Understanding Asian Glow: FRIEND OR FOE?

Story by Teena Apeles.

Seeing red every happy hour? Or should we say, does everybody else see that unseemly crimson creep up on your face with that first sip? It’s not just you. About a third of East Asians, and even some Southeast Asians, suffer from the uncomfortable flushing that accompanies drinking. But beyond aesthetics, the Asian glow, which is caused by a genetic condition, comes with some serious consequences. Contributing writer Teena Apeles parses out fact from fiction.

 


WHEN YOU HEAR the phrase “Asian glow,” what comes to mind? The word “glow” to me mostly has positive connotations, like “pregnancy glow,” referring to an expectant mother’s complexion and overall appearance as being radiant. Or there’s “glow” as in bright, shining.

While I’d like to think of the Asian glow, also called the “Asian flush,” as something complimentary or something one would like to achieve, for anyone who experiences this flushing of the face after drinking alcohol — or knows someone who does — it’s anything but. Me with a bright red face … not something cute nor radiant and, depending on how much alcohol I consume, neither is the feeling when I’m experiencing it: I turn dark red, I feel feverish and dizzy, my whole body throbs and I get incredibly self-conscious of my appearance because it can look alarming. If you’re in the same alcohol-induced, red-face drinker camp as I am, you know this all too well and probably just brush it off as an annoyance — or find ways to prevent it, but more on that later.

Twenty-three-year-old Faith, who works as a beauty writer, recalls the first time she got the Asian glow during college, “when I had a shot of vodka at a fraternity house,” though it didn’t seem to alarm anyone, including herself. “No one really said anything, because it seemed like common knowledge that Asians got red when they had alcohol,” says the Chinese American. “I remember seeing my dad get red when he drank beer, so I guess I wasn’t too surprised. I was more annoyed about the side effects: My heart was pounding, and I got a huge headache.”

Jeannie, a Korean American in her early 30s, remembers experiencing the Asian glow when she first drank. “Actually, I maybe suspected it even before, because my dad had it, and I’d seen other older Korean people have it,” she says. “I’m not sure if I know the science — I heard that it’s because we miss an enzyme to process alcohol, but other people describe it more simplistically as an allergy.” Jeannie goes on to echo Faith’s and my complaints about the physical effects that follow: “You don’t really enjoy drinking once it starts giving you a pounding headache.”

At last year’s Audrey anniversary gala, where cocktails and high-end whiskey abounded, Chinese American TV personality and journalist Lisa Ling opened the event by joking that she liked attending events like this — with a predominantly Asian audience — because she knew she wouldn’t be the only who would be red by the end of the night. And, yes, while that line was met with a lot of laughter, studies suggest this condition should not be taken lightly by any means, especially if you drink often. But first, let’s get down to what causes it.


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THE SCIENCE BEHIND THE FLUSH
The symptoms that accompany the facial flushing, which Jeannie and Faith described, are what a significant percentage of East Asians (Chinese, Japanese or Korean) experience, due to a genetic condition that prevents their bodies from breaking down the alcohol. And Jeannie is correct that a particular enzyme is the culprit.

“Between 30 to 40 percent of East Asians have a genetic variation in an enzyme called aldehyde dehydrogenase 2 (ALDH2),” explains Dr. Jessica Wu, a Los Angeles dermatologist and assistant clinical professor of dermatology at the USC School of Medicine. “This enzyme converts alcohol to another compound called acetaldehyde.” People who have a fully active ALDH2 enzyme can break down the acetaldehyde, but in ALDH2-deficient individuals, “this compound accumulates in the body and releases histamine. The combination of acetaldehyde and histamine produces the characteristic symptoms of alcohol intolerance: redness, flushing, shortness of breath, headaches, nausea and heart palpitations.”

The alcohol-induced symptoms in individuals can vary from mild to extreme, depending on whether a person inherited one or two of these variant genes. In the latter case, facial flushing can be quite severe, resulting in an almost purple flush and other symptoms. That sure takes the fun out of drinking, right? But people with this genetic variant condition still drink despite these symptoms. “My patients who are young women are especially embarrassed by this because drinking is often a part of socializing, dating and business entertaining,” says Wu.

