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)

This is called the Alcohol Flush Reaction.

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

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)

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

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).

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)

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. 

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)

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)

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)

“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)

“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)

“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)

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)

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)

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)

"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)