Timothy had always been health-conscious. After years of social drinking, she decided to quit alcohol for good. But giving up the ritual of sipping on a drink at social gatherings felt impossible. That's when alcohol-free beer and wine seemed like the perfect alternative—offering the taste and experience without the intoxication. However, what Sarah didn't realize was that these supposedly "harmless" drinks might still be affecting her liver in ways she hadn't anticipated.

With a global shift toward healthier choices, the rise of alcohol-free beverages has been fuelled. Do these drinks, however, live up to their promise of being risk-free? New research shows that while they may eliminate the dangers of intoxication, they still pose metabolic and liver-related risks, which calls for moderation in the long run.

What Happens in your Body within 10 Minutes of Drinking Alcohol-Free Beverages?

The first time you take a sip of an alcohol-free beverage, your body responds almost instantly. Anshul Singh, Lead Clinical Nutritionist and Dietetics Department says, "In as little as 10 minutes, your taste buds have picked up on the flavors, and your brain might even get a placebo effect, giving you the sensation that you're about to be drunk. Some alcohol-free drinks have up to 0.5% ABV, which goes into the bloodstream in minute quantities but will probably not affect you in any significant way."

By the 30-minute mark, your body has metabolized the sugars, artificial sweeteners, or additives in the drink. "Some people may experience a mild insulin spike, which can cause temporary energy boosts. Some non-alcoholic drinks also contain fermentation byproducts or botanical extracts that mimic the sedative effects of alcohol, causing slight drowsiness or relaxation," adds Anshul.

After 60 minutes, most of the drink has been metabolized. Although there is no risk of intoxication, repeated consumption can subtly affect metabolism, gut health, and even trigger cravings for alcohol among those in recovery. Those sensitive to sugar, caffeine, or preservatives might experience even more pronounced effects over time.

How Alcohol-Free Drinks Affect Your Gut and Liver Connection

Your liver and gut health are connected, forming what is called the gut-liver axis. Anshul emphasises, "Even though drinks without alcohol seem harmless, they usually contain sugars, artificial sweeteners, and fermentation byproducts that can disturb this delicate balance."

• High sugar content may lead to insulin resistance, inflammation, and fat accumulation in the liver.
• Artificial sweeteners may change the gut microbiota, causing metabolic imbalances.
• Preservatives and artificial flavors can also enhance gut permeability, thus potentially leading to leaky gut syndrome.

Long-term consumption of these drinks may gradually affect digestion, liver detoxification, and overall metabolic health, making moderation necessary.

Do Alcohol-Free Drinks Still Trigger Liver Enzymes?

Even though these nonalcoholic beverages contain virtually insignificant alcohol, the liver processes them as well. "These small concentrations of alcohol-which may go as high as 0.5% ABV-trigger the liver's detoxification pathways but only at much weaker intensities compared to ordinary alcoholic drinks. But the added sugars, artificial sweeteners, and preservatives in the products could pose significant pressure on liver functions over the long term," explains Anshul.

High sugar intake causes insulin resistance, which can lead to the buildup of fat in the liver and increase the risk of developing NAFLD. Some fermentation byproducts in these beverages also trigger oxidative stress, which puts extra pressure on the liver. Though occasional consumption will not pose a significant threat, regular consumption might lead to chronic liver stress and metabolic imbalance.

Do Non-Alcoholic Beverages Affect Liver Detoxification?

Although trace amounts of alcohol exist in alcohol-free beer and wine, the body will still have to metabolize them. The body employs the same enzymatic pathways used for alcoholic beverages but at a much lower intensity. However, the added sugars, preservatives, and fermentation byproducts present their own set of challenges:

• Mild inflammation to the liver due to the additives and byproducts within the drinks.
• Insulin resistance resulting from excessive sugar intake, causing fat accumulation in the liver.
• Detoxification pathways are overburdened, and impairment of liver function occurs gradually.

Alcohol-free drinks do not cause the liver to become overwhelmed as traditional alcohol does, although it does have a lower, but still important, risk for someone who is drinking too much. For someone with a problem of liver disease or metabolic syndrome, limiting alcohol-free drinks is also important.

Should You Drink Alcohol-Free Beverages?

Alcoholic beverages have always been a dangerous drink, but the safer option for those who want to avoid intoxication. However, it is not totally risk-free. Its impact on metabolism, gut health, and liver function cannot be ignored. Although they are not harmful at first, their consumption over a long period leads to insulin resistance, liver stress, and imbalance in the gut.

For the consumers who love these drinks, moderation is the way forward. The expert shares, "The choice of brands with the least additives, lower sugar, and natural ingredients will reduce risks. In addition, supplementing with a diet that is rich in antioxidants, fiber, and hydration can complement the liver in general."

For most, thought that adopting alcohol-free beverages was a healthier decision. On discovering their side effects on liver health, though, she learned to limit its intake and settle for alternatives that included infused sparkling water, herbal teas, or even kombucha with controlled sugar levels.

The bottom line? Alcohol-free doesn't mean consequence-free. The best way to achieve long-term health is by paying attention to what goes into the body and yet still enjoy social rituals of preference.

