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Beer is consumed worldwide and is a universally popular beverage. This is due to its sensory, nutritional, and medicinal properties. Surveys have shown that light to moderate consumption of alcoholic beverages (including beer) with relatively low alcohol contents can provide various favorable impacts on humans' health, including nutritional benefits, anti-mutagenic and anti-carcinogenic effects, reduction of cardiovascular disease (cardioprotective effect), hypolipidemic effect, immune system stimulation, anti-osteoporosis effect, and reducing risk of dementia. On the contrary, consumption of these beverages in excessive amounts results in some heath disorders, such as allergy induction, increase in the plasma concentration of uric acid, mutation and cancer induction, increase in the risk of dementia, obesity, and some social misbehaviors. Health-related aspects of beer (both positive and negative impacts) have been comprehensively reviewed in this article.
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International Journal of Food Properties
ISSN: 1094-2912 (Print) 1532-2386 (Online) Journal homepage: http://www.tandfonline.com/loi/ljfp20
Health-Related Aspects of Beer: A Review
S. Sohrabvandi , A.M. Mortazavian & K. Rezaei
To cite this article: S. Sohrabvandi , A.M. Mortazavian & K. Rezaei (2012) Health-Related
Aspects of Beer: A Review, International Journal of Food Properties, 15:2, 350-373, DOI:
10.1080/10942912.2010.487627
To link to this article: http://dx.doi.org/10.1080/10942912.2010.487627
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International Journal of Food Properties, 15:350–373, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 1094-2912 print / 1532-2386 online
DOI: 10.1080/10942912.2010.487627
HEALTH-RELATED ASPECTS OF BEER: A REVIEW
S. Sohrabvandi1, A.M. Mortazavian1,
and K. Rezaei2
1Department of Food Technology, National Nutrition and Food Technology
Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid
Beheshti University of Medical Sciences, Tehran, Iran
2Department of Food Science, Engineering and Technology, Faculty of Agricultural
Engineering and Technology, University of Tehran, Karaj, Iran
Beer is consumed worldwide and is a universally popular beverage. This is due to its sensory,
nutritional, and medicinal properties. Surveys have shown that light to moderate consump-
tion of alcoholic beverages (including beer) with relatively low alcohol contents can provide
various favorable impacts on humans’ health, including nutritional benefits, anti-mutagenic
and anti-carcinogenic effects, reduction of cardiovascular disease (cardioprotective effect),
hypolipidemic effect, immune system stimulation, anti-osteoporosis effect, and reducing risk
of dementia. On the contrary, consumption of these beverages in excessive amounts results
in some heath disorders, such as allergy induction, increase in the plasma concentration of
uric acid, mutation and cancer induction, increase in the risk of dementia, obesity, and some
social misbehaviors. Health-related aspects of beer (both positive and negative impacts) have
been comprehensively reviewed in this article.
Keywords: Allergy, Beer, Cancer, Coronary heart disease, Health, Nutrition.
INTRODUCTION
Beer, the complex brewed beverage made from malt (germinated barely), hops,
water, and yeast, is widely consumed all over the world. In 2002, the estimated aver-
age beer consumption per capita was 72.9 L. In some countries, this figure was higher
than 130 L.[1] According to the FAO, in 2002, beer with the annual consumption of
1.3 hectoliter ranked as the fifth world-consumed beverage, after tea, fizzy drinks, milk
and coffee.[2] The consumption of beer is of special interest because of its organolep-
tic and health-related characteristics and also due to its low cost as compared with other
types of Western and European alcoholic beverages, such as wine. For instance, research
examinations have shown that overall positive expectancies for beer were much higher
than that for wine. Hard liquor is linked to the largest number of negative consequences
expected by the participants.[3–6] Hittner[7] reported that, among female college stu-
dents classified as female “high-frequency” drinkers, 48.1% preferred mixed drinks and
Received 9 December 2009; accepted 18 April 2010.
Address correspondence to A.M. Mortazavian, Department of Food Technology, National Nutrition
and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti
University of Medical Sciences, PO Box 19395-4741, Tehran, Iran. E-mail: mortazvn@sbmu.ac.ir
350
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HEALTH-RELATED ASPECTS OF BEER 351
43.5% preferred beer, while “low-frequency” drinkers preferred mixed drinks to other
alcoholic beverages. According to the above study, the majority of male students pre-
ferred beer, whether they were “high-frequency” or “low-frequency” drinkers. It seems
that male college students may choose beer because of its cheaper price, its acceptance
as a normal drink in the Western societies, and also due to its association with perceived
masculinity.[8,9] According to Innes,[10] effectiveness and lower cost of beer are among
the reasons for replacing red wine as the cardioprotective beverage. Statistics indicate that
those engaged in team sports consume more beer than wine.[11]
Beer has traditionally been a popular drink among many cultures. For example, in
ancient Egypt, and subsequently in many other cultures, beer was the beverage of choice
for all members of the family at different ages.[12] The oldest historical evidence show that
formal brewing dates back to about 6000 B.C. in ancient Babylonia. About 160 types of
beers were produced at that time. In ancient Egypt, Rome, China, India, and Iran, numerous
types of beers and beer-like beverages from different grains were industrially manufactured
and regulations were set for their production, sale, and export. Beer was consumed not only
as a regular social drink, but also as an important component of religious ceremonies.[13]
The basic ingredient of classic/normal beer is malted barley. Other cereals can also
be added as adjuncts. Hops add a characteristic bitter flavor and yeast is essential for the
fermentation.[14] Various brewing parameters, such as the variety of barely and the malt-
ing process, temperature, and pH of mashing, sparging, boiling, the variety of hops added
during wort boiling and fermentation conditions, including yeast strains, pitching rate, tem-
perature, pressure, aeration, agitation, and stirring as well as storage and aging conditions,
influence the type and quality of beer.[13,15] Normal beer contains 2.5–13% (v/v) ethanol.
