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Pjbrooks / PLoSmedicine.org
A condition called 'Asian flush' happens to certain people of Asian descent after they have consumed alcohol. The red blush, shown on right, is the result of a deficient gene.
Between the brisk cold and the holiday cheer, many of us get a little red in the face this time of year. But for some people of Asian descent, a New Year’s toast – or even a few beers after work – will trigger a bright red blush known as the “Asian flush,” which can also increase their risk of deadly esophageal cancer.
“When I drink, the skin in my face and even all the way down to my waist will start to turn red,” says Patrick McMahon, a 30-year-old education director from Seattle, who’s half-Japanese. “I think the blood vessels dilate and I get very flushed. It’s often mistaken for a sunburn.”
That response is typical for about a third of people from East Asian descent, says Philip J. Brooks, an investigator with the Division of Metabolism and Health Affects at the National Institute on Alcohol Abuse and Alcoholism.
“It happens predominantly in individuals of Japanese, Chinese or Korean descent,” he says. “People who have this will get a facial flush and a headache and will feel nauseous at the time they’re drinking. And it’s not just flushing. They’ll also get an increased heart rate. It’s a pretty unpleasant experience.”
What causes this reaction?
Brooks says it’s basically a genetic inability to properly metabolize alcohol (or ethanol) which, thanks to enzymes in the liver, is normally metabolized first into the toxic chemical acetaldehyde – an animal carcinogen that causes DNA damage and other cancer-promoting effects -- and then into the harmless substance acetate. People with the flushing response have a genetic deficiency in the alcohol-metabolizing enzyme ALDH2, which can lead to an accumulation of the toxic substance acetaldehyde.
“Individuals with this particular genetic disposition can’t metabolize it to the acetate,” says Brooks. “So it builds up in their body and causes the vasodilation which causes the flushing response.”
In some people – those with two copies of the deficient gene -- the symptoms are so severe they can’t tolerate alcohol at all. Those with only one copy of the gene often learn to live with the heart palpitations and the flushing, though.
And that’s where things get risky.
“People with this ALHD2 deficiency have a really high risk of getting esophageal cancer when they drink alcohol,” says Brooks, who wrote about the link between the Asian flush and esophageal cancer in a 2009 paper in PLoS Medicine, a journal published by the Public Library of Science. “Anyone who drinks is at risk, but the more you drink, the more your risk goes up. And when you’re ADLH2-deficient, your risk goes up much more dramatically.”
According to studies, a person with a single copy of the deficient gene who drinks just two beers a day is up to 10 times more likely to develop esophageal cancer than a person who’s able to metabolize the alcohol properly.
Unfortunately, while many people of Asian descent are familiar with the flush, Brooks says too few realize it’s not just an inconvenience, but a red flag for one of the deadliest cancers worldwide.
“It’s not just an issue that affects appearance, but an indication that they’re at increased risk of esophageal cancer if they drink heavily,” says Brooks. ”You have to think about the production of acetaldehyde throughout the body. We want people to discuss this with their doctor and be sure their doctor is aware of the data that’s out there.”
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I am a 100% Japanese. My mom called and told me this from Japan months ago so I quit drinking. I didn't look right and feel right; after I had a just sip of wine or beer, my whole body was red and my heart started beating fast! I don't miss drinking at all, now love being the designated driver for my friends and watch everyone having "fun" while I'm sober. LOL!
I am one quarter Hawaiian and I have this. No fun. I'm now the Full time DD.
I also have this problem but i have found that taking Pepcid AC an hour or so before i drink to dramatically calm the symptoms of AFR ( Alcohol Flush Reaction).
But does that reduce your cancer threat? I wish you wouldn't risk it!
Tim, you still have a 10X higher risk of esophageal cancer. Pepcid AC is only calming the short-term reaction.
Is it truly worth the increased risk to your health to continue drinking?
My long-time girlfriend is Vietnamese and suffers from this condition. To combat the physical effects felt after consuming alcohol, she takes Pepcid-AC. I'm not sure why it helps, but this is the only way she can enjoy a glass of wine.
It's possible that the antacid reduces acidity level in the stomach, which leads to less alcohol being dissolved and available to be processed and absorbed, thus less acetaldehyde buildup.
Actually pepcid/tagamet are both types of drugs which block a particular histamine receptor to decrease acid secretion in the stomach and has the side effect of also blunting some skin reactions. Just because the skin reaction is being blocked does not mean the cancer risk is lowered though. The toxicity is still present- just not the normal skin/heart response.
I have no Asian in my ancestry, but have the same flushing and heart palpitations. I can't stand the taste of alcohol and never have been able to. My body was telling me something years ago. I tried to drink socially, but forget it. It wasn't worth it. Now, I never drink....haven't for 15 years. Good to go!
one word: Pepcid.
Take one ~45 min before drinking and you won't turn red.
I'd like to see how it affects the risk of cancer...
its obama's fault!
i was on a medical tourism visit to seoul, korea, may and november 2008, and visited hospitals and clinics where they were using and developing cyber laser knives for cancer surgery, used for spine and head; they said japanese, koreans have higher incidence of brain and spinal tumors and cancers, possibly attributed to the heavy drinking of whiskey which was charcoal filtered and presumably lead to an increased incidence of those illnesses; 10-15% higher incidence rate in those countries compared with european non-asian demographics; i've never seen or head of AFR tho with japanese woman for 19 years; never saw AFR with asians; seen a few red irish noses, tho!
