When an individual gets a red face after drinking alcohol, people will generally think of the syndrome called Asian flush. Also sometimes called alcohol flush reaction or Asian glow, what we are in fact colloquially referring to here is one of many reactions to a genetic abnormality that prevents the proper metabolism of alcohol.
Who is at risk?
This genetic abnormality is typically, but not exclusively, carried by people of Asian descent. According to a 2007 study, approximately 36% of people of Japanese, Chinese and Korean origin experience flushing from alcohol.
A subsequent literature review confirmed these findings, further adding that:
The ALDH2*2 allele appears to be most prevalent in Chinese-American, Han Chinese and Taiwanese, Japanese, and Korean samples. Much lower rates have been reported in Thais, Filipinos, Indians, and Chinese and Taiwanese aborigines
Despite the weight of research indicating a strong prevalence among Asians, the reality is that anyone can be born with this genetic abnormality and experience a flushing response from alcohol.
Individuals usually report feeling a warm numbness or tightness in their face 10 to 20 minutes after consuming alcohol. This then escalates to more of a pulsing or throbbing feeling and coincides with the skin around the eyes and face turning red. The facial redness and other symptoms usually remain for about 1 to 2 hours depending on the amount of alcohol consumed.
Scientifically speaking, the flushing reaction is a hyperemia induced erythema, typically associated with, but not isolated to, superficial capillaries in the facial region. More simply put, it is a redness of the skin caused by increased blood flow to near surface veins in the affected areas.
This flushing is the most noticeable of many symptoms and is caused by build up in the body of a substance called acetaldehyde, a toxic byproduct of alcohol metabolism.
Learn more about symptoms.
Causes & Triggers
As mentioned above, the condition is genetic, i.e. you’re born with it. This doesn’t mean you have some kind of disease from birth until you die. In fact, it is precisely what you don’t have that gives rise to all the problems.
What we lack is an enzyme called aldehyde dehydrogenase 2 (ALDH2). This enzyme is usually responsible for converting toxic acetaldehyde into relatively non-toxic acetate during the metabolism of alcohol.
On the one hand, people with this genetic variation tend to metabolize alcohol faster and in turn produce more acetaldehyde in a shorter period of time.
This is further complicated by another genetic deficiency in an enzyme that is normally responsible for breaking acetaldehyde down into a non-toxic substance.
These two genetic factors contribute to the acetaldehyde build-up and are amongst the main, but not the only, causes of the underlying syndrome.
Learn more about causes & triggers.
Whilst symptoms can be uncomfortable for the drinker, the short term risks are minor and more likely associated with alcohol intoxication rather than anything to do with the condition itself.
Moreover, given the discomfort typically experienced by drinkers who have this condition, it is much harder to get sufficiently intoxicated to the point where they are at risk from over intoxication. In this regard, the condition has been seen as a safeguard that prevents individuals from the various risks that face regular drinkers, such as alcoholism.
Importantly, this condition should be distinguished from other related conditions that pose significant short-term risks to the drinker, such as an allergy to alcohol.
In contrast to the minor short term risks, the long term risks are real and significant. Numerous governmental health bodies have flagged acetaldehyde as a known carcinogen and have publicly warned people who flush from alcohol of the health risks that arise as a result of continued alcohol consumption.
In this regard, it is extremely important to be aware of these health risks, drink alcohol in moderation and follow appropriate safety measures to avoid prolonged acetaldehyde build up in your body.
Learn more about health risks.
Conditions often confused with Asian flush are the various allergies associated with alcohol. Despite the apparent similarities in the short term symptoms, the causes and dangers surrounding them are vastly different.
Learn more about related conditions.
Real Life Experience
Upon surveying a large number of sufferers, the overwhelming feedback was that they were frustrated about not being able to enjoy alcohol like everyone else.
This is understandable when you consider the role alcohol plays in the social fabric of many societies. From celebrating, dating, fine dining to doing business, alcohol does, and most likely always will, play a big part in these facets of social interaction.
It’s no surprise then that not being able to fully participate in these social norms often leaves sufferers feeling excluded. This is not because they can’t drink alcohol – they can. It is because the physical symptoms (red flushing, facial swelling, red eyes, etc) are unsightly, and it is precisely in these moments that people want to look their best.
This video was posted by a fellow sufferer. She describes some of the physiological symptoms discussed above along with the accompanying feelings of embarrassment commonly reported by surveyed subjects.
At the end of the video she makes a very good point. This is something that a lot of people go through and, as she so rightly states, there must be something we can do.
What Can We Do?
First and foremost, getting educated about the condition is the best first step anyone can take if they want to learn how to deal with it.
The majority of medical practitioners will have you believe that the glow is genetic and the only way to avoid it is to abstain from alcohol consumption altogether.
Along with being rather unhelpful, this commonly heard piece of advice is also somewhat outdated. As we will explain below, there are now a number of things one can do to combat their symptoms.
1. Pre-Drink Pills
People like the idea of a quick fix to their problems, like a magical pill that makes everything go away. The reality is that, whilst there are many concoctions that have been shown to aid the reduction of alcohol flushing, relying solely on a pill has it’s major drawbacks. Like they say on nearly every dietary supplement being sold today, “vitamines are not a substitute for a normal healthy diet”.