Most beers worldwide have alcohol contents in the range 3 to 6% (v/v).[5,12] Considering
their alcohol contents, beers are usually classified as low-strength (having about 2–3%
alcohol), medium/average strength (having about 5% alcohol), and high-strength/strong
(>5–6% alcohol) beers.[12] Lager, ale, pilsener, and stout are several of the most con-
sumed types of beers.[1] Low-alcohol beers with <2.5% alcohol and non-alcoholic beers
with <0.5% alcohol have been developed in recent years.[13]
Studies have shown that light-to-moderate consumption of alcoholic beverages,
including beer, can provide various advantages to human health due to the presence of
protein, B vitamins, certain minerals, phenolics (antioxidants), ethanol, dietary fibers, and
even prebiotic compounds.[16,17] However, an excessive amount of alcohol consumption
leads to adverse effects on the individuals and also to the society. In the present study,
the health-related aspects of beer (both positive and negative) have been comprehensively
reviewed.
STAGES OF BEER MANUFACTURE
The process for brewing normal beer consists essentially of malting barley that
includes steeping, germinating and kilning stages, crushing the malted barley and adding
water to create the mash, separating the resultant aqueous extract known as “wort,” boil-
ing the wort with hops, cooling and clarifying the wort, fermenting the wort (in two
stages), filtering, adding other additives, pasteurizing, and finally packaging the beer. Beer
characteristics can be influenced by the variety of barley used for the brewing and the
conditions applied in each of the above steps.[14] Figure 1 shows generic stages of beer
manufacture.
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352 SOHRABVANDI, MORTAZAVIAN, AND REZAEI
Malting Crushing Mashing
Lautering
Wort boiling with hop
Wort cooling and clarification
Wort aeration/Inoculation of yeasts
Fermentation
Removal of yeasts (filtration)
Aging
Pasteurization
Packaging
Figure 1 Generic stages of beer manufacture.
HEALTH BENEFITS OF BEER
Beer contains components that bring some nutritional and medicinal health advan-
tages for consumers. From a nutritional point of view, beer contains protein, B vitamins,
and some minerals. Beer contains more protein and B vitamins than wine does. However,
the antioxidant content of beer is equivalent to that of wine, but the specific antioxidants are
different in these sources.[18] From a medicinal standpoint, components, such as phenolic
compounds, ethanol, and dietary fibers, are also important and are discussed below along
with their nutritional properties.
Nutritional Highlights
Beer can offer significant contributions to the dietary intake. Table 1 shows this daily
contribution to the men and women from a nutrients intake point of view, in average. The
nutritional highlights of beer are discussed below:
Vitamins. As shown in Table 1, significant levels of several B vitamins are supplied
through the moderate consumption of beer. The quantity of the present vitamins depends
upon the raw materials as well as the process practices. However, among B vitamins,
thiamine is notably deficient in beer. It has been proven that thiamine deficiency stimulates
alcohol consumption, because thiamine shortage interferes with glucose metabolism.[19]
Ethanol shows antagonism with the bio-utilization of vitamins. Therefore, non-alcoholic
beer would be a wiser choice than high-alcoholic beverages. There is also a negative
correlation between the intake of alcohol and that of carbohydrates.[12]
Minerals. Cereals, water, hops, yeast, processing conditions, and type of contain-
ers can contribute to the mineral contents of the beer.[20] Minerals in beer have nutritional
importance and may also influence the brewing process.[21] In addition, the type and
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HEALTH-RELATED ASPECTS OF BEER 353
Tab le 1 The approximate percentages of nutrients after the ingestion of 1 L of normal beer, as compared with
recommended daily intake (modified from Bamforth[12,17]).
The minimum and maximum approximate percentage of nutrient supply for
adults (age 25–50)
Male Female
Nutrients Min. Max. Min. Max.
Energy (Kcal) 6 43 8 57
Protein (g) 5 8 6 10
Carbohydrate (g) A A a a
Fat (g) A A a a
Vitamin A (µg) Neg.Neg.
Vitamin D (µg) Neg. Neg.
Vitamin E (mg) Neg. Neg.
Vitamin K (µg) Neg. Neg.
Vitamin C (mg) nS∗∗ 50 nS∗∗ 50
Thiamine (mg) 0.2 5 0.3 7
Riboflavin (mg) 1 47 1.5 61.5
Niacin (mg) 16 42 20 53
Vitamin B6(mg) 3.5 85 4.5 106
Folate (µg) 20 300 22 333
Vitamin B12 (µg) 150 1500 150 1500
Biotin (µg) 2 or 7∗∗∗ 15 or 50 2 or 10 15 or 75
Calcium (mg) 5 17.5 5 17.5
Phosphorus (mg) 11 50 11 50
Magnesium (mg) 17 57 22 71
Potassium (mg)bnS nS nS nS
Sodium (mg)bnS nS nS nS
Iron (mg) 1 5 0.6 3
Zinc (mg) 0.07 10 0.08 12
Selenium (µg) <0.6 10 <0.7 13
aFor a diet containing alcohol, the recommendation is that the population average should have 15% of total
dietary energy in the form of protein, 47% as carbohydrate, and 33% as fat.
bBeer contains potassium and sodium in the range of 330–1100 and 40–230, respectively.
Negligible. ∗∗nS =not specified. ∗∗∗Dependent on the individuals and conditions.
