A S I A N V O I C E S 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.
Rosalie Chan On assignment for HuffPost

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.

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.