About 92 percent of the world’s population can enjoy drinking just fine without turning red. Lucky them. But for ALDH2-deficient individuals, heavy drinking can have harsher consequences beyond facial flushing over time.


THE LINK BETWEEN THE ASIAN GLOW AND CANCER
Dr. Philip J. Brooks of the National Institute on Alcohol Abuse and Alcoholism was doing research on the general topic of alcohol and cancer when, in 2007, he became acquainted with Dr. Akira Yokoyama and his “tremendous work” on the relationship between ALDH2-deficiency and esophageal cancer in the Japanese population. The two met at the International Agency for Research on Cancer. “I was struck by how strong the data was and how relatively too few people were aware of it, compared to some of the other effects of alcohol,” says Brooks.

Brooks and Yokoyama went on to write the article “The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption,” published in PLOS Medicine on March 29, 2009, with colleagues Mary-Anne Enoch, David Goldman and Ting-Kai Li. If you missed out on this research hitting the news, despite it being featured in every major news outlet during that time, so did I, which is why it’s so important that you share it. Here’s your chance to separate the fact from fiction and, perhaps, spare loved ones in your life who drink a lot of headaches … or much worse.

Brooks and Yokoyama’s article states, “ALDH2-deficient individuals are at much higher risk of esophageal cancer (specifically squamous cell car- cinoma) from alcohol consumption than individuals with fully active ALDH2.” And this particular alcohol-related esophageal cancer is quite deadly: The five-year survival rate in the United States is only 15.6 percent and 31.6 percent in Japan. But what you should take from this, Brooks emphasizes, “is this cancer is preventable.”

And while it would seem that if you just have one copy of this variant gene your risk of developing esophageal cancer would be lower than if you have two copies, that’s not the case. “People who have two copies get so sick when they drink that they basically don’t drink,” he says. “Ironically, they are protected from being alcoholics, and they are actually at a lower risk of getting esophageal cancer because they just don’t drink. So it’s kind of a complicated genotype.”


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THE CURE FOR THE ASIAN GLOW
Let’s get one thing straight: There is no cure per se for alcohol-induced flushing if you are ALDH2 deficient, despite articles you see online. Sure, people have posted that there are ways to mask or minimize the onset of the flushing — a cursory search will even bring up some herbal remedy to take 21 days before having a drink to remove all symptoms. And some people say they have developed a higher tolerance to alcohol and experience less flushing over time, but these things are not in themselves a cure for the root of what causes it: your genetic condition.

For instance, in a 1988 article titled “Antihistamine Blockade of Alcohol-induced Flushing in Orientals” — yes, it used that term — published in the Journal of Studies on Alcohol and Drugs, the authors shared results of an alcohol study conducted on Asians. Half of the subjects received 50 milligrams of diphenhydramine and 300 milligrams of cimetidine before receiving low doses of alcohol; the other half, placebo tablets. The abstract states: “The antihistamine group showed a significant reduction in the skin flush. The antihistamine also neutralized the systolic hypotension induced by the administration of alcohol.”

Now does this mean you should start popping antihistamines before you drink so you don’t turn red? Most definitely not. According to the U.S. National Library of Medicine and National Institutes of Health, you should not drink alcohol when you are taking antihistamines, period.

Other remedies for the Asian glow you’ll see online or learn from Asian friends — as I have — are antacids, which contain histamine blockers that people have reported minimize flushing. “I actually can’t remember how I first heard about how to avoid it. I think it must have been from a friend or classmate, who recommended Pepcid AC,” says Faith. “I did some Googling and decided to try it out for myself and found that it worked, but that Zantac (which does the same thing but has a different active ingredient) worked better for me.” She takes one Zantac 45 minutes before she takes her first sip of alcohol to avoid the Asian flush and other symptoms.