concentration of minerals have been used to differentiate among different types of drinks,
such as wines,[22,23] vinegars,[24] coffees, teas, and beers.[1] Beer is an important dietary
source of selenium. The relatively high potassium to sodium ratio (typically 4:1) in beer
is consistent with a low sodium diet. This ratio gives beer a significantly greater diuretic
effect than water.[25] It was reported that beer is a good source of silicon compared with
seafood and cereal products.[26]
Medicinal Values
Despite the healthy aspects achieved by regular/moderate consumption of beer, its
excessive daily intake can lead to different health disorders as described in its own section
subsequently. Recently, a renewal interest has been focused on beer, a common beverage
with a moderate antioxidant activity/capacity coupled with low ethanol content, without
the negative effects produced by high doses of ethanol.[27]
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354 SOHRABVANDI, MORTAZAVIAN, AND REZAEI
Epidemiological, experimental, and clinical investigations have revealed that light-
to-moderate consumption of alcoholic beverages, such as beer, provides various health
benefits to humans. According to studies reported,[28 –30] a U-shaped model describes the
connection between alcohol consumption and most of the diseases. This means higher
death rates among those who abstain as well as those who drink an excess of six drinks a
day. Statistics indicates that low alcohol consumption (10–15 g alcohol/day, equivalent to
about one glass of normal beer per day) reduces annual mortality when compared with non-
drinking and heavy drinking rabbits.[15] The therapeutic effects of beer have been partly
attributed to its alcohol content as well as to its phenolic and protein profiles. Ethanol,
regardless of its direct impact on platelet aggregation, HDL metabolism, and fibrinolysis
(all involved in the pathogenesis of cardiovascular diseases), could play an important role
in the absorption of phenolic compounds in vivo.[27]
Epidemiological studies have suggested associations between the consumption of
phenolic compounds and the prevention of many human diseases associated with oxidative
stresses, such as atherosclerosis, cancer and tumor development, diabetes, neurodegenera-
tive diseases, and aging. It has been reported that flavonoids have an anti-inflammatory
effect.[31,32] Phenolics, which are more efficient than other types of antioxidants (e.g.,
vitamin E, Vitamin C, and β-carotene), may significantly contribute in maintaining
the endogenous redox balance in humans.[27 ,33 –37] A large number of phenolics may
act as antioxidants, with mechanisms involving both free radical scavenging and metal
chelating.[27 ,38 –42] Free radicals can initiate reactions that modify unsaturated lipids (espe-
cially polyunsaturated ones), proteins, and nucleic acids, which are associated with the
early stages of atherosclerosis and carcinogenesis and also with the development of neu-
rodegenerative diseases.[43] Coffee has been recognized as the main source of phenolic
compounds followed by other phenolic-rich foods, such as red wine, fruits and fruit
juices, vegetables, beer, tea, olive oil, and milk.[35,44,45] More than 35 phenolic compounds
have been identified in beer (about 80–90% from malt and 10–20% from hops).[15,46]
However, the in-vivo antioxidant potential and efficiency of these compounds substan-
tially are affected by their bioavailabilities.[35] It has been shown that phenolic acids from
beer are assimilated and extensively metabolized in humans.[35] From the structural point
of view, phenolic compounds in beer belong to simple phenols; benzoic and cinnamic acid
derivatives; coumarins; catechins; di-, tri-, and oligomeric proanthocyanidins; prenylated
chalcones; and flavonoids as well as alpha- and iso-alpha acids.[15] Besides antioxidant
compounds, trace elements, such as zinc, copper, and selenium, also play an important
role in antioxidant protection in vivo. These elements are part of the active site of intercel-
lular antioxidant enzyme superoxide dismutase and glutathione peroxidase.[38] The most
important medicinal properties of beer are described in the following sections. The prin-
cipal medicinal values of beer after regular drinking in light-to-moderate amounts and
relevant selected publications are summarized in Table 2.
Anti-mutagenic and anti-carcinogenic effects. Cancer has been a serious
cause of human mortality.[47] It has been shown that the consumption of phenolic
compounds, as proper antioxidants, through beer or other phenolic-rich foods is asso-
ciated with the protection against oxidative-related diseases including various types of
cancers.[42] These compounds are able to block free radicals.[43] There are some reports
showing that beer may counteract the carcinogenesis.[48 –50] Investigations on the labora-
tory animals and humans indicated an increase in the plasma antioxidant activity after
the ingestion of beer.[51,52] Angiogenesis, the formation of new capillary blood vessels
for supplying oxygen and nutrients, play a key role in the development of malignant
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Tab l e 2 The principal medicinal values of beer after regular drinking in light-to-moderate amounts.
Medical impacts Main involved component(s) Some suggested mechanism(s) Sources
Anti-mutagenic and anti-carcinogenic
effects
Phenolics, Pseudouridine,
Spongouridine, Glycine betaine,
Melanoidins
-Antioxidant effect
-Modulation of carcinogens metabolism
-Anti-inflammatory effect
31, 32, 43, 47–50, 60, 62, 65, 66, 101
Dietary fibres -Facilitating intestinal excretion
Cardioprotective effect
Ethanol -Increasing serum HDL-C 10, 29, 49, 51, 52, 77, 80, 83, 87, 92, 93, 101, 103
-Stress alleviation
-Decrease of cholesterol and triglycerides
-Protection against oxidative stresses
Phenolics -Avoiding hyperhomocysteinemia
Folic acid -Immunomodulation
Different compounds -Sedative and hypnotic impacts
Hop-derived bittering agents -Stress alleviation
Immune system stimulation -Hypolipidemic effect
Proteins and amino acids
Anti-osteoporosis effect
-Stimulating non-specific immunity and
secretion of cytokines
87
Reducing risk of dementia, retardation
of aging
Different components
-Inhibiting bone resorption 43, 49, 50, 104
Phenolics
Reducing risk of dementia, retardation
of aging
Ethanol, Phenolics -Stress alleviation 31, 32, 35, 49, 60, 101, 109, 110
-Protection against oxidative stresses
-Antibacterial activity
Prevention of diabetes Phenolics -Bacterial intracellular modifications 31
Anti-microbial activity (gram positive
bacteria)
Isohumulones 113–116
Treating stomach ulcer Ethanol -Anti-infective effect on Helicobacter
pylori
131
(Continued)
355
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Tab l e 2 (Continued).
