If you suffer from Asian flush, Asian glow, alcohol flush reaction or whatever you want to call it, you’ll know exactly how embarrassing it is. You’re not alone. With over 30% of Asians and a notable percentage of non-Asians experiencing a red face from alcohol, the problem is widespread and relatively understudied. We asked Jeik, a member of the SRQ Labs team, what it was like the first time he experienced the Asian glow: “I remember the first time my face went red from alcohol. It was about 15 years ago and I was at a house party trying to get the interest of a girl. The night was progressing pretty well. We were chatting and all signs were pointing in a positive direction. That was until she offered me a beer. A simple, innocent, cold, refreshing beer. I downed it with manly gusto, trying to hide the fact that i’d never drunk a full bottle of beer before. Little did I know, this would start a 20 minute count down to me becoming the focus of the room for all the wrong reasons.
It didn’t take long before I began to feel the skin on my face heating up and beginning to tingle. Not long after that it became harder to breath and I could feel my eyes becoming bloodshot. I could tell something was wrong by the concerned look on the girl's face. Then I heard a voice from across the room yell out “Look how smashed he is!”. At this point everyone’s eyes were on me, my face was pulsating and quickly becoming the centre of everyone’s attention. “Are you on drugs?” she asked as she distanced herself from the laughing stock of the room.”
What a curse! Alcohol is fundamentally rooted in most societies as a means of celebration, bonding and courtship. A glass of wine on a dinner date, after work drinks, an important client lunch, a bar full of hopeful singles, the list goes on. These are all situations where having blood shot eyes, a red face and looking like you’re on drugs will not go down well. To complicate things further, all out abstinence from drinking alcohol usually doesn’t go down too well either. Many Asian flush sufferers report feeling left out or excluded when they turn down an offer for a drink. In fact, in some cultures turning down an alcoholic beverage can be overtly rude and offensive to the person offering.
So, what does one do?
The answer is simple. Unlike the majority of Asian flush sufferers who simply see themselves as genetically excluded from the fun and enjoyment of social alcohol consumption, we at SRQ Laboratories never gave up. After decades of hard work and perseverance we finally cracked it! But wait… Before we get into that, we need to back up a bit and take a note out of the book of famous Chinese general, military strategist, and philosopher, Sun Tzu. In his widely renowned work titled The Art of War, Sun Tzu emphasised the need to “know your enemy”. Our enemy is alcohol flush reaction, so let’s take a moment to get to know it before we begin firing rockets.
2. Alcohol Flush Reaction - (i.e. Asian Flush or Asian Glow)
The condition we’re talking about here is when you get a red face shortly after consuming alcohol. This occurs because of a genetic deficiency in the way we metabolise alcohol in our liver. Simply put, when our body tries to break down alcohol it gets flooded with a metabolic by-product of alcohol called acetaldehyde.
In a healthy liver, acetaldehyde is broken down into a harmless non-toxic substance called acetate. However, in alcohol flush sufferers it isn't broken down adequately and ends up passing through the liver and into our system. This causes all kinds of unpleasant symptoms that are commonly reported to detract from the enjoyment of alcohol and cause people to feel embarrassed and self conscious.
2.1. What is acetaldehyde?
Acetaldehyde is produced by the partial oxidation of ethanol by the liver enzyme alcohol dehydrogenase. It is toxic and has been shown to irritate the skin, eyes, mucous membranes, throat, and respiratory tract when consumed at a high enough dosage. In this regard, it is little surprise that the symptoms of Asian glow include redness of the skin, redness and glazing of the eyes and difficulty breathing. Acetaldehyde also poses longer term dangers, being flagged in a 1999 study by Dr. Carreón-Valencia of the International Agency for Research on Cancer as "possibly carcinogenic to humans". In 2009, the IARC confirmed this and distributed a press release in which they stated: "Carriers of the inactive enzyme are extremely slow to metabolise acetaldehyde, as a result, they experience higher internal levels of acetaldehyde and have much higher risks of oesophageal cancer and cancers of the head and neck compared with individuals with the active enzyme."
As you can see, the toxic substance causing us to experience alcohol flush reaction is also causing us serious long-term harm because of our liver’s inability to break it down. So, why can’t we break down acetaldehyde like normal consumers of alcohol? The problem lies with an obscure liver enzyme that goes by the name of ALDH2.