While I haven’t tried antacids or antihistamines before drinking (the latter makes me feel a little loopy as it is), I must admit I’m curious to see what would happen. For once, can I not be the one bright red, unhealthy-looking face in group pictures?

Even if they do work, this is not a cure for my condition. Using anything to mask the facial flushing and continue drinking, Brooks feels, is particularly dangerous because it isn’t reducing the risk of esophageal cancer. “And to the extent it makes you think you can keep drinking more,” he adds, “it’s actually worse.”

The takeaway? If you’re an ALDH2-deficient individual, it is in your genetic makeup and can’t be changed. Therefore, there is only one sure way to avoid alcohol-induced flushing (and you know the answer): Don’t drink.


THE RED FLAG THAT SAVES LIVES

If something doesn’t make you feel good, consider it your body’s way of protecting you. It’s saying whatever you’re doing is simply not good for you. So here’s the silver lining on that Asian glow and its unpleasant related symptoms: These adverse reactions you experience when drinking alcohol make you less likely to abuse alcohol (this has been shown in research with groups of East Asians who have the condition) and, in turn, suffer from alcoholism and all the health risks associated with it, including esophageal cancer.

Of course, it’s difficult in social situations not to drink while the rest of the world seems to be partaking in what most consider a pleasurable pastime. But university students with this ALDH2 deficiency especially (yes, we’re talking to you, young women) should take note of the alcohol-related risks that come with heavy drinking over time.

Heavy drinking is simply bad for your health as it is. “Readers should be aware that the American Heart Association warns that drinking more than a glass of wine a day (for women) is associated with a higher risk of obesity, diabetes and heart disease,” says Wu. And if you do have alcohol intolerance, she suggests that you “drink sparingly and choose your drinking occasions wisely.” And if you care about your skin, here’s another reason to take her advice: “Repeated episodes of flushing can enlarge the facial veins, leading to permanent redness and/or ‘spider’ veins on the face.”

I’m well beyond university age, but the Asian glow still bothers me. I do wish I could happily enjoy a cocktail or beer with my friends or even my husband without consequence. But I’ll admit the condition does save me money most of the time — drinks are expensive in Los Angeles! (Except, of course, when I go out with friends and we split the bill evenly and I’m the one person who gets stuck paying extra money for their expensive glasses of wine. Goodness, if I can have that extra cash back from all those nights. …)

So what’s your verdict now that you know what causes your uncomfortable alcohol-induced flushing? Are you going to treat the Asian glow as a friend or a foe? I vote friend, because a good friend is someone who looks out for you. And to that I will toast — and wear my facial flush that follows proudly.

This story was originally published in our Summer 2014 issue. Get your copy here

Lies You’ve Heard About Asian Glow

Story by Teena Apeles.

All Asians turn red when they drink.
False. It’s estimated that 36 percent of East Asians have the genetic variance that causes facial flushing, according to Dr. Philip Brooks and his colleagues. Other studies suggest this genetic variant in Southeast Asians as well, such as Vietnamese and Indonesians, and there is a considerably low occurrence of the ALDH2 deficiency in the Filipino population compared to Japanese, Chinese and Koreans.

Only Asians have the ALDH2 deficiency.
False. It is estimated that 8 percent of the general population has this genetic condition. It has also been observed in South American, North American and Mexican Indian populations, but the deficiency, according to many published works, occurs “rarely” or is “virtually never seen” in Caucasians or Africans. “For the most part, we don’t think that the flushing you see in Caucasian people is the same ALDH2 deficiency that you see in the East Asian population,” says Brooks.


If you are Asian and get flushed after drinking alcohol, you definitely have the deficiency.
False. While it’s a pretty solid biomarker for the genetic condition among East Asians, Brooks says the only way to know for certain that you have the deficiency is to have genotyping done. In the Japanese study by Dr. Yokoyama, participants were given a questionnaire that was designed to be almost 99 percent accurate in identifying people with the ALDH2 deficiency, and an ethanol patch test was also suggested as fairly accurate.