Medical impacts Main involved component(s) Some suggested mechanism(s) Sources
Radio-protective effect β-pseudouridine 120
Enhancing sociability, sexuality, and
tension reduction (relaxation)
Ethanol 135, 136
Mouthwash, enema, and vaginal
douche, and application on wounds
Ethanol, low pH/high acidity, other
components
12, 121
Appetite stimulation and promotion of
bowel movement in the elderly
Ethanol, low pH/high acidity 122
Better cognitive function at old ages Ethanol, probably phenolics 123, 124
Facilitating renal excretion of
aluminium
Salicylic acid 126
Estrogenic properties (treatment of
pre-menopausal problems (hot
flashes) as well as prevention of
osteoporosis in post-menopausal
women
Phenolics (especially prenylnaringenin) 43, 61
Anti-viral and anti-HIV activities Prenylated chalcone xanthohumol,
further hop constituents
- Inhibiting HIV-1 induced cytopathic
effects and HIV-1 replication in
peripheral blood mononuclear cells
134
356
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HEALTH-RELATED ASPECTS OF BEER 357
tumors.[53] The inhibition of angiogenesis by beer consumption prevents tumor growth and
metastasis.[54,55] It has been indicated that humulone (a bitter acid from beer), which was
isolated from hop extract, is a strong inhibitor of angiogenesis, in vivo and in vitro.[56,57]
There are several reports indicating that phenolic compounds in beer can inhibit the devel-
opment of prostate, breast, intestine, ovarian, and blood cancers.[58,59] Xanthohumol (a
principal prenylated flavonoid) and other hop prenylflavonoids have been found to be a can-
cer chemoprotective/chemopreventive agent. These components can inhibit the metabolic
activation of procarcinogens, induce carcinogen-detoxifying enzymes, and also prevent
tumor growth via inhibiting inflammatory signals of angiogenesis at early stages.[43,60]
However, it was concluded in a study that dietary intake of prenylflavonoids through
normal beer consumption would not be sufficient, unfortunately, to achieve plasma concen-
tration that could inhibit IQ (2-amino-3-methylimidazo[4,5-f]quinoline) activation in vivo.
IQ is a procarcinogen found in cooked meats, in the Ames Salmonella mutagenicity test,
and in an assay for binding of IQ metabolites to DNA at micro-molar concentrations.[61]
Xanthohumol, iso-xanthohumol, 8-prenylnaringenin, and other prenyflavonoids from hops
inhibited the cDNA-expressed human cytochrome P450 enzyme, Cyp1A1, Cyp1B1,
and Cyp1A2, but not Cyp2E1 and Cyp3A4 at micro-molar concentrations.[61] These
cytochrome P450s mediate the metabolic activation of many chemical carcinogens.[48]
Phenolics have shown a positive effect on phase 2 enzymes activity. Phase 2 enzymes
mediate the conjugation of carcinogens to endogenous ligands (such as glutathione, glu-
curonic acid, acetate, and sulfate) and, therefore, facilitate their excretion.[43] Several
phenolic compounds derived from hops have reportedly shown antimutagenic properties
against heterocyclic amines and similar carcinogenic compounds.[47 –49, 61] Ethanol alone
did not show any antimutagenic activity against these heterocyclic amines and such effect
has mainly been attributed to the pseudouridine and its analogs, such as spongouridine[47]
as well as glycine betaine (betaine glycine)[62] present in the beer rather than phenolics.
Kimuar et al.[62] and Arimoto-Kobayashi[63] reported that the mutagenic action of some
heterocyclic amines generated in cooked proteinaceous foods (such as meat and fish) could
be modified by the presence of glycine betaine in beer. Melanoidins (the polymeric and
coloured final products of the Maillard reaction), which are formed non-enzymatically dur-
ing the roasting of malt, indicate peroxyl radical scavenging potential.[64,65] Melanoidin
fractions with relatively high molecular weight (>200 kDa) also weakly induced NADPH-
cytochrome creductase and size-dependently modulated GST activities in the Caco-
2 colon cancer cell line.[66] The in-vivo action of melanoidins on the cancer requires further
investigation.
Beer has been shown to contain 0.4–6.2 g L1of dietary fibers.[67] The British
Nutrition Foundation recommended 18 g of dietary fiber per day as a desirable level for
adults.[12] Therefore, beer might be able to prevent colon cancer in individuals drinking
beer on a regular basis. Consumed beer does not support the growth/activity of harmful and
pathogenic intestinal microorganisms.[12] Stimulating the growth and/or activity of faecal
bacteria increases the risk of cancer because of converting pro-carcinogen compounds to
carcinogenic compounds.[68]
Reduction of cardiovascular disease (cardioprotective effect). Coronary
artery disease (CAD)/cardiovascular disease (CVD) are the main cause of mortality
in Western industrial countries[69] and are one of the most dangerous diseases of our
time.[70,71] The main reason for the high mortality from CAD is myocardial infarction
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358 SOHRABVANDI, MORTAZAVIAN, AND REZAEI
due to the thrombosis of coronary arteries.[72] The regular light-to-moderate consump-
tion of alcoholic beverages is associated with significant reductions in the mortality
related to coronary heart disease (CHD). This is known as the cardioprotective effect of
beer.[10, 29, 30,36,49 ,51 ,52 ,73 –87] Ethanol is able to increase high density lipoprotein (HDL)-
cholesterol plasma level, to decrease platelet aggregation, and to enhance blood fibrino-
genesis, all associated with a low risk of CHD.[88,89] The same results have been reported
for beer.[82,87] Vinson et al.[86] found that consumption of lager significantly decreased
cholesterol and triglycerides. Moderate consumption of beer has been reported to improve
lipid metabolism and to increase antioxidant and anticoagulant activity of the host resulting
in higher cardioprotective effects.[36,51,52] Beer may protect the organisms from oxidative
stresses and prevent atherosclerosis.[49,50] The antioxidant capacity of beer, as mentioned
before, is related to its polyphenolic compounds.[90,91] These compounds block free radi-
cals, which are potent oxidizing agents of fats in the body. The lowest risk of myocardial
infection was observed among men who drank beer almost on a daily basis (4–9 L a
week).[82] According to recent large population-based studies, moderate drinking of beer
in the range of 1–3 daily drinks is associated with a 30–40% decrease in the coronary dis-
eases compared to not drinking it at all.[29] Hypolipidemic effect of beer is also associated
with a decrease in the risk of cardiovascular diseases. Several studies on laboratory ani-
mals and human subjects have shown that the level of plasma lipids decreases after the
ingestion of beer.[51, 52, 92, 93] It has been reported that the beer proteins and amino acids
might have much wider biological functions than their basic biosynthetic roles as building
blocks of the human body.[51] Controlling plasma cholesterol and reducing lipid level in
the blood are among those functions. In other words, proteins and essential amino acids are
bio-active components of beer.[51,52] Gorinstein et al.[94] found that beer with high protein
and essential amino acid concentrations effectively reduced total cholesterol and LDL-
cholesterols in rats. However, it did not affect total radical-trapping antioxidative potential.
