Physicians: Facial Flushing and Esophageal Cancer

WINE TALK
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I flush.

The articles deals with ALDH2-deficient people who facially flush when drinking alcohol.

Have any physicians heard of this? It was reported in 3/09. It may be found all over the internet, originally from the NIH.
Besides me, it could affect about 540 million others.

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Esop?

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employee stock ownership program?

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Maybe the thread title got chopped off?

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Esophageal Cancer I think…
blush

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Thanks, Ed. I have resubmitted title.

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I am one of the many who get this.
Can’t do anything about it unfortunately.
That might change with a drug called 4-MP(4-methylpyrazole) or Convivia.
Still going through testing.
In the mean time, screening and surveillance is the only logical path.

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A big question is:

Is all facial flushing from an ALDH2 deficiency? It strikes many Asians, but I’m European…

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I personally don’t think so.
Alcohol will cause vasodilation by itself.
I think this is the intense redness that you see after a few minutes more than quick vasodilation. You wouldn’t know unless you were tested.
I haven’t been tested.
Also, this is more common in Asians but not exclusive.

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welcome to my life

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I actually answer this question a lot for Asian friends who ask me about flushing. Keeps it fresh in my mind. It was covered in either the first or second class I took at Davis.

It does effect Asians the most, with Southern Asians having the highest reported rates. If I remember right it’s like 90% for Vietnamese then drops as you head north to about 10-15% when you reach Japan, with Cantonesse about 50%. It’s very rare, or maybe unreported in very northern Europe (Norway, Sweden, Denmark - the old Vikings). In non-Asian populations I think it’s a 1-2% average rate.

I’m doing all that from memory, maybe someone can go pull out their old textbooks and verify the numbers.

went and checked wiki:

Alcohol flush reaction - Wikipedia" onclick="window.open(this.href);return false;

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The bane of my existence. I can partially keep it in check by taking n-acetyl cysteine an hour or so before consumption. It (either by itself or by conversion to cysteine and then glutathione) helps bind with the acetaldehyde which is what ALDH2 deficient people can’t process as well as normal folks. It can be easily found in the nutritional supplements section of some whole foods/molliestones type places or at vitamin shops online.

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Barry