ASIAN VOICES
05/22/2018 09:00 am ET Updated May 24, 2018

The Definitive 'Asian Flush' Guide: What To Know If You Get The Glow

If you turn red when you imbibe, having more than 5 drinks a week could signal danger — and Pepcid isn't really a solution.

Depending on how much he’s eaten that day, Julius Liu says he’ll turn “beet red” after having half a beer or so. He said he’s learned a few hacks over the years to control it, like spacing out drinks, eating a meal or stepping outside.

The response is commonly known as “Asian flush” or “Asian glow.” It’s been associated with embarrassment and low alcohol tolerance. 

“The peer pressure was hard to balance with this condition, socially and biologically,” Liu, 44, told HuffPost.

Approximately one-third of people of East Asian descent experience the “glow,” a response to drinking alcohol that includes facial flushing, nausea and itchiness. An estimated 540 million people around the world experience this, though it mostly affects Asians.

If you search the internet, there are countless articles on how to prevent “Asian flush,” such as by taking Pepcid, which is otherwise used for treating heartburn or upset stomach. And people go to great lengths. But experts say we shouldn’t necessarily be using preventative measures, and should be listening to our bodies instead.

“Asian flush” is actually a biomarker to tell people who experience it to stop drinking.

“If you regularly drink alcohol and you carry the Asian flush, it’s possible that you have cumulative damage over you,” said Ketan J. Patel, a researcher at the MRC Laboratory of Molecular Biology who has studied the flush. “Since we’ve never lived this long, we don’t know what the consequences might be as we live longer and longer.” Patel would like to further his research in how alcohol damages DNA.

A recent study found that those who drink alcohol and carry the gene that causes the flush may be at a higher risk of cancer.

If you’ve experienced “Asian flush” or have seen it in a friend, here are the answers to why it happens and what the effects of it are.

First of all, why do we struggle with metabolizing alcohol?

To break down alcohol, there are a couple of enzymes involved, experts explain. The first enzyme is called alcohol dehydrogenase, which converts alcohol into a toxic molecule called acetaldehyde. The second enzyme, called acetaldehyde dehydrogenase (ALDH2), breaks down and metabolizes acetaldehyde. People who experience facial redness when they drink have a mutation in this second enzyme, making it less efficient or even inactive. The flush is an indication of toxins accumulating in the body.

Acetaldehyde also triggers the release of histamine, which causes increased blood flow to the skin, leading to redness and itchiness.

DragonImages via Getty Images

What’s the historical context? I heard it’s something about how we boiled water and made tea instead of drinking alcohol back when water wasn’t drinkable. Are these stories true?

It’s estimated that the genetic mutation that causes “Asian flush” first appeared 10,000 years ago in southern China. Over the centuries, as people migrated, the gene started to take hold in the Asian population, and it’s now a common genetic mutation in Asia.

What does it mean if I get the flush? Apparently I’m damaging my DNA?

In the short term, Asian flush is just one of the effects of acetaldehyde accumulating in the body. However, a high concentration of toxins can damage DNA in the long term.

“It’s also directly toxic to cells in the body,” said Dr. Aaron White, senior scientific advisor to the director at the National Institute on Alcohol Abuse and Alcoholism. “It can damage DNA and is probably responsible for some of the cancers that develop in people who drink heavily, particularly, cancers in the head and neck area.” White said it may also lead to esophageal cancer, which is more often than not related to drinking and smoking. There’s mounting evidence that people who have a mutation in acetaldehyde dehydrogenase and experience getting flushed are at a much higher risk of developing esophageal cancer.

“If people get it, it’s your body’s way of telling you it’s not good for your body,” White said. “It means you should keep your alcohol intake to a minimum. When you damage DNA, it increases the likelihood of cancer. It increases the likelihood that cells won’t replicate correctly and will become cancerous.“ If you get Asian flush, it’s better to drink less.

There can be social pressures around drinking — in many cultures, for example, drinking is a sign of masculinity. But binge-drinking increases one’s chance of cancers in the mouth, stomach and esophagus. High levels of drinking over a long period of time will impact one’s health, and it’s even more risky when paired with exposure to other carcinogens, such as from smoking.

So should I be drinking at all? I know it’s hard to say how much, but what’s a general benchmark?

“We don’t know the answer to that because no one is studying people with Asian flush long enough,” Patel said. “If you have Asian flush and drink above five units of alcohol a week, the risk of cancer is quite high.”

That being said, Patel says there’s no general benchmark. “It’s not my job as a scientist to tell people whether they should drink or not; it’s just to lay out the evidence,” he said.

The effects of alcohol will vary from person to person, and it’s best to listen to the signs of your body, as heavy drinking could lead to damage to cells and DNA, as well as liver inflammation.

What’s the deal with Pepcid?

Pepcid blocks histamine receptors, so it will reduce symptoms like flushing. However, it will not protect you from long-term effects and inflammation. While these drugs can stop the appearance of Asian flush, they will not do anything about the histamines circulating, says Dr. Daryl Davies, clinical pharmacy professor at University of Southern California.

In the advent of the Internet, it’s become more popular to use them as an antidote to the flush. “They weren’t developed to be used to mask Asian flush, but they’ve become quite popular in the Asian community now,” Davies said. “It’s really not a smart decision. You’re simply hiding the reactive agents that are trying to protect you.“

What about these alcohols that claim to reduce acidity?

Alcohol does not reduce acidity. It increases acid levels in the gut and can irritate the stomach.

Do Asian alcohols make any difference?

No, they don’t, Davies says. The ADH enzyme metabolizes all alcohols into acetaldehyde, whether it’s beer, wine, whiskey or sake. However, the more diluted the alcohol is, the lower your alcohol levels will be, and the smaller the impact on your body. For example, drinking a beer will have a slower impact on your body than taking a shot. But in terms of health response, alcohol is alcohol.

Do different groups of Asians experience this differently?

Asian flush is most commonly seen in East Asians, such as Chinese, Japanese and Korean people. However, this characteristic depends on the gene. Different individuals will have different severities of this enzyme deficiency. There hasn’t been much genetic testing on this enzyme as it’s not a lethal mutation, although one study estimated that one-third of East Asians have this.

“Most Asians who have this mutation have no serious consequences unless they drink. If they have flushing, they know they have that level of mutation,” Davies said. “If have the deficiency, it’s no big deal. It just tells you if you can or cannot drink certain amounts of alcohol ... Drinking in moderation is good. Binge-drinking is bad in any society, regardless of whether you have the genetic mutation or not.”

How about non-Asians who experience flushing after drinking?

Non-Asians can experience facial flushing also. For example, 3 to 29 percent of Caucasians experience it. For Caucasians, an increased incidence of flushing is associated with a familial risk of alcoholism. However, the flush is more prevalent for Asians. The main takeaway is this: If you are experiencing flushing or irritation after drinking, it’s a sign from your body to stop.

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