It has been reported that the contents of total proteins, albumin, and most studied amino
acids in beer were significantly higher than those in wine.[95] In some sources, the improved
lipid metabolism induced by moderate beer consumption has mainly been attributed to its
polyphenolic compounds.[51,93,96,97] According to Gasowski et al.,[98] to receive the best
results in terms of plasma lipid improvement, beer with the highest antioxidant potential
must be consumed. The immune activation property of beer (discussed in the next sec-
tion) is also deeply involved in atherogenesis.[99] Ingestion of folic acid from beer leads
to a decrease in the homocysteine content of the blood.[100 ] Hyperhomocysteinemia is a
significant risk factor for vascular diseases.[12]
The fact that moderate consumption of alcohol leads to stress alleviation may also
take part in reducing heart problems.[101 ] Morrell[102 ] suggested that beneficial effects of
alcohol consumption are consequences of drinking impacts on relaxation. Beer may be
particularly valuable as compared to other alcoholic beverages, as the hop-derived bittering
agents are said to have sedative and hypnotic impacts.[101 ]
Immune system stimulation (immunomodulation). It was observed that
beer stimulated non-specific immunity in rats.[103 ] It appears reasonable that ingredients of
beer could play some roles in modulating immune system functions, e.g., influencing the
production and secretion of cytokines.[87] More studies are needed to find out other aspects
of immunomodulation associated with each component of beer, i.e., bioactive proteins,
phenolics, and alcohol.
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HEALTH-RELATED ASPECTS OF BEER 359
Anti-osteoporosis effect. Beer may counteract osteoporosis.[49,50] It has been
found that humulone (the bitter acid from beer) isolated from beer hop extract strongly
inhibits bone resorption.[104 ] Stevens and Page[43] reported that beer flavonoids have an
inhibitory effect on osteoporosis. Beer is a good source of silicon, which can reduce the
risk of osteoporosis.[17 ,105 ]
Reducing risk of dementia. Due to the enormous burden on our health care
system, dementia is becoming one of the major challenges of the current century in our
societies.[106 ] For instance, Alzheimer’s disease causes more than 360,000 new cases in
the United States annually, with a national annual cost of caring for such patients more
than US$50 billion.[107 ,108 ] Light-to-moderate alcohol consumption has been recognized
to be associated with a reduced risk of dementia in individuals aged 55 or older.[109] It
has been pointed out that the consumption of 1–6 drinks per week was correlated with a
lower risk of dementia incidents among older adults when compared with abstention.[110]
By doing a 2-yr follow-up study of alcohol consumption, Deng et al.[111 ] found that light-
to-moderate drinking was associated with a significantly lower risk of dementia compared
with no drinking at all. Phenolic acids of beer with relatively high antioxidant capacity
may afford protection against oxidative-stress-related diseases including neurodegenera-
tive diseases.[35] Moderate consumption of beer reduces the odds of age-induced macular
degeneration,[112 ] which is an eye disease related to the lack of certain antioxidants, such
as luetin, in the diet.
Other health-related benefits of beer. Epidemiological studies have suggested
a close relation between the consumption of phenolics from phenolic-rich foods and the
prevention of diabetes and aging.[35] Iso-humulones from hops have indicated certain
levels of antibacterial activity on most gram-positive bacteria.[113 –116] However, their pos-
itive role in the human body is still questionable. Lactic acid bacteria (gram-positive) are
the most abundant microbial contaminants in beer.[117, 118] Thus, further investigations
are required about the impact of these components on the pathogenic microorganisms
regarding gastrointestinal infections in vivo. Drinking beer reduces radiation-induced chro-
mosome aberration in human lymphocytes too.[119 ] β-Pseudouridine separated from beer
was found to be a potent protector against the damage caused by radiation.[120 ] Beer has
also been reported for such applications as mouthwash, enema, and vaginal douche.[12,121]
However, regular consumption of beer can prevent vitamin deficiency diseases, such as
beriberi, and other neurological diseases.[12] Low doses of alcohol, including that of beer,
have been reported to stimulate appetite and facilitate bowel movement in the elderly.[122]
There is evidence that moderate alcohol consumption may be associated with better
cognitive function at old age.[123, 124] Beer drinking, as well as a low fat or weight reduc-
tion diet, relates to substantial reduction in the risk of urolithiasis.[125 ] Silicic acid from
beer can promote the renal excretion of aluminum.[126 ] There are several reports that
some extracted phenolic compounds from hops (especially 8-prenylnaringenin) exhibit
estrogenic properties.[15 ,43 ,127 –129] Therefore, drinking 8-geranylnaringenin-rich beverages
may have positive influence on the treatment of pre-menopausal problems (hot flashes)
as well as prevention of osteoporosis in post-menopausal women[43]. On the contrary,
it has been implied that xanthohumol shows anti-estrogenic properties[60]. This charac-
teristic effect might be beneficial because of the competitive receptor-binding between
xanthohumol and mutagenic hormones such as 17β-estradiol. These hormones are con-
sidered as endogenous tumor promoters stimulating cell growth via interaction with
estrogen receptors leading to an increase in the risk of breast and uterine cancers[130].