That said, these pre-drink pills are helpful and having a knowledge about what they contain and how they work is vital for anyone looking to manage their flushing problem.
1.1. NAC (N Acetyl Cysteine) Based Formulations
As we mentioned above, the key cause of our unwanted symptoms is a toxic by-product of alcohol metabolism called acetaldehyde.
In a 1995 study conducted on rats, researchers discovered that the administration of NAC, prior to dosing with alcohol, significantly reduced their levels of blood acetaldehyde.
The researchers concluded by saying:
Increase in blood acetaldehyde with ethanol treatment was significantly attenuated with N-acetyl cysteine treatment. These results suggest that acetaldehyde may be the cause of ethanol-induced hypertension and elevated cytosolic free calcium and renal vascular changes.
Whilst they were examining the effect on alcohol induced hypertension rather than flushing, the underlying culprit is the same – i.e. acetaldehyde.
In addition to experimenting on rats, a small number of low profile clinical trials have been conducted on humans too. The purpose of these trials was to specifically test the effect of NAC on blood acetaldehyde and whether this had any effect on flushing.
The results showed a noticeable change in blood acetaldehyde when NAC was taken before consuming alcohol. The catch is, one must continually dose with NAC in order to sustain the subdued levels of acetaldehyde when drinking more than one drink. This usually involves a pre-drink dosing and then re-dosing every hour thereafter for as long as they would like to continue drinking.
1.2. Antihistamines (i.e. Pepcid AC)
There is a scattering of research and a strong base of anecdotal evidence to suggest that antihistamines like Pepcid AC or Zantac can be effective in reducing the flush response from alcohol.
One such study conducted in the United States found that some antihistamines (specifically H2 receptor antagonists) may have the ability to ‘activate ALDH isozymes’ and thereby assist in reducing the amount of acetaldehyde that makes its way into our system.
Another theory is that antihistamines have to effect of slowing down the metabolism of alcohol, thereby giving ALDH2 deficient drinkers more time to break down the toxic metabolic by-products of alcohol – i.e. acetaldehyde.
According to the bulk of anecdotal evidence, it does appear that these antihistamines work in varying degrees from person to person. This variation is most likely due to improper dosing and timing of ingestion.
To find out more you can read our overview of alcohol flushing products, which takes a look at all the pre-drink pills currently available and their effectiveness in dealing with the condition.
2. The Holistic Approach (Best Results)
Like most health conditions, popping pills is not the best and most sustainable solution. This is because our bodies have a tendency to build a tolerance and render whatever pill it is to be less effective over time.
The genetic abnormality that gives rise to Asian flush is no different. This is why the most effective way to tackle the problem is from multiple different angles. By doing so, we can bring our bodies to an optimal state that is better able to deal with our genetic shortcomings when it comes to metabolizing alcohol.
In addition to the risk pre-drink supplementation,
2.1. Pre-Drink Procedures
You might be surprised to hear that there are many things you can do to prepare your body for alcohol that does not involve taking anything like a pill.
Various aspects such as the timing of alcohol consumption, when you start drinking and what you do before you drink has been shown to have a drastic impact on the level of alcohol flushing experienced.
We rounded up a group of willing participants to test out a few simple pre-drink procedures to see whether they had any impact on the severity of alcohol related flushing.
The first group were told to drink 2 standard drinks as they normally would. The second group were given a few simple guidelines to follow before and during their drinking.
The second group all showed drastically reduced redness and other related symptoms, without having taken a pill of any kind. This indicated to us that the timing and manner of consuming alcohol has a significant effect on the flush response experienced.
2.2. Dietary Alterations
Another factor that we found to play an important role was diet. Like with any condition, the severity experienced by the sufferer can be drastically altered simply by receiving the right kind of vitamines and amino acids via their daily eating habits.
The various supplements that have been made available for people with alcohol flush reaction simply aim to compensate for what our bodies need and are lacking in our everyday diet. Therefore, maintaining a diet rich in these particular vitamines and amino acids reduces the need for supplementation and maintains the body in a optimal state for alcohol metabolism and acetaldehyde reduction.
Moreover, being aware of what foods exacerbate flushing is also of upmost importance. Like any histamine based reaction, there are some foods that should be avoided altogether in order to reduce the severity of the reaction.
A few simple and painless alterations to ones diet can ensure their bodies are kept in an optimal state for alcohol consumption and free of any food based substances that will make their condition worse.
2.3. Alcohol Selection Guidelines
Finally, when taking a holistic approach, one must pay particular attention to the kind of alcohol they consume. This is because, similar to the foods that should be avoided, certain types of alcohol have been brewed or mixed with substances that aggravate the flush response.
Therefore, being aware of what is contained without the alcohol you are drinking is vital and can mean the difference between a night out with a bright red face and experiencing no red face at all.
3. Applying the Holistic Approach
Combining the above-mentioned factors with the right supplementation is by far the best way to avoid the glow – this is the undeniable truth that you will not be told by someone marketing you a solution in a bottle.
If you would like to apply this approach and try it for yourself, you can read more about our empirically tested Asian flush cure or contact us for more information.