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The redness reaction your face gets after ingesting alcohol is called Alcohol Flush reaction.

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Flushing is caused by a buildup of acetaldehyde (ADH1B), a toxic byproduct of alcohol metabolism. This is due to genetic variants, or mutations, in acetaldehyde and acetate (ALDH2), leading to prolonged elevation of ADH1B.

ALDH2 Gene Mutation can lead to prolonged high acetaldehyde levels, which causes flushing.

Approximately 36-40% of East Asians have the ALDH2 Gene Mutation and experience alcohol flushing and other symptoms such as nausea and tachycardia (increased heart rate).

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First, the enzyme, ADH1B, converts alcohol into toxic acetaldehyde.

The variant, rs1229984, speeds up the conversion which results in a faster buildup of acetaldehyde when ALDH2 is less present.

Some people have this variant, which causes them to absorb more toxics at a faster rate and results in flushing.

“These genes encode enzymes that metabolize alcohol into acetaldehyde (ADH1B) and acetaldehyde into acetate (ALDH2).” (Cho, 2023)

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Next, the enzyme ALDH2 converts toxic acetaldehyde from alcohol into harmless acetate in the body.

The variant, rs671, results in a less active ALDH2 enzyme, causing toxic acetaldehyde to build up.

Some people have this variant, resulting in flushing.

“Genetic variants in ALDH2 and ADH1B alter alcohol metabolism leading to prolonged, elevated levels of acetaldehyde.” (Cho, 2023)

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Ever had a few drinks with friends and noticed your face—or your buddy’s-- turning red?

I’ve read what happens to our bodies when we turn red—and why we should listen to it more.

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After ingesting alcohol, an individual may experience reddening of the face, headaches, and an increased heart rate.

This is called the Alcohol Flush Reaction.

Approximately 36% of East Asians experience alcohol flushing, linked to both biology and cultural environment.

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Genetic Influences on Alcohol Flushing in East Asian Populations

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The Asian Flush Syndrome: ALDH2 Deficiency and Long Term Health Consequences

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The Interaction Between Biological and Sociocultural Factors Increases Risk of Cancer in East Asian Alcohol Flushers

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ALDH2 deficiency and Acetaldehyde buildup can immensely increase the risk of certain cancers, even with light amounts of drinking.

Alcohol flush is caused by certain genetic variants in ALDH2 and other genes, increasing risks for cancer, cardiovascular disease, and Alzheimer's disease.

Acetaldehyde is considered a Group 1 Carcinogen.

“Excess acetaldehyde ...is also a known mutagen and animal carcinogen proven to cause DNA damage and have other cancer-promoting effects” (Zeng, 2023)

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Addressing alcohol flush reaction requires a good understanding of its genetic roots and the sociocultural environments that can increase its risks.

I've now learned a great deal after taking a deep dive into why I experience this reaction and understanding my body better.

Flushing isn’t only a symptom—it's your body’s way of staying alert to your health.

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ALDH2*1/*2 heterozygotes have 7x higher risk of esophageal squamous cell carcinomas (ESCCs).

There is a 13.5x higher risk of ESCCs if the individual is an alcoholic.

“The ALDH2*2 allele have been observed to be at higher risk for developing esophageal cancers in studied Eastern Asian populations, especially China.” (Zeng, 2023)

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Drinking heavily can lead to an increased risk for coronary artery disease, type 2 diabetes, and hypertension.

This risk can be independent of alcohol intake. While some conditions might be associated with alcohol use, conditions can also develop in people who do not drink alcohol.

“Studies have also linked ALDH2 polymorphisms with increased risk for cardiovascular disease and associated factors contributing to risk, mediated by alcohol consumption.” (Zeng, 2023)

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ALDH2 deficiency is linked to and can cause mitochondrial dysfunction and ROS, or reactive oxygen species.

According to Zeng, "ALDH2*2 allele results in an overall increase in late-onset AD risk, while similar results but higher ratios were found in Chinese populations.” (Zeng, 2023)

“Although evidence directly connecting the ALDH2*2 allele and Alzhiemer’s is not abundant, several risk factors such as increases in mitochondrial reactive oxygen species (ROS) and changes in essential cellular bioenergetics have been recorded, which can significantly increase risk for AD.” (Zeng, 2023)

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Cultural Norms in East Asian Communities

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Cultural Norms in East Asian Communities

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Cultural norms, workplace traditions, and peer influence can override biological deterrents and encourage risky drinking in flushers.

“47.1% of all respondents said that they drink regularly to socialize with co-workers and colleagues. 87% of South Korean employees drink at least once per week, and 23% binge drink.” (Zeng, 2023)

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Drinking Behaviors and Social Harmony in East Asian Communities

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Drinking Behaviors and Social Harmony in East Asian Communities

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Social harmony and collectivism are prioritised over individual needs in East Asian populations, and alcohol consumption becomes more of an adherence to group norms.

“In Japan, Ikkinomi, which involves gulping liquor in one shot and is a welcoming tradition in colleges and businesses, has led to acute alcohol intoxication." (Zeng, 2023)

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Drinking is framed as a group activity, where refusing alcohol can be viewed as socially disruptive.

Drinking is often tied to maintaining relationships and collectivism.

Workplace gatherings in Korea often involve heavy drinking for the sake of team bonding. In a study of 1,185 Korean drinkers, going out with friends made up 44.2% of drinking occasions vs. 27.5% at home meals.

“The protective role of flushing may be canceled out by the prodrinking social cultures of East Asian populations.” (Le, 2023)

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Unawareness of Flushing Health Implications

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Unawareness of Flushing Health Implications

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Many people are unaware that flushing can be a sign of long-term health problems.

“In a survey done in Singapore focus groups, those who experienced flushing reactions to alcohol did not consider themselves as having increased risks of experiencing short- and long-term effects from alcohol consumption, compared to non-flushing groups. 58% of the entire sample group did not believe that any connections existed between alcohol-flushing and long-term health consequences” (Zeng, 2023)

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In Le's study, drinkers with a recognized flushing were interviewed about their alcohol use and their flushing tendency. Every participant was asked if they felt embarrassed about their alcohol flush reaction.

Japanese participants of a study were seen to be less embarrassed about flushing than Japanese-Americans, emphasizing a difference in how the symptom is socially perceived in different countries.

"These observations demonstrate that drinking behavior in East Asian individuals is strongly influenced by both cultural customs and social engagement.” (Le, 2023)

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Only about 42% of flushers know the long-term health risks.

According to studies, flushers often overestimate their ability to drink due to peer pressure and drink more than intended. They can participate in high-risk drinking at gatherings or work-related activities. It also mentions that more than half of the people with alcohol flush are unknowing of the health risks associated with flushing.

“Flushers overestimate expectations from their peers and drink more than what their peers expect of them.” (Le, 2023)

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Health warnings may not be enough. Prevention will be most effective if it addresses both the scientific and the cultural aspects of drinking.

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Education, genetic screening, and other ways to reduce risk are important for people who experience flushing.

"A meta-analysis proved brief alcohol-control intervention programs to be effective in patients evident through 6 and 12 month check-ups and showed a mean decrease of approximately four drinks." (Zeng, 2023)