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360 SOHRABVANDI, MORTAZAVIAN, AND REZAEI
Further investigations are required to clarify the overall impact of beer (in-vivo) con-
taining mixed estrogen/anti-estrogen activities. It has been reported that alcohol protects
against infection by Helicobacter pylori, which is known as a key factor in producing
stomach ulcer[131,132]. Prenylated chalcone xanthohumol (XN) and other hop constituents
possess antiviral activities against a series of DNA and RNA viruses.[133] XN inhibited
HIV-1-induced cytopathic effects (i.e., the production of viral p24 antigen and reverse
transcriptase in C8166 lymphocytes) with EC50 values of 2.3, 3.6, and 1.4 µM, respec-
tively. XN also inhibited HIV-1 replication in peripheral blood mononuclear cells with
an EC50 value of 58.5 µM.[134] Wall et al.[135 ] found that college students endorsed
greater “positive” alcohol outcome expectancies, including enhanced sociability, sexuality,
tension reduction, and liquid courage in an on-campus bar as compared to a labora-
tory setting. By surveying female college students, MacLatchy-Gaudet and Stewart[136 ]
found a positive correlation between the five positive alcohol outcome expectancies
(arousal, social/sexual enhancement, personality transformation, global positive effect,
and relaxation) in three specific contexts (social, sexual, and tension) and moderate alco-
hol consumption. It has been reported that beer contains some fibers with prebiotic
potential.[17]
SPECIAL TYPES OF BEER
Production of novel-type beers (produced from grain with different manufacturing
practices compared with normal beer) and beer-like beverages (produced basically from
non-grain materials) have recently been developed. Low-alcohol and non-alcoholic beers,
beer with high amounts of dietary plant proteins, low-calorie beers, gluten-free beers,
beers containing savoury agents (such as fruits), and beers containing functional agents
are among novel-type beers. Some of these kinds of beers may exhibit additional health
advantages over the regular beers. However, these effects are rather complicated. For
example, although it is somewhat reasonable to assume that non-alcoholic beers should
possess all of the health-beneficial effects of normal beers (except for those related to
the alcohol), the synergistic or probably antagonistic impacts of ethanol on the health
potency of some medicinal components should also be considered. It is of course accept-
able that low-alcohol and non-alcoholic beers do not display possible harmful impacts
of beers containing higher alcohol levels, i.e., those issues related to the alcohol part of
the beer. Dietary plant proteins (especially soy) play a positive role in controlling plasma
cholesterol.[137 ] Opaque sorghum beers with low alcohol content (2–3 mL 100 mL1)
are popular alcoholic beverages in Africa. Their low alcohol content makes them suit-
able beverages for adults and teenagers.[132, 138] This beer can improve the macronutrient
supply of the diet and the bioavailability of such micronutrients as iron and zinc.[138, 139]
Sorghum contains various phenolic and antioxidant compounds with health-promotional
effects.[26]
POSSIBLE HARMFUL EFFECTS OF BEER
Although the light-to-moderate consumption of beer comprises different health ben-
efits, an excessive consumption might also lead to health disadvantages due to the excessive
intake of such compounds as ethanol and allergens. These aspects are discussed further in
the following sections and are summarized in Table 3.
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Tab l e 3 The principal health disadvantages of beer after indiscriminate drinking.
Medical impacts Main involved component(s) Some suggested mechanism(s) Sources
Vitamin shortage Ethanol 19
Allergy induction Biogenic amines generated by lactic
acid bacteria contaminants(ethanol
exhibits potentiating effect on
biogenic amines function)
117, 118, 149, 153, 154–157, 158–162
Hyperuridemia Ethanol -Inhibiting urinary excretion of uric
acid, increase in plasma concentration
of oxypurines
163–168
Mutagenicity and cancer inductio Ethanol, toxic amines (nitrosamines) 50, 176, 177.
Increasing risk of dementia Ethanol, aluminium in canned beer 179, 180
Obesity Ethanol 37
Adverse effects on digestive system:
stimulating increase of hepatitis, fatty
degradation of liver, cirrhosis,
pancreatitis and peptic ulcers
Ethanol 12, 50, 169–172
Negative effects in pregnant women
expert athletes as well as hepatic and
medicated people
Ethanol 184–186
Increasing blood pressure Ethanol 187–189
Harmful effects on teeth Residual sugar, low pH and high acidity 190
Adversely modifying the hormonal
status in men
Isoflavanoids 58
Domestic and social violence, traffic
accidents, inappropriate work events,
falls, and drawing as well as physical
and sexual abuse of children and
women
Ethanol 12
361
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362 SOHRABVANDI, MORTAZAVIAN, AND REZAEI
Allergy Induction
Several cases of contact urticaria induced by beer have been described since
1980.[140 ,141 ] Moreover, ingestion of beer has been related to the cases of severe IgE-
mediated anaphylaxis.[142 ,143 ] Also, hypertensive crises have been reported after beer con-
sumption in patients treated with drugs inhibiting the detoxification enzyme monoamine
oxidase.[144 –148] The adverse effects were found both in tap and non-alcoholic beers
caused by tyramine.[149 ] Beer was observed to be a cause of headache in migraine-
susceptible consumers.[150 ] Garcia-Casado et al.[151 ] isolated two allergens associated with
contact urticaria and severe IgE-mediated anaphylaxis from beer, namely, barely protein
Z4(45 Kd) and lipid transfer protein 1 (LTP1; 9 Kd).
