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Some East Asians – and non-Asians – have an intolerance to alcohol that causes blushing cheeks, nausea, itching and inflammation. Photo: Shuttersock

Red cheeks after a single alcoholic drink? ‘Asian flush’ is your body sending you a message

  • Some East Asians – and others – have an intolerance to alcohol that causes blushing cheeks, nausea, itching and inflammation
  • A genetic mutation is responsible for the flush, and there’s no known cure, but it could be a blessing in disguise, lowering the risk of cancers from alcohol

Some East Asians get a reaction to alcohol called “Asian flush”.

It’s caused by a genetic mutation inhibiting the breakdown of toxins in alcoholic beverages. As a result, the redness, nausea and inflammation can make drinking an isolating experience.

For games, we have beer cans. For parties, rounds of tequila shots. For work events, wine and cocktails. Alcohol is the social lubricant, easing anxiety and guaranteeing fun. But as I slowly sip on whatever concoction slips past my lips, there’s only one thought plaguing my mind: my face.

It’s burning. It’s itching. I can feel a rash-like discomfort spreading across my cheeks and towards my neck. Physically unbearable and uncomfortable.

Alcohol flush syndrome (Asian flush) affects about 40 per cent of East Asians, and even one drink can set it off. Photo: Shutterstock

Emotionally it’s worse. I hear the murmurs and see the side-eyed glances clock my splotchy complexion. “Do I look drunk?” I wander around my colleagues. “Am I noticeably red,” I frantically ask my friends, ready to douse my cheeks in heavy-duty concealer.

Scientifically, this phenomenon is called alcohol flush syndrome. More colloquially, it’s known as “Asian flush”, though it can affect non-Asians as well.

How much alcohol is too much? Here’s what the experts say

Many East Asians – about 40 per cent to be exact – have this reaction. Specifically, it’s caused by a genetic mutation that reduces the ability to metabolise alcohol.

Experiencing the infamous glow can be isolating in several ways.

“After just downing half a glass, some already feel their headaches coming. Their heart may be beating faster,” says Saw Hoon Lim, a senior lecturer in the department of biochemistry and pharmacology at the University of Melbourne in Australia.

Saw Hoon Lim, a senior lecturer in the department of biochemistry and pharmacology at the University of Melbourne, experiences Asian flush, but looks at it like it’s a blessing.

“You feel and look a bit hungover or drunk, and that might be embarrassing to some extent.”

However, Lim, who experiences facial flushing herself, says it’s important to reframe how we view Asian flush – less as a sign of weakness and more as a “blessing in disguise”.

“It’s your body’s way of telling you that you’re taking in something a little dangerous. Something that’s not good for your body.”

So they don’t drink alcohol? They don’t owe you an explanation so don’t ask

What causes ‘Asian flush’?

For most people, the toxic parts of alcohol are broken down and metabolised by an enzyme called aldehyde dehydrogenase (or ALDH2). However, many East Asians like me are deficient in it. This leads to the build-up of toxins in our body and the experience of Asian flush.

In other words, “our bodies are intolerant to alcohol”, Lim says. Beyond what’s visible on the outside, “we feel nauseous, sometimes itchiness on the skin … physiologically, the body feels very (bad) because the ALDH2 is less functional”.

Couple who quit drinking alcohol feel so much better – you can too

‘Asian flush’ is indicative of bigger health risks

To this day, I’ve scrambled to find a cure to mask the redness. Pepcid, an antihistamine typically used for heartburn relief, is one common (albeit temporary) remedy to reduce inflammation.

There’s even a market for “glow patches”, which claim to transfer antioxidants and vitamins into the bloodstream.

Neither of these, however, are US Food and Drug Administration-approved to aid with drinking.

There is no known cure for this genetic mutation. The best thing we can do is to listen to our bodies – and research – and stop drinking.
Daryl Davies, co-director of the Institute of Addiction Science at University of Southern California, advises against using histamine blockers to stop ‘Asian flush’.
Numerous studies have found that Asians with “flush” are at an increased risk for oesophagal, throat and mouth cancers because of the enzyme. Using histamine blockers like Pepcid to reduce these effects, expert Daryl Davies warns, can escalate alcohol intake and exacerbate these cancerous outcomes.

“Your body is giving you signals. It’s not tolerating the alcohol, and it’s saying to limit your consumption … and yet when you get that peer pressure in a business or party setting, people try to drink through it,” says Davies, co-director of the Institute of Addiction Science at the University of Southern California.

“These (histamine) blockers like Pepcid are exactly the wrong approach, because all that’s doing is masking the outcome. It’s not breaking down the enzyme, so now you have that circulating in your body for longer periods of time without the consequences of your body telling you to slow down.”

‘Alcohol-free is a movement’: bars in US, Asia promote no-booze events

So why keep drinking through the flush?

Turning down a drink or two isn’t as easy as it sounds when alcohol is not only socially acceptable, but also socially pervasive. Those who have grown up in Asian households also understand the gruelling pressure to “push through the flush” as a noble badge of honour.

But I can’t help but wonder, is drinking for the sake of “fitting in” worth the discomfort and “lobster face”?

A resounding no is instinctual, yet I often find myself caving in out of fear that it’ll make me more of a social pariah to opt for a mocktail than to turn beet red. But Lei Yu, a Rutgers University professor teaching in the department of genetics and the Centre of Alcohol and Substance Use Studies, believes more people would be compassionate if they understood what Asian flush really was: alcohol intolerance.

Lei Yu teaches in the department of genetics and the Centre of Alcohol and Substance Use Studies at Rutgers University in the US.
“The issue is in our heads,” says Yu, who suggests reframing it as a medical condition, rather than a cosmetic one. “There’s nothing to be ashamed of for people who have lactose intolerance, right? There’s no shame or stigma, and people always say, ‘Oh, I don’t drink dairy products.’ There’s nothing wrong with that.”

If we tell ourselves we’re intolerant to alcohol, “we don’t marginalise ourselves”, Yu points out. “You don’t isolate yourself or feel bad, and then you’ll have a healthier lifestyle.”

That isn’t to say I won’t indulge in the occasional martini or still go out drinking with my friends. I may, however, just cradle the same glass and take slow, steady sips.

Jenna Ryu is a Wellness reporter at USA TODAY

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