I had this when I took a particular medication. Drinking even a glass of wine had me burning hot and deep scarlet red for hours. Felt awful. I no longer take that medication LOL
I love how so many people are talking about how they don't get the flush if they take a Pepcid. Did you catch the part where you are 10 times more likely to get esophageal cancer from drinking? It seems extremely unlikely that Pepcid AC will lower your risk of cancer, all it does is hide the symptoms of your problem. Is drinking really worth it? I had a boss who had throat cancer, and when he called us into his office to tell us all, he said the doctors believed 100% that it had come from years of smoking. He wasn't even a pack-a-day smoker. More social and cigars when with his friends or drinking. He told all of us that if he could go back he wouldn't touch a cigarette at all, and that he hoped we would learn from his lesson and quit if we were smokers, or never smoke if we weren't. He sure didn't seem to think that the part of smoking that was fun in his youth was worth it when the cancer came. His young kids didn't either. Just as I doubt that most people who get esophageal cancer are thinking, "Man, I am glad that I had those drinks when I was younger. Totally worth it!"
I don't drink, but reading this article just reinforces that I have made the right choice in being the permanent designated driver.
I am of Northern European ancestry and used to get this. Haven't had a drink in 18 years.
Heh, wow. Mixed ancestory, no asian that I know of, and I've had this issue (mild) my whole life. For whatever reason, it's worse with wine than the hard stuff. Take a drink and flush red/get warm and people automatically start asking 'are you ok?' Sometimes I get the critical look from the waitress, trying to figure out if I've had too much to drink or am going to get sick.
Most of the time I go out for drinks with friends, I enjoy the bar food, maybe one mixed drink. If I stick to one that's more fru-fru, less booze, I don't always turn red. So even though I love my espresso martinis, I might have ONE every other time I go out with them. I've always figured it's an early warning system of some sort from my body, and it doesn't like booze, so I just don't push it.
ironic...as an alcoholic, i take medication to CAUSE this flushing response.. i do wish I had just been born with the deficient gene along with the alcoholism genes so that i would have had a much harder time going down that road..
I don't get it. if you have the deficient gene which makes drinking alcohol unpleasant, why do you drink it at all?
You would think that there would be a lot of information about this since Japanese, Chinese & Korean culturally are heavy drinkers.
If you have this problem, I suggest you smoke pot instead.
If one does not drink alcohol, is there still a risk of getting esophageal cancer simply by being ALHD2 deficient?
I had the "Asian flush" once. I think I got it from some bad Chinese food.
What is the regular rate of esophageal cancer? This is poor science reporting. If the risk, for example, is .0000001% and now it's .000001%, it's still a very small risk. Please give the actual risk.
I'd heard reference to an inability of some Asians to digest alcohol to explain their seemingly rapid ability to get drunk. I guess there is truth to that rumor, but the consequences can be even more grave.
do native americans also have this gene?
I wondered this as well, since Native Americans are considered to be of ancient Asian descent.
I've heard that red flush effects Alaska Natives just the same. I'm a quarter Inupiak Eskimo and have definitely gotten huge red spots on my face a couple times while consuming harder drinks. I can't recall beer being a culprit. But now that I know of the cancer risk associated I'll be asking my doctor at the next visit.
It is not just Asian people with a deficiency of alcohol dehydrogenase who should be concerned about the links between regular alcohol consumption and cancer. As I discuss in "A Cancer Prevention Guide for the Human Race, " there is abundant data linking regular, daily alcohol intake (as well as periodic binge drinking) with an increased risk of far more common types of cancer than esophageal cancer. Among the cancers most closely linked with regular alcohol intake (in addition to esophageal cancer) are: breast cancer, stomach cancer, colon and rectal cancer, head and neck cancer, pancreatic cancer, liver cancer, and prostate cancer. (There is also weaker research evidence linking frequent alcohol intake with other cancers, as well.)
Robert A. Wascher, MD, FACS
Author, "A Cancer Prevention Guide for the Human Race”
I am not of Asian decent but I get this "Flush" when I drink hard liquor. I have to limit my self to 1-2 drinks per night or 1 with dinner. I do not have this issue when I toss back a few beers. I thought this was related to an issue where I could not break down the sugar in hard liquors... Beer... no problem... Interested, scary thought on throat cancer, though. Why do this problem not appear with Beer??? How can you be tested for this deficiency?
We are all going to die anyway so drink up and enjoy yourself while your here.
We are all going to die, indeed. But, I wanna stay here longer mate! :)
I remember reading an article one time that none of the other races can breakdown alcohol as efficiently as caucasians..... hence we are not cheap dates.... Having said that I lift my glass of Gin and tonic to my Asian friends...
I wish someone would come up with some kind of enzyme shot or anything that could help people who couldn't drink. I got really red fast (face and eyes) after only one beer. It sucks. I'm not an alcoholic and don't intent to be one but it would be great if I could at least enjoy 1 drink with friends socially especially during special occassions such as Christmas, New Year Eve etc.
I'd recommend you trying some anti facial flushing supplements. I prefer NoGlo, I take it every day for 1 month, and now I feel myself much better ! It's safe and so you don't have to worry about you red face while partying and hangover day after.