One problem with the beer is that due to the abundance of free precursor amino
acids the presence of contaminant microorganisms having decarboxylating activities dur-
ing the fermentation and storage of beer leads to the formation of biogenic amines,
such as tyramine, putrescine, cadaverine, and histamine.[117, 152–157 ] The contaminant
microorganisms are usually lactic acid bacteria (i.e., Lactobacillus and Pediococcus
spp.).[117 ,118 ,157 ,158] Both tyramine and histamine can be formed in bottled beers by lactic
acid bacteria, mainly lactobacilli, surviving insufficient pasteurization.[149] Amine levels
can be used as an indicator of poor microbial quality of the brewing procedure.[149, 155]
Brewer’s yeast is unable to form biogenic amines.[117, 157] Some amines (such as tyramine
and agmatine) can also be formed during mashing and wort boiling due to thermal
decarboxylation.[158 ] Malt is a source of agmatine, putriscine, spermidine, and sper-
mine, while tyramine, histamine, and cadaverine have been formed during the main
fermentation by the contaminating lactic acid bacteria.[149 ] Low to moderate amounts
of biogenic amines (about 50 mg/kg food) can be ingested without any side effects
on the consumer health. Detoxifying enzymes can alter them before they can be harm-
ful. However, upon a higher intake, some cases of food poisoning could occur with
such symptoms as headaches, respiratory distress, heart palpitation, hypertension or
hypotension, facial flushing, itching, swelling, diarrhea, vomiting, migraine headache,
and several allergy-related disorders.[156, 159–162 ] For instance, tyramine intakes exceed-
ing6mgwithina4hperiodfrombeers containing over 10 mg tyramine per liter would
be dangerous for consumers.[148 ] It is important to point out that alcohol, and probably
some biogenic amines other than tyramine, present in beer can also potentiate tyramine
effects.[149]
Increase in the Plasma Concentration of Uric Acid
Beer, as well as other alcoholic beverages, may increase the plasma concentrations
of uric acid, oxypurines, and uridine, and their ingestion occasionally induces gouty arthri-
tis in patients with gout.[163 –165] Several mechanisms involved in such ethanol-induced
issues have been reported: (1) increase of lactic acid level in the blood as a result of
ethanol intake inhibits the urinary excretion of uric acid; (2) adenosine triphosphate
(ATP) consumption and purine degradation induced by ethanol ingestion accelerates uric
acid production; and (3) the plasma concentration of oxypurines (hypoxanthine and xan-
thine) is increased due to the enhanced ATP consumption and slightly inhibit xanthine
dehydrogenate activity derived from ethanol metabolism.[163–166 ] Yamamoto et al.[166 ]
reported that beer increased the concentration of uric acid in serum carrying significant
amounts of purine (e.g., guanosine, hypoxanthine, xanthine, and guanine) compared to
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HEALTH-RELATED ASPECTS OF BEER 363
other alcoholic beverages. Beer consumption resulted in a greater increase in the concen-
tration of uric acid in the plasma than did the other alcoholic beverages. On the contrary,
there are a few reports indicating that organic acids present in the beer might decrease
the uric acid level in the plasma.[167, 168] Overall, due to the lack of sufficient informa-
tion on this area, more studies need to be undertaken to reconfirm some of the findings
mentioned here.
Mutation and Cancer Induction
There are enough evidences showing that excessive consumption of alcohol increases
the risk of mouth, pharynx, larynx, esophagus, liver, colon, and breast cancers.[12 ,169 –172]
These effects are merely related to the daily intake of alcohol. In the case of beer,
there are a few studies suggesting that the intake of beer increases the risk of cer-
tain cancers, not because of alcohol, mainly due to the toxic amines present in the
beer.[173–175 ] Some amines at relatively high concentrations can react with nitrate-forming
nitrosamines, many of which are known to be carcinogenic, mutagenic, teratogenic, and
embriopatic.[154 ,156 ,176 ,177] For individuals consuming red meat more than twice a day and
for those having a white-collar job, excessive intake of beer is associated with an increased
risk of colon cancer.[173] There is a theory that nitrosamines are produced through the malt-
ing process by drying with hot air heated by direct firing techniques. However, some recent
studies have reported that the level of nitrosamines in the beer are very low imposing no
risk to the consumers, especially due to the fact that nowadays maltsters have altered the
process to indirect firing techniques.[15]
Increasing Risk of Dementia
While light-to-moderate alcohol intake can reduce the odds of dementia, exces-
sive alcohol consumption is associated with an increased risk of dementia and
depression.[111 ,178 ] Cerebral, cerebellar, brain stem degeneration, optic atrophy, polyneu-
ropathy and pellagra are from nerves system disorder symptoms arising from excessive
consumption of alcohol.[12] The acidic nature of beer increases the metal migration (includ-
ing aluminum) from the containers in canned beers, in which aluminum together with tin,
steel, or steel foil have a protective effect on the quality of beer. Aluminum (at 10 mg L1)
was found in the canned beer without any adverse impact on the flavor, color, or the clarity
of it. If the aluminum alloy of high quality is not used during the production of the contain-
ers, migration of aluminum to the product will accelerate.[179 ] There is a possible direct
relation between high aluminum content in the tissues and neurodegenerative disorders
(such as Alzheimer’s disease) or other encephalopathies or in some cases osteomalacia is
present.[180 ,181 ]
Enhancing Obesity
Excessive intake of energy as alcohol may predispose consumers to obesity, espe-
cially in susceptible individuals. Consumers taking high-alcoholic (strong) beers are more
prone to obesity than those consuming light beers.[37]
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364 SOHRABVANDI, MORTAZAVIAN, AND REZAEI
Other Health Threatening Effects of Beer
It has been reported that high consumption of alcoholic beverages can have a neg-
ative influence on the digestive system and incidence of hepatitis, fatty degradation of
liver, cirrhosis, pancreatitis, and peptic ulcers.[12] A negative effect of beer on the pro-
tein metabolism in the body has also been proven.[182,183] Drinking alcoholic beverages is
not recommended for pregnant women and expert athletes as well as hepatic and medi-
cated individuals.[184–186] There are a few reports showing that consumption of alcoholic
beverages increases blood pressure.[187, 188] This is contrary to the results of Jastrzebski
et al.,[189 ] who reported that beer consumption had no adverse effects on blood pressure
in rats. Therefore, complementary investigations are required to further clarify the matter.
This point should be taken into special consideration as statistical data show that CHD
patients are often suffering also from high blood pressure.[188 ] High consumption of beer
might have harmful effects on teeth due to its significant levels of residual sugar as well as
its low pH (especially at pH <4.0).[190] Lapcik et al.[58] demonstrated that isoflavanoids
(phytoestrogens) from beer may adversely modify the hormonal status of men.
CONCLUSIONS
Beer is one of the most commonly consumed alcoholic beverages with beneficial
effects on human health. This is mainly true when “medium-strength beer” is ingested in
a moderate level (light-to-medium consumption). Health advantages of beer (nutritional
and medicinal) are associated with the presence of components, such as antioxidants, cer-
tain minerals, certain vitamins, fiber, as well as relatively low levels of ethanol. Health
disadvantages of beer are mainly attributed to the excessive intake of alcohol and to a
lesser extent to the ingestion of some poisonous and allergen agents. Non-alcoholic beers
could possess certain health benefits associated with the components other than the alco-
hol. On the other hand, consumption of low-alcohol and non-alcoholic beers can avoid
possible health threatening issues related to excessive alcohol intake.