2.2. What is the ALDH2 enzyme?
The ALDH2 enzyme is responsible for breaking down acetaldehyde into harmless acetate. As we’ve seen above, not only does it protect us from the likes of Asian glow, but it also ensures we are not exposed to the long-term carcinogenic effects of acetaldehyde. People with alcohol flush reaction have inherited a deficient ALDH2 enzyme from their parents, who inherited it from their parents, and so on. As a result, people are often told they can't do anything about it and advised to abstain from alcohol if they don't like going red. But the guys at SRQ Labs didn’t stop there. You see, whilst the enzymatic deficiency is permanent, it doesn’t mean the function of the enzyme can’t be boosted to break down acetaldehyde like any normal healthy liver. To understand how to do this we need to have a look at the various symptoms of Asian flush and how they are triggered.
3. Symptoms of Alcohol Flush Reaction
Here's a short video of a YouTube user describing her experience with the symptoms of Asian flush. As Alexi points out in the video, the most embarrassing symptom of Asian flush is a bright red face, usually accompanied by slight swelling around the flush affected areas. Other symptoms include:
Looking well presented and attractive is challenging enough without having to do so with a swollen red face. Think about the amount of time we spend shopping for nice clothes, doing our hair, makeup or whatever it is so that we can look our best for an important business lunch, dinner date or any kind of public social gathering. If you’re unlucky enough to have alcohol flush reaction then all of this effort goes down the drain after half a beer - and those of you nodding your head know exactly what we’re talking about.
Not only that but you can also throw in a pair of bloodshot red eyes, glazed over like you’ve spent the whole day smoking you know what. This is not a good look, especially if you’re trying to maintain a well presented image in a business context.
4. What Can Trigger Asian Glow?
The symptoms of Asian glow above are triggered by an acetaldehyde induced histamine release. If our livers could process acetaldehyde properly we would release fewer histamines and be able to enjoy drinking without a red face just like everyone else.
Luckily the amount of acetaldehyde our bodies are required to process, and the resulting severity of our red faces, can be controlled by managing the triggers at all stages of the flushing process. To do this we need to look at what happens from the moment alcohol enters our system, on to when it is processed by our livers, and finally when it causes our red face. Doing this allows us to understand, dissect and counter the triggers at multiple stages of the flushing process.
4.1. What are you drinking?
There are many additives used in the production of alcohol that can worsen the effects of Asian flush. Being aware of the kinds of alcohol that contain such additives and avoiding them can reduce the histamine load the body is required to handle. On such example is aged spirits. These are usually stored in wooden barrels for many years and as a result tend to accumulate molecules called tannins that have been shown to cause a minor histamine re-action in some people. This can exaggerate symptoms in people with Asian glow who are already trying to deal with the histamines from acetaldehyde.
Another example is red wine, which contains high amounts of tannins because of its dark colour and the oak barrels it is usually stored in. White wine can also have tannins too, so it is advisable to check online for commercially available low-tannin varieties of wine such as Beaujolais and Tempranillo. Another alcohol additive to watch out for is sulphites. Beer and cider both contain sulphites that have been shown to cause many people various unpleasant symptoms such as headaches and flushing. Combine this with the toxic effects of acetaldehyde and you’ve got yourself an Asian glow blow out! But wait a second, if aged spirits, wine and beer are all potential triggers of Asian flush, what is there left to drink? This was the precise question that confronted the guys at SRQ labs when disecting the additives in these common alcoholic beverages. In answer to this, they put together a highly comprehensive cocktail recipe guide, specifically designed with alcohol flushing in mind.
4.2. Deficient liver enzymes
As mentioned above, the flush inducing toxins in alcohol are usually broken down by the ALDH2 enzyme. People who flush from alcohol have a deficiency in this liver enzyme and this triggers a flow on effect that causes Asian flush. To correct for this deficiency, the ALDH2 enzyme can be assisted by glutathione, one of the most powerful anti-oxidants the body can handle. Glutathione is produced naturally in our bodies but is depleted rapidly whenever alcohol is consumed. This is why it is important to replenish your body's glutathione levels before and even during the consumption of alcohol.
Whilst glutathione does an excellent job of assisting the deficient ALDH2 enzyme, it is not perfect. As a result, there’s always a little bit of acetaldehyde and causes our bodies to release flush causing histamines. This is why it is equally important to control our reaction to these histamines with compounds that have anti-histamine and anti-inflamatory properties. As we will discuss later, antihistamines such as Pepcid AC and Zantac are severely outdated and pose unnecessary risks when taken with alcohol. This is why natural alternatives such as Quercetin and Bromelain are not only safer but, in our experience, more effective than their pharmaceutical alternatives.
5. Related Conditions
As mentioned above, there are many additives in alcohol that can cause unwanted side effects independent from alcohol flush reaction itself. Because of this, many people have incorrectly classified the Asian flush syndrome as an allergy to alcohol.
