Vishnu Priya Pulipati, MD and Penny Kris-Etherton, PhD, RDN, FNLA, CLS
Have you ever gone into a store looking for a beverage and been overwhelmed by the many options available? With so many choices, selecting a healthy beverage can be challenging. Beverages are important in a healthy dietary pattern. They provide fluids for hydration as well as important nutrients to achieve current dietary recommendations. They also provide about 1 out of every 6 calories of daily energy intake and also more than half of the average daily intake of added sugar. Some beverages contribute significantly to vitamins A, C, D, calcium, potassium and magnesium in the diet. However, many beverages contribute to excess calories, and saturated fat, all of which need to be monitored to maintain a healthy weight and heart. Many of these beverages are loaded with added sugars and nothing else; even though they provide fluids, they are of no nutritional value and can increase risk of many chronic diseases. Guidance is presented below about the nutritional benefits (or the lack thereof) of some common beverages in the marketplace.
Types of beverages:
- Water: the most popular beverage for hydration
- Milk: an important source of protein, calcium, potassium, and vitamin D
- Fruit & vegetable juices: sources of many nutrients but can also contain added sugars and sodium
- Coffee and tea: Popular and healthy beverages when they do not contain added sugars and saturated fatty acids (SFA)
- Alcoholic beverages: can be a source of enjoyment when consumed in moderation.
- Other beverages include:
- Sugar-sweetened beverages (soda, kombucha, etc.)
- Diet or sugar-free beverages
- Carbonated water
- Milk alternatives (plant milks such as soy, almond, rice, and coconut, among others)
- Sports drinks
- Energy drinks
Current beverage recommendations:
The 2020-2025 Dietary Guidelines for Americans  recommendations for beverages include:
- Calorie-free beverages (water) and those with essential nutrients (fat-free or low-fat milk, fortified soy beverages and other milk alternatives, ½ cup/day of 100% juices) should be the primary beverage choices.
- Consumption of added sugar should be less than 10% of calories per day.
- If coffee is consumed, moderate consumption (three to five 8-oz cups per day or up to 400 mg/day of caffeine) is acceptable. Other sources of 400 mg/day of caffeine are 10 cans of cola or two “energy shot” drinks.
- If alcohol is consumed, it should be consumed in moderation and only by adults of legal drinking age – limit to 1 drink per day for women and two drinks per day for men. One alcoholic drink equivalent contains 14 grams (0.6 oz) of alcohol. One drink is 12 oz of beer, 5 oz of wine or 1.5 oz of distilled spirits.
Healthy beverage options:
Water (the beverage option of choice):
- Water is a calorie-free beverage that is great for staying hydrated.
- The National Academy of Medicine recommends that women consume 9 cups of fluids/day and that men consume 13 cups. Beverages are an important source of fluids in the diet.  Fluid needs increase in hot weather and with physical activity.
Fat-free milk, low-fat milk, and fortified unflavored milk alternatives:
- Dairy products and milk alternatives provide nutrients such as calcium, phosphorus, vitamins A, D, riboflavin, B12, protein, calcium, potassium, and other minerals. If using milk alternatives, make sure they are fortified with nutrients found in milk.
- Fat-free and low-fat milks provide similar nutrients with less fat, saturated fat and calories versus whole milk.
Fruit and vegetable juices:
- Juices (100% juice) provide nutrients such as potassium, vitamins, and minerals. However, they are lower in dietary fiber than whole fruits and vegetables.
- Suggest drinking as 100% juice without added sugars and added sodium (limit to ½ cup/day; choose whole fruit and vegetables instead).
- Smoothies are thick, creamy beverages blended from varying combinations of fruits, vegetables, yogurt, milk, and nuts.
- Nutritious smoothies are made from whole foods such as fruits, vegetables, and low-fat dairy, rich in protein, fiber and other nutrients.
- There are many different smoothie powders that can be used; some provide a nutrition boost (like protein powder, shortfall nutrients, including fiber and antioxidants), but for others evidence for health benefits is lacking.
- In addition to natural sugar from the food-based ingredients (e.g., fruits), some smoothies may contain added sugar (from granulated sugar, honey and/or syrups), increasing the risk of adverse health conditions.
Low or no-calorie beverage options:
Besides water and beverages with essential nutrients, there are low or no-calorie choices with minimal to no nutritional value that can be a part of a healthy diet.
Plain coffee or tea:
- Caffeine is a natural stimulant found in tea, coffee, and cacao plants. Caffeinated beverages vary widely in their caffeine content.
- A recent review of the health effects of coffee and caffeine indicated benefits .
- Caffeine can increase mental performance, reduce the risk of depression, Parkinson’s disease, liver fibrosis, cirrhosis, and liver cancer.
- Possible adverse effects of too much caffeine include anxiety, disturbed sleep, short-term increase in blood pressure, and harmful effects on pregnancy.
- Caffeine is not recommended for disease prevention. However, in adults without specific health conditions, moderate coffee consumption can be a part of a healthy diet. 
- These include sparkling water, fizzy water, soda water, and seltzers.
- Many are calorie-fee or contain few calories, some carbonated waters have added sugars and non-nutritive sweeteners.
Beverages with non-nutritive sweeteners:
- Non-nutritive sweeteners (saccharin, aspartame, Ace-K, sucralose, neotame, advantame) are commonly used as sugar substitutes or sugar alternatives. They are widely used in “sugar-free” or “diet” beverages.
- They are Generally Regarded as Safe (GRAS) by the FDA for the general population as long as they do not exceed the acceptable daily intake. 
- Replacing added sugar with non-nutritive sweeteners can reduce calorie intake in the short term as long as other calories are not consumed in place of those displaced by non-nutritive sweeteners.
- Studies are ongoing to evaluate the effects of the non-nutritive sweeteners on eating behavior, hunger satisfaction, and craving for sugar in animals and humans.
Beverages to avoid/limit:
Beverages with added sugars:
- Added sugars include caloric sweeteners and syrups used to improve taste and help with preservation. Examples include brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, lactose, malt syrup, maltose, molasses, raw sugar, and sucrose.
- Naturally occurring sugars in fruits (fructose) and milk (lactose) are not added sugars.
Highly caffeinated beverages:
- These include energy drinks.
- Over-consumption of highly caffeinated beverages including coffee containing extra shots of expresso can have adverse health effects. Many include added sugars and high fat (high saturated fat) dairy products, which should be limited.
- These beverages contain added sugars (i.e., high-fructose corn syrup, sucrose, etc.), electrolytes, minerals, and sometimes protein, caffeine, or vitamins.
- Sports beverages advertise benefits for hydration, especially during intense exercise. However, they vary in the content of fluids, electrolytes, and added sugars.
- Although rare, there is a risk of water intoxication with excess consumption of sports drinks that cause an imbalance of electrolytes in the body.
How do I know if my beverage is healthy or not?
Read the Nutrition Facts label on the product container. For additional information about the Nutrition Facts Label, see reference .
 Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. https://doi.org/10.17226/10925.
 van Dam RM, Hu FB, Willett WC. Coffee, Caffeine, and Health. N Engl J Med. 2020;383(4):369-378. doi:10.1056/NEJMra1816604