Microalgal-bacterial granular sludge (MBGS) could offer a sustainable alternative to traditional aerobic methods in brewery wastewater (BWW) treatment. This study compared MBGS with conventional activated sludge (AS) in treating real BWW and highlighted its advantages and challenges. MBGS achieved comparable chemical oxygen demand removal efficiency (93%) compared to AS (89%). Additionally, MBGS exhibited higher phosphate removal capabilities than AS. Extra nitrogen was added to influent to balance C/N ratio of BWW. MBGS was robust in handling C/N ratio fluctuations with an 82% total nitrogen removal efficiency. Metagenomic analysis further indicated that most of the genes involved in carbon, nitrogen and phosphorus metabolism were up-regulated in MBGS compared to AS. Despite changes in the microbial community and settling ability due to high starch and sugar content in BWW, MBGS demonstrated high efficiency and sustainability. Further research should optimize MBGS operation strategies to fully realize its potential for sustainable BWW treatment.