-free cocktails and spirits, said it dropped its beverages from 0.4% ABV to 0.0% after market testing showed shoppers were confused by trace amounts.

The labeling debate carries real stakes for some drinkers. Tim Savoy, 36, received a liver transplant in 2022 for alcohol-related cirrhosis and now drinks nonalcoholic beer nearly every day, sticking mostly to beer alternatives. Doctors have cautioned him about trace alcohol and told him that volume matters. Routine blood work shows his liver functioning normally, he said. “The minute that is not the case, I will completely re-evaluate,” Savoy said.

The American College of Obstetricians and Gynecologists has warned that no amount of alcohol is safe during pregnancy. The American Association for the Study of Liver Diseases has issued similar warnings for people with compromised livers and recommends that those with liver disease avoid nonalcoholic beverages.

Stanford University School of Medicine instructor Molly Bowdring said hard data on the effects of nonalcoholic beverages remains scarce. She said she is aware of only one randomized controlled trial on the topic, which was funded by the alcohol industry and found that nonalcoholic alternatives reduced overall consumption among excessive drinkers.

“It really does leave it as an open question for people who are purchasing these beverages,” Bowdring said.