ACKNOWLEDGMENT
This article is related to the Ph.D. student thesis (Shahid Beheshti University of Medical
Sciences).
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... The research topics address the improvement of several characteristics, such as foam formation stability [5], beer aging [6], and research and development of non-traditional beers [7,8]. Among non-traditional beers, functional beers stand out, as they seek to combine moderate consumption of the drink with health benefits [9]. This perspective aligns with the new market trend of functional beverages that attract consumers based on their perception of disease prevention through a functional diet [10]. ...
... The moderate consumption of beer is already of health interest as the beverage is rich in amino acids, minerals, vitamins, and phenolic compounds [9]. Furthermore, the insertion of non-amylaceous adjuncts to beer seeks to provide the release of bioactive molecules, such as those with antioxidant and nutraceutical capacities, besides contributing to the final sensory profile of the product [11]. ...
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Beer is one of the oldest and most consumed beverages worldwide, and recent trends point to increased consumption of functional beers. However, there is a lack in the scientific literature on the effects of adding functional adjuncts in distinct steps of the manufacturing process and its implications on the final physicochemical and sensorial profile. Therefore, the present review analyzes the ingredients used and their insertion stage to achieve a functional beer with bioactive compounds, higher antioxidant activity, and improved sensory characteristics. The addition of fruits, herbal extracts, plants, and mushrooms in beers was documented. Furthermore, adjuncts were successfully added in wort boiling, fermentation, maturation, and packaging. The wort boiling step stands out among these four due to the superior extraction of phenolic compounds from the added adjuncts. On the other hand, adjunct addition in the maturation step induced low increases in antioxidant and phenolic content of the respective enriched beers. Fruits represented the majority of adopted adjuncts among the studies evaluated. Furthermore, the addition of fruits represented a positive increment in the beer’s volatile profile and an increase in sensory acceptability. A gap in the literature was found regarding the analysis of phenolic compounds with appropriate techniques such as HPLC-MS. Furthermore, there is a need to study the bioavailability of the incorporated bioactive compounds to prove the health claims inferred about these beers. In conclusion, functional beers are a little-explored relevant field, with potential for new studies.
... These results are promising, but it must be stressed related research is still at an early stage [59]. A non-alcoholic beer component, β-pseudouridine, was found to be a potent protector against the damage caused by radiation (radioprotective effect) [60,61]. Potential properties of beers' nonalcoholic fractions are presented in Figure 5. Finally, we wanted to understand how taste preferences can shape the desire for special beer consumption. ...
... Potential properties of beer's nonalcoholic fractions[13,[51][52][53][54][55][56][57][58][59][60][61]. ...
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The transition from adolescence to adulthood can be a challenging period for many students. This period is associated with an increase in alcohol consumption (AC) which can develop a drinking behavior or shape the preferences for certain alcoholic beverages. The purpose of this study was to analyze the AC pattern among Romanian university students, by investigating the association between taste and consumption, including preferences for special beer. A 30-item omnibus-type questionnaire was distributed to undergraduate students and used to gather sociodemographic data, alcohol expectancies, drinking motives and consequences, and special beer consumption. Results showed a statistically significant relationship between the age of first alcohol use and the existence of an alcoholic family member. The main reasons for AC are taste, sensation, relaxation, and socialization. Both female and male students tend to drink occasionally, with a preference for public places. Female students prefer a sweet taste, choosing special beers over the regular ones. The students’ residence may also influence the choice of special beers. Understanding the students’ drinking behavior and taste preferences is essential to create useful strategies to discourage excessive AC. Special beer, a growing segment in the beverage industry, could represent a healthier and safety alternative to AC
... These results are promising, but it must be stressed related research is still at an early stage [59]. A non-alcoholic beer component, β-pseudouridine, was found to be a potent protector against the damage caused by radiation (radioprotective effect) [60,61]. Potential properties of beers' nonalcoholic fractions are presented in Figure 5. Finally, we wanted to understand how taste preferences can shape the desire for special beer consumption. ...
... Potential properties of beer's nonalcoholic fractions[13,[51][52][53][54][55][56][57][58][59][60][61]. ...
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The transition from adolescence to adulthood can be a challenging period for many students. This period is associated with an increase in alcohol consumption (AC) which can develop a drinking behavior or shape the preferences for certain alcoholic beverages. The purpose of this study was to analyze the AC pattern among Romanian university students, by investigating the association between taste and consumption, including preferences for special beer. A 30-item omnibus-type questionnaire was distributed to undergraduate students and used to gather sociodemographic data, alcohol expectancies, drinking motives and consequences, and special beer consumption. Results showed a statistically significant relationship between the age of first alcohol use and the existence of an alcoholic family member. The main reasons for AC are taste, sensation, relaxation, and socialization. Both female and male students tend to drink occasionally, with a preference for public places. Female students prefer a sweet taste, choosing special beers over the regular ones. The students’ residence may also influence the choice of special beers. Understanding the students’ drinking behavior and taste preferences is essential to create useful strategies to discourage excessive AC. Special beer, a growing segment in the beverage industry, could represent a healthier and safety alternative to AC.
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Six biogeneic amines have been tested in 42 samples of wort and beer, representing 7 different types of beer of two Italian breweries. Histamine and tryptamine were never found, putrescine and cadaverine, which were always present, ranged between 0.2 and 0.7 ppm and 2.2 and 5.6 ppm respectively. β-phenylethyl-amine, which was present only in red and dark worts and beers, did not exceed 1 ppm. Tyramine exhibited a different trend in the two breweries reaching over 30 ppm in one and about 3 ppm in the other. As the increase takes place during fermentation, it is possible to ascribe this phenomenon to the presence of active decarboxylating strains of contaminant bacteria in the yeast.