Anshul Singh is the Team Lead with the Clinical Nutrition and Dietetics Department at Artemis Hospitals in India.

Knee replacement surgery has witnessed remarkable advancements over the past few years. Traditionally, total knee replacement was performed as a uniform procedure ("one procedure fits all"), where the entire knee joint was replaced regardless of the extent or location of damage.

However, with the evolution of modern orthopedics, the focus has shifted towards precision and personalized treatment. In this direction, an A La Carte or Modular approach towards patients who need knee Replacement has emerged, which customizes or personalizes the surgery according to the patient’s specific condition.

Understanding The “à la carte” Concept

The term “à la carte” refers to selecting individual items from a menu. In knee replacement surgery, it means replacing only the damaged portion of the joint instead of the entire knee.

The knee is anatomically divided into three compartments:

• Medial compartment (inner side)
• Lateral compartment (outer side)
• Patellofemoral compartment (front portion involving the kneecap)

In many patients suffering from osteoarthritis, the disease affects only one or two of these compartments—most commonly the medial compartment. In such cases, replacing the entire knee may not be necessary. Modular implants allow surgeons to selectively treat the affected area while preserving healthy bone and ligaments.

The à la carte technique helps preserve the natural structure of the knee while effectively treating only the damaged portion, resulting in better and more natural functional outcomes for patients.

However, this approach is not suitable for all patients. It is generally not recommended in inflammatory conditions such as rheumatoid arthritis.

How It Differs From Total Knee Replacement

In Total Knee Replacement (TKR), all three compartments of the knee are replaced, making it an effective solution for advanced and widespread arthritis.

In contrast, Modular Knee Replacement offers a more targeted approach:

• Replacement of a single compartment (Partial Knee Replacement)
• Replacement of two compartments (e.g., medial + patellofemoral)

This selective treatment helps maintain the knee’s natural structure and function.

Advantages Of The Modular Approach

For carefully selected patients, this technique offers several important benefits:

• More natural knee function: Preservation of ligaments and bone provides a more natural feel.
• Faster recovery: Less invasive surgery leads to quicker rehabilitation.
• Reduced pain and blood loss: Minimal surgical trauma results in less discomfort.
• Improved mobility: Patients often achieve a better range of motion.
• Enhanced lifestyle comfort: Activities like sitting cross-legged or squatting may be easier and can be done unrestricted compared to total knee replacement.

Who Is the Ideal Candidate?

Not every patient is suitable for this procedure. Proper patient selection is one of the most critical factors in ensuring the success of this procedure. Ideal candidates typically include people:

• Having arthritis limited to one or two compartments
• Having stable knee ligaments
• Who do not have a severe deformity in the knee

Long-Term Outcomes

When performed in the right patient, modular knee replacement delivers excellent long-term outcomes (90 to 95 per cent survivorship for 15 years). Its success largely depends on accurate patient selection and flawless surgical expertise.

In some cases, if arthritis progresses in the remaining compartments over time, conversion to total knee replacement can still be done. However, this is relatively uncommon when proper indications are followed.

Role Of Robotic Technology

Robotic-assisted surgery has further enhanced the precision of this technique. It enables:

• Millimeter-level accuracy
• Precise implant positioning
• Restoration of patient-specific knee alignment

Conclusion

Ala Carte or Modular Knee Replacement represents a significant shift toward personalized orthopaedic care. Instead of a "one-size-fits-all " approach, surgeons can now tailor treatment based on the patient’s anatomy and disease pattern.

For many patients, this means less invasive surgery, faster recovery, improved function, and a more natural-feeling knee. Individuals experiencing persistent knee pain are advised to consult an orthopaedic specialist early to determine the most appropriate treatment option.

Beyond lung cancers, air pollution fine particulate matter (PM2.5) is increasing mortality for breast as well as liver cancers, according to a global study led by the Union for International Cancer Control (UICC), including researchers from the Indian Council of Medical Research (ICMR).

The important study showed that long-term exposure to PM2.5 increases the overall risk of developing cancer and the chances of dying from it compared with those living in cleaner environments.

For every 10 micrograms per cubic meter (µg/m³) increase in PM2.5 exposure, the overall risk of cancers increases by more than 11 per cent. At the same time, the risk of death also increases by more than 12 per cent for every 10 µg/m³ increase in PM2.5 exposure.

The researchers argued that while other common risk factors like tobacco and alcohol are being targeted with notable progress, air pollution is silently eroding the gains being made.

“We have made huge strides in reducing deaths from cancer, but polluted air is silently undermining that progress. It is a risk people cannot opt out of, and one that disproportionately affects women, children, and people living in poverty,” Cary Adams, CEO, UICC.

“The cancer community continues to make progress in addressing other major risk factors, including tobacco use, alcohol consumption, and viral, bacterial, or parasitic infections such as HPV and HBV that cause cervical and liver cancers. It is increasingly clear that air pollution must also be recognized as a major and preventable factor that increases the risk of developing cancer and of dying from the disease,” added Dr Elisabete Weiderpass, Director, IARC.