There are certain types of alcohol that don’t cause facial flushing.
False. Some Asians have speculated that rice-based liquor does not cause flushing. “I found I don’t get red if I drink sake or Korean drinks like soju or makgeolli,” says Jeannie. “Engineered for Asian people!” And Faith believes that a little lemon or lime with liquor goes a long way for her: “Tequila is my drink of choice because it always settles best with my body. I think part of the reason tequila settles better with me is because I usually chase shots with a slice of lime or lemon, and something about the acidity in them helps the al- cohol digest better or something.” She adds, “I know for a fact that when lemons or limes are involved, I have way less of a chance of getting the Asian glow or any of the side symptoms.” But Brooks says there is no basis — and he’s not aware of any data — for ALDH2-deficient people to assume that different kinds of alcohol won’t cause facial flushing, and if it does, on occasion, that that in any way decreases one’s risk for esophageal cancer.

 

 

 
This story was originally published in out Summer 2014 issue. WANT TO LEARN MORE? Be on the lookout for our feature story coming soon! You can also purchase the issue TODAY.

Get Ready to Party! Audrey Helps You Get Through the Holiday Season

’Tis the season to indulge, so go ahead — don’t let us be a wet blanket on the festivities. Just heed a bit of pre-party advice to minimize post-party fallout. And when you’ve binged to your heart’s content, we’ve got a few tips to help you recover.

PREGAME:

* Two weeks before, make sure your teeth are party-ready with Glo Science’s latest G-Vial whitening gel — just apply with a brush twice a day for 30 seconds.

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* Pregame like dermatologist extraordinaire Dr. Jessica Wu, who says in her book, Feed Your Face, that she like to have a snack (try almonds!) before a big dinner to avoid overeating.

* An hour out, before you slip on that special dress, maximize your hotness with a Wei Beauty Décolletage Treatment Pad, a mask with coconut water, kelp and free radical-fighting gingko, specifically made for the delicate skin on your chest.

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PARTY TIME:

* In her book, Dr. Wu recommends a dry red wine like cabernet sauvignon or pinot noir for maximum antioxidants (chardonnay, if you prefer white). If you’re more a cocktail kind of girl, she says go for vodka with club soda or diet tonic water.

* Don’t forget to hydrate with a glass of water after every drink. That’ll also help you moderate your drinking.

* After all that rich, scrumptious food, chew gum with xylitol, like Vitacare Whitening Gum, to freshen breath.

POST-PARTY:

* Whatever you do, don’t forget to take off your makeup. Keep Koh Gen Do Cleansing Spa Water and Pure Cotton on your nightstand to remove even waterproof makeup with mineral-rich water from Japan’s Yumura Hot Springs — no tugging and no rinsing required.

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* In the morning, apply cotton balls soaked in soy milk (squeeze out the excess) for five minutes to reduce swelling, hydrate skin and constrict veins in bloodshot eyes, says Dr. Wu.

Read more tips to get you through the holiday season in Audrey‘s Winter 2013-14 issue, out now!

 

Hot Beverage: World’s First Sriracha-Flavored Vodka Launches (Yes, Really)

While an LA judge may have just ordered a Southern California sriracha hot sauce factory to partially halt its operations after complaints from neighbors, it seems like there is a new, and definitely interesting, way for us to get our spice-fix.

In what may be the most genius (or horrifying, however you look at it) alcoholic concoction, Phillips Distilling — the same company that has debuted other flavored vodkas like UV Cake and UV Espresso — has just released UV Sriracha Vodka.  As stated by the company’s press release, the vodka has a blend of “chilis, garlic and vegetables” that “honor(s) the traditional sriracha hot sauce.”

UV recommends putting it in a Bloody Mary or a strawberry margarita and offer recipes on their website.  Of course, you could also take a shot of it straight on like other vodkas or put it on your food like regular sriracha, but we don’t necessarily suggest that.

As unique of a concept as it is, we have to ask, would you take a sip?

Throwback Thursday: The Truth About Asian Women & Alcohol

Story by Janice Jann.

