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.
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.”
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.