Risks of PM2.5: Beyond Lung Cancer

The study, based on data from 42 meta-analyses and systematic reviews published between 2019 and 2024, showed significantly strong associations for liver, colorectal, and breast cancers.

As per recent data from the International Agency for Research on Cancer (IARC), PM₂.₅ exposure contributes to 434,000 lung cancers per year, accounting for more than a quarter of preventable lung cancers in women and nearly one in six in men.

In addition to lung cancer risk, the study noted that the rising levels of PM2.5 are associated with

• a 32 per cent higher incidence of liver cancer
• an 18 per cent increase in the odds of developing colorectal cancer.

• a 12 per cent higher overall risk of dying from cancer,
• a 20 per cent higher risk of death from breast cancer,
• a 14 per cent from liver cancer,
• a 12 per cent from lung cancer.

Who Is At A Higher Risk

According to the researchers, people living in low- and middle-income countries bear the greatest overall burden. These countries frequently lack the resources to reduce pollution at source or to provide timely access to cancer prevention, diagnosis, and treatment.

The challenge is compounded by the projected rise in global cancer cases, expected to increase from 20 million in 2022 to 35 million by 2050. People at risk include:

• Women and children, particularly in settings where solid fuels are used for cooking and heating.
• Women exposed to household air pollution face a 69 per cent higher risk of lung cancer, alongside increased risks of cervical cancer.
• Outdoor workers and communities living near industrial facilities are also at heightened risk, with exposure often concentrated in economically deprived areas.

What Actions Are Required?

The researchers underscored that the evidence presented in the report is already sufficient to justify decisive action to reduce exposure to polluted air. They called upon policymakers to make required changes across energy, transport, industry, and urban planning to reduce the risk of cancer from air pollution.

The study urged the need for properly implementing effective interventions that are well-established. These include:

• Stronger emissions standards and enforcing the WHO air quality Standards
• A transition to clean energy and clean cooking
• Improved urban design by investing more in green infrastructure
• Expanded air-quality monitoring in High-Risk Areas
• Update cancer control plans.

During the summer, it is important to stay hydrated, but for kidney patients, excessive intake of fluids is just as dangerous as not drinking enough. Most people are encouraged to drink extra fluids during hot weather; however, patients with chronic kidney disease (CKD) and those on dialysis must exercise greater control over their daily hydration and fluid intake because their bodies cannot effectively excrete excess fluids, leading to potential complications.

What is overhydration?

Dr Anupam Roy, Additional Director – Nephrology and Kidney Transplant at Aakash Healthcare Multi-Specialty Hospital, Dwarka, said, “Overhydration occurs when the body retains more fluid than it is able to eliminate. For kidney patients, overhydration typically leads to fluid overload as a result of excessive fluid accumulation in the body. Early signs of fluid overload may include swelling in the feet, ankles, and/or face. If not treated, fluid may continue to build up and cause the lungs to fill with fluid, resulting in shortness of breath and difficulty lying down. If left untreated, gaseous exchange in the lungs will be impaired, and the patient will require immediate medical treatment for pulmonary oedema (a life-threatening complication).”

What happens when you are overhydrated?

The effect of excess fluid on the heart and blood pressure is considered a significant concern. Excess fluid results in additional strain on the cardiovascular system, leading to high blood pressure. This extra workload may also increase the risk of serious complications (e.g., heart failure) for individuals who already have hypertension or heart disease. Dialysis patients are at particular risk of developing complications since they rely on regularly scheduled treatments to remove excess fluid. Excessive fluid consumption between dialysis sessions may complicate and increase the discomfort associated with removing excess fluid during dialysis.

How does overhydration affect kidney disease patients?

Overhydration may also cause an imbalance in electrolytes, such as sodium. Consuming a large amount of water without adequate intake of electrolytes could dilute sodium in the bloodstream, resulting in hyponatraemia. Symptoms of hyponatremia vary from mild (nausea and headaches) to severe (confusion, seizures, and, in extreme cases, coma). This condition can potentially be life-threatening for kidney disease patients, who often have difficulty maintaining an optimal balance of electrolytes.

Many people forget that they can obtain fluids from certain foods and drinks, such as soup, yogurt, watermelon, and tea or juice. In the summertime, people tend to consume these types of foods and drinks more often, which can cause them to exceed the recommended daily fluid intake. Many also believe that drinking extra water will flush toxins out of their system; however, when the kidneys are not functioning properly, excess fluids can be difficult to remove from the body.

How much water should kidney patients drink?

Dr Roy said that proper hydration for someone with kidney disease needs to be planned carefully. The amount of fluid a person can consume depends on their stage of kidney disease, urine output, and whether they are on dialysis. Some simple strategies can help maintain proper hydration: use small cups for drinks, consume fluids throughout the day rather than all at once, avoid foods high in salt (as these increase thirst), and track daily fluid intake.

The main reason for drinking fluids is to ensure the right amount is consumed; therefore, the most important aspect of hydration is maintaining balance. Maintaining this balance can help prevent complications and allow individuals to remain as healthy as possible. When kidney patients understand their hydration needs and receive proper guidance during the summer, they can avoid causing further harm by placing additional strain on their bodies.