Have you ever wondered why some people turn red in the face after just a little bit of alcohol? And if you are one of those people, we sympathize with you because it’s not great news.
Do you blush even after just a sip of an alcoholic drink? In fact, this isn’t a major concern. On average, for every three people in East Asia, such as China, Japan, and South Korea, one experiences flushing syndrome when consuming alcohol or beer.
A genetic mutation in the body makes many Asians intolerant to alcohol, leading to flushing, nausea, and itching when consuming alcoholic beverages.
This phenomenon is also known as “Asian flush”, caused by a genetic mutation that inhibits the breakdown of toxins in alcoholic drinks, resulting in redness and even inflammation. Common symptoms include a warm sensation, itching, hives-like rashes spreading over the cheeks and neck, along with physical discomfort. Approximately 40% of East Asians react to alcohol in this manner.
“Some people experience headaches and rapid heart rates after just half a glass. They feel a bit nauseous and dizzy, experiencing a certain level of embarrassment,” said Saw Hoon Lim, a senior lecturer at the Department of Biochemistry and Pharmacology at the University of Melbourne, adding that this is how the body responds to harmful agents introduced into it.
This syndrome arises due to a deficiency of one of the enzymes involved in alcohol metabolism: aldehyde dehydrogenase, which is primarily inherited among Asians. Such reactions are relatively rare, but not entirely foreign to people in other regions.
However, besides causing facial flushing, this syndrome also has both positive and negative impacts on health. The following article will explain the mechanisms behind this syndrome.
How does your body metabolize alcohol?
Alcohol is absorbed and broken down in the liver through a two-step process. In the first step, the enzyme alcohol dehydrogenase converts alcohol into a fairly toxic chemical known as acetaldehyde. The digestion of this harmful substance is also why you feel dizzy and nauseous after drinking.
Next, a second enzyme, aldehyde dehydrogenase, converts acetaldehyde into acetic acid (a harmless acidic component commonly found in vinegar).
1 in 3 East Asians flush after drinking alcohol.
Aldehyde dehydrogenase deficiency is quite common among Chinese, Korean, and Japanese individuals. Most of them inherit two copies of the defective gene for this enzyme from both parents. As a result, their livers continue to produce a faulty version of this enzyme.
Those who inherit the defective gene from only one parent produce both normal and faulty enzymes. However, the effect of this deficiency only accounts for 1% of the overall enzyme activity, not the 50% you might expect. This is because the faulty version is less stable, and copies of the enzyme need to work together to function effectively.
If you inherit a deficiency, whether partially or fully, of aldehyde dehydrogenase, acetaldehyde will accumulate rapidly in your body immediately after you take a drink—followed by all the accompanying unpleasant sensations. These are indeed the familiar “hangover remnants” you experience: nausea, sweating, headaches, rapid heart rate, dizziness, and a flushed face.
Is flushing a good or bad sign?
The good news is that due to the deficiency of aldehyde dehydrogenase, alcohol addiction and alcohol-related cancers are less common in East Asia. Because of the uncomfortable sensations they experience after drinking, they tend to drink less.
However, there is also bad news. If you lack aldehyde dehydrogenase but still drink, you remain at high risk for alcohol-related cancers, such as esophageal cancer. This risk is highest for those with a partial deficiency. Because, the remaining functioning enzyme operates weakly, making it less capable of withstanding the harmful effects of alcohol consumption.
People who flush when drinking alcohol are at high risk of cancer.
Despite this, many people with aldehyde dehydrogenase deficiency still drink. The reasons for their preference for alcohol are quite complex. It could be due to metabolic factors or brain stimulation, or it may involve social elements.
Some individuals feel more “euphoric” than others when consuming alcohol, and this can contribute to addiction.
Other studies on the drinking habits of Asian American college students have shown that social influences can help mitigate the unpleasant effects on the body due to aldehyde dehydrogenase deficiency. For example, exposure to drinking culture from a young age, peer pressure, or family attitudes towards alcohol…
Can antihistamines stop flushing?
In popular media, antihistamines are often advertised as a remedy for flushing syndrome when drinking alcohol.
Indeed, there are many types of medications that can reduce flushing, but they are not traditional antihistamines. Some other medications used to treat acid reflux (such as Zantac and Tagamet) also help reduce alcohol-induced flushing. However, these medications only block H1 histamine receptors and cannot completely eliminate flushing caused by alcohol.
If you have aldehyde dehydrogenase deficiency, it’s best to avoid alcohol as much as possible.
H2 receptor antagonists have fewer side effects and are relatively safe medications. However, they only alleviate symptoms and do not reduce the harmful effects of acetaldehyde. Misusing drugs or excessive drinking can increase the risk of cancer.
So, if you have aldehyde dehydrogenase deficiency, it’s best to avoid alcohol altogether. But if you choose to drink, keep it to a minimum and let your face flush naturally.
Regardless of how alcohol enters our bodies, it is metabolized the same way. However, remember that the amount of alcohol you drink and the rate of consumption affect acetaldehyde levels in your body differently.
Is Antabuse a “miracle” drug?
Whether flushing or not, we should avoid alcoholic beverages.
For a long time, it has been noted that workers in rubber factories experienced similar symptoms when drinking alcohol. In the 1930s, Disulfiram, a banned chemical, was discovered, and by the 1950s, it was marketed as Antabuse (a drug for alcohol dependence). In the 1980s, experts recognized that Antabuse could inhibit the activity of aldehyde dehydrogenase.
Therefore, using Antabuse can create a temporary deficiency of aldehyde dehydrogenase, and just one drink can produce uncomfortable symptoms similar to those experienced by genetically deficient individuals.
However, this is certainly not a “magic pill” and does not work for everyone. Especially for those with aldehyde dehydrogenase deficiency, the temporary dizziness is not enough to keep them away from “the demon of alcohol.”