BOOZE CONTROL

Studies indicate that nearly 40 percent of Asian American women drink alcohol and, while that’s less than the 55.2 percent national average, we are at a higher risk for all sorts of medical issues due to our binge drinking. So why do we do it? Editor Janice Jann investigates.

As I lean over the toilet bowl, my hair grazing the rim, I catch a glimpse of my reflection in the water. “Who is this puke-strewn girl, bleary-eyed and green-faced, with her pajamas on backwards, staring back at me?” I think to myself. I mutter, “Never again, never a—,” before nausea sweeps in.

There have been many morning afters like this in the years I have been drinking, each time steeped with more regret than the last. Most of my peers have stories like mine. Many laugh, “Who hasn’t gone through it?”

As normal as binge drinking has become, new studies indicate that Asian American women may want to hold off on that second cocktail the next time they drink for reasons more than just avoiding the toilet bowl the next morning.

The most recent National Survey on Drug Use and Health revealed that the national average of alcohol use for all adults in the U.S. is 55.2 percent, while the national average for Asian Americans is 39.8 percent.

Genetic factors play an important role in why Asian have lower rates of alcohol consumption, according to Tamara Wall, a University of California, San Diego professor of psychology and the director of Psychological Services for the Alcohol and Drug Treatment Program at the Veterans Affairs San Diego Healthcare System. Studies have shown that 30 to 50 percent of the Asian population have a gene, inactive aldehyde dehydrogenase 2 (ALDH2–2), which causes them to metabolize alcohol differently from people who do not have this gene. This manifests itself physically through headaches, nausea and facial flushing, a.k.a. the “Asian glow.”

Jess, 24, can attest that facial flushing causes her to drink less. “I think if I didn’t have it, I’d be more open to having a casual cocktail with friends and clients,” she says. However, that hasn’t stopped her from binge drinking one recent weekend. Stressed out about her job and living situation for the past couple of months, she “needed a way to just vent and live in the moment.” According to Jess, “I was determined to let myself loose and it was actually my goal to drink until I didn’t remember anything at all.” After four double shots of tequila and two single shots, she did exactly that and stayed in bed sick until 4:30 the next afternoon. “I think it was the stress that had been piling on that pushed me over the edge,” she says.

 

Using alcohol to self-medicate, to relieve stress or to forget problems, has become an increasingly common occurrence among women of the post-Baby Boomer age. As more women enter the workforce, they have to deal with the stressors of the 21st century: increasing challenges in their careers; cultural norms of the workplace, which often includes happy hours and two-martini lunches; motherhood and familial obligations; the list goes on.

Christina, an attorney, agrees. When asked whether work causes her to drink more, she says, “Oh, definitely. That’s a definite issue. I think one reason why people drink so much, especially in my profession, is we’re pretty stressed out. We’re responsible for other people’s issues so when we do have a chance for release, it does get out of hand. Alcohol lets you forget about things for a moment. I knew of one associate who was so stressed, she used to drink every morning before going to work. It was a way to numb herself before she had to deal with the day.”

Though Christina may drink out of stress, she also drinks to celebrate. “After I passed the bar exam, I went out with a friend and I was taking shots galore,” she remembers. “I drank so much tequila that it made me sick to my stomach. I just didn’t give a sh—t that day because I was so happy I passed.”

By the end of the night, Christina “was sitting at my bathroom, wanting to die. You just wanted it to be over with. Every time something like that happens, I tell myself I will never do that again and it happens again.”

Meky had a similar experience on her birthday. “I’m kind of embarrassed to say I got wasted on my 25th birthday and not, like, my 21st or something,” she laughs, thinking back to the celebratory weekend where she downed five Jack Daniel shots in less than an hour, was carried to her car on a friend’s back, and woke up the next morning, her clothes piled by the door.

The National Institute on Alcohol Abuse defines binge drinking for women to be four drinks over a time span of two hours, but once you’ve hit that zone, it’s often difficult to stop at merely four drinks for the night. “It all starts tasting the same after a while,” says Christina. “You become desensitized after a certain amount.”

