Asian Flush Syndrome: Is Alcohol Giving You a Red Face?

Getting a red face after downing a couple of alcoholic beverages is not a sign of strong qi (energy flow) or good blood circulation, but rather, it is an indication that your body is not metabolising alcohol efficiently. This phenomenon called Asian Flush Syndrome is common among Asians of Chinese, Japanese and Korean descent.

“If you are Asian and drink alcohol frequently, you may have a higher risk of getting stomach or oesophageal cancer or peptic ulcers due to a genetic inability to efficiently process acetaldehyde, a toxic by-product of alcohol metabolism,” says Dr Victor Lee Tswen Wen, Consultant Surgeon, Department of Hepatobiliary & Transplant Surgery, Singapore General Hospital (SGH).

How well the body metabolises or breaks down alcohol is dependent on two enzymes:

  1. alcohol dehydrogenase which converts alcohol into acetaldehyde and
  2. acetaldehyde dehydrogenase (ALDH2) which breaks down acetaldehyde into harmless substances.

Because 80 per cent Asians have an overactive alcohol dehydrogenase, they tend to break down alcohol into acetaldehyde faster — up to 100 times faster. As alcohol is broken down faster, there may be little to no alcohol “buzz”.

Making things worse, most Asians have an inactive variant of the liver enzyme ALDH2, which means that acetaldehyde takes much longer to clear from their blood.

Asian flush syndrome and your risk of cancer

The build-up of acetaldehyde is what causes blood vessels to dilate and the face to turn red – the so-called “Asian flush syndrome”. The problem goes beyond aesthetics: Acetaldehyde is more toxic than alcohol and a known cancer-causing agent.

“Acetaldehyde can trigger inflammation in the upper gastrointestinal tract, cause DNA damage and increase your risk for gastrointestinal diseases, namely oesophageal and stomach cancers as well as peptic ulcers,” says Dr Lee.

If you have Asian flush syndrome and drink two beers a day, your risk of oesophageal cancer is up to 10 times higher than that of a person who has normal ALDH2.

Signs of the Asian flush syndrome

  • Facial blushing
  • Rapid heartbeat
  • Nausea
  • Headaches

Tips to cope with Asian flush syndrome

1. Don’t drink, or drink moderately

If you must drink, drink moderately. Men should limit themselves to two standard alcoholic drinks per day and women should stick to a maximum of one alcoholic drink per day. One standard alcoholic drink: 1 can of beer (355 ml/5% alcohol) or 1 glass of wine (about 150 ml/12.5% alcohol).

2. Avoid binge drinking

Binge drinking overloads the body’s ability to metabolise alcohol. If you suffer from the Asian flush syndrome, wait till the redness subsides before taking another drink to avoid acetaldehyde overload. Besides, the liver can only metabolise about one ounce (30 ml) of alcohol per hour (equivalent to less than 1 can of beer or 1 glass of wine).

3. Choose drinks with less alcohol content

Read the bottle labels. Choose red or white wines with 12.5% or less alcohol per volume (APV). Beers, wine coolers, table wine and sparkling wine have lower APV than spirits.

4. Eat before and/or whilst you drink

A full stomach protects the stomach lining against excessive irritation due to alcohol. Snacking on fatty and carbohydrate-rich foods such as seeds, nuts, cheese, pizza, pasta and bread can also prevent the alcohol from entering the small intestines too quickly and thus can slow down the rate of alcohol absorption.

5. Drink plenty of water and/or alternate with non-alcoholic drinks

Because alcohol is a diuretic, it can increase your thirst. Quench your thirst with water or non-alcoholic drinks instead of with more alcohol.

-Teresa Cheong for Health Xchange, with expert input from the Department of Hepatobiliary & Transplant Surgery at the Singapore General Hospital (SGH).

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