This is not the case. Furthermore, it should be noted that an allergic reaction to alcohol is extremely rare and, given the quantity of alcohol in one standard drink, a real allergy to alcohol can be devastatingly severe and sometimes even result in death.
The more likely explanation for a reaction to alcohol is sensitivity to one of the ingredients used in its production. Many beverages contain traces of yeast, wheat and even dairy to only mention a few. This is why if you have food allergies it is very important to be aware of the contents of every alcoholic beverage you consume to ensure there are no additional flush causing catalysts hiding inside.
6. Health Risks
Up until now we’ve focused on the short-term symptoms of Asian flush in the form of a red face, headaches, restricted breathing, etc. These are symptoms come in the way of enjoying alcohol and therefore it’s no surprise that they usually command the spotlight of most of the discussion about the topic. What is often overlooked are the more serious longer term risks. We’ll assume you’re all aware of the long-term risks of alcohol consumption in general. These are important considerations for anyone consuming alcohol on a regular basis. But what a lot of people don’t know about are the additional long-term risks specific to people with ALDH2 deficiency (i.e. Asian flush).
In 2009, scientists from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and Japan's Kurihama Alcohol Center conducted a study which showed a link between alcohol flushing and esophageal cancer, concluding that: “ALDH2 eficiency resulting from the ALDH2 Lys487 allele contributes to both the alcohol flushing response and an elevated risk of squamous cell esophageal cancer from alcohol consumption.”
This research was subsequently picked up and released to the public by the National Institutes of Health in a press release, going on to say: “Dr. Brooks cites the high mortality from esophageal cancer and the large number of individuals with the deficient enzyme, known as aldehyde dehydrogenase 2 (ALDH2).”
These findings have also been confirmed by the International Agency for Research on Cancer and have supported their move to classify acetaldehyde as carcinogenic to humans. Not only that, but they go on to describe various other dangers of sustained acetaldehyde exposure such as DNA damage and abnormal muscle development. With such an emphatic warning now considered to be factually and scientifically sound, it is surprising that most Asian flush sufferers are completely unaware of the long term dangers they face as a result of their deficient ALDH2 enzyme.
This further emphasises the importance of being conscious about the amount of acetaldehyde that is entering our bodies when we drink alcohol and the various ways to reduce it.
Luckily our bodies provide a warning signal by exhibiting the various symptoms of Asian flush. This means that we can know when we are being exposed to too much acetaldehyde and begin to do something about it.
7. Using Antihistamines for Asian Flush
The problem with using antihistamines to mask your alcohol flush reaction is that it ignores the root cause of why it is happening in the first place. As we discussed above, the root cause of the flushing is acetaldehyde exposure and, if you recall from the previous section, this can dramatically increase the risk of esophagael cancer. By simply masking the unpleasant side effects and doing nothing about the amount of acetaldehyde your body is exposed to, the use of Pepcid and Zantac can cause you to consume more acetaldehyde than you otherwise would and in turn put you at greater risk of such cancers.
Other sources claim that the consumption of anti-histamines actually have the effect of slowing down the metabolism of alcohol and the rate at which the body was required to process acetaldehyde. In this regard, the use of Pepcid AC and Zantac may play a role in reducing the amount of acetaldehyde that makes it’s way into our bodies when we consume alcohol, but the evidence is unclear and therefore the risks are still very real.
8. What’s Better Than Pepcid and Zantac?
The use of antihistamines like Pepcid and Zantac by alcohol flushers started back in the 80’s after a study found a link between the use of such antihistamines and the severity of a person’s alcohol flush response.
But we’re not in the 80’s anymore and science has since come a long way in determining the best way to drink alcohol without a red face - and it’s not with pharmaceutical antihistamines.
The key was in understanding that alcohol flush reaction can be addressed from two important angles rather than just one. Firstly, the body’s ability to break down acetaldehyde needs to be boosted to the level and functionality of a person who doesn’t have Asian flush. Secondly, the body’s histamine defences must be primed and ready to stop any reaction to the acetaldehyde that sneaks through the first line of defence.
In order to achieve this you can’t simply rely on popping an antihistamine and hoping for the best. The various compounds required for this level of defence need to be balanced to perfection in order to allow for the right amount of glutathione synthesis to occur whilst also maintaining an adequate level of histamine defence to finish off the job.
The smart guys at SRQ Labs have spent countless trials testing and refining the perfect balance of natural compounds that do exactly this.
Ayurveda reads it as
Pathology of this "flush" is summarised as aggravated pitta in blood and liver (rakta and yakrt) has been pushed up due to udaana and praana weakness.