What’s scarier is that blackouts and vomiting are not the only negative consequences associated with binge drinking. Wall cites an increase in dangerous behaviors such as driving while intoxicated and risky sexual activities.

Binge drinking could also lead to alcoholism, which will require CA drug and alcohol detoxification eventually.

And even though the ALDH2–2 gene have put Asians at a lower risk for developing alcohol problems, it puts them at a higher risk for developing medical problems. Wall lists esophageal cancer, pancreatic cancer, hepatitis and liver problems as common problems for Asian binge drinkers. “The data are pretty clear that if you have the [gene] and you drink heavily, you’re much more likely to developing head and neck cancer,” she adds.

Being an Asian woman, there are even more consequences to frequent binge drinking. In a 2008 New York Magazine article, Susan Foster of the National Center on Addiction and Substance Abuse at Columbia University said, “There are huge differences in the way our bodies metabolize alcohol. Women have less body water and more body fat than men. The water dilutes the alcohol in the bloodstream, and will stay in her body longer, even if she is the same size as the guy.” What that means is that women get inebriated with lower levels of consumption at a faster rate. Additionally, alcohol has been known to interfere with fertility and increase the risk of breast cancer. Some researchers believe that a woman who has four drinks a day would increase her nongenetic chance of developing breast cancer by 32 percent.

Freaked out yet? Researching this story has made me think twice about reaching for that soju bottle again at our next staff happy hour. Now, instead of just dreading how I’ll feel trying to get the alcohol out of my system, I’ll also worry a little about what it’s doing inside my body. Just thinking about it stresses me out so much I want to grab a drink.

So what are some alternatives for a lush like me?

“Working out is probably a more positive avenue,” says Christina about dealing with work pressure. “I find as I get older, I try things like meditation courses to help me not think and stress out as much.”

Moderation is also key. “The standard guidelines for women is you shouldn’t drink more than one drink per day,  nd for men two drinks,” says Wall.

Sure, a mere one drink a day could be a buzzkill, but at least I’m at a lower risk for killing myself faster.

 This story was originally featured in our Winter 2011-2012 issue. Get yours here

Feature Story | Booze Control

BOOZE CONTROL

Studies indicate that nearly 40 percent of Asian American women drink alcohol and, while that’s less than the 55.2 percent national average, we are at a higher risk for all sorts of medical issues due to our binge drinking. So why do we do it? Editor Janice Jann investigates.

ISSUE: Winter 2011-12

DEPT: Feature Story

STORY: Janice Jann

As I lean over the toilet bowl, my hair grazing the rim, I catch a glimpse of my reflection in the water. “Who is this puke-strewn girl, bleary-eyed and green-faced, with her pajamas on backwards, staring back at me?” I think to myself. I mutter, “Never again, never a—,” before nausea sweeps in.

There have been many morning afters like this in the years I have been drinking, each time steeped with more regret than the last. Most of my peers have stories like mine. Many laugh, “Who hasn’t gone through it?”

As normal as binge drinking has become, new studies indicate that Asian American women may want to hold off on that second cocktail the next time they drink for reasons more than just avoiding the toilet bowl the next morning.

Continue reading

Fall 2012 | The Market: Dynamic Duo

DEPT The Market
ISSUE Fall 2012
AUTHOR Paul Nakayama

HED: THE DYNAMIC DUO

He’s one way when he’s sober, completely different when he’s drunk. Columnist Paul Nakayama uncovers the truth behind your masked man.

I just returned from Comic Con with a pile of Batman books, and it’s a few days before The Dark Knight Rises premieres. I’m almost fanatically on the Batman bandwagon this week, and if I could look good in black leather and spandex, I would be running around dressed in it. Now, this is probably not a good way to portray myself considering I’m the magazine’s resident dating columnist, but I’m more of an “unintentional-abstinence-sucks-so-don’t-do-what-I-do” sort of advisor anyway. So, in sheer geek revelry, I’m going to use Batman as my device for talking through this month’s Awful Truth topic: “dual identities,” or why men are flirtier when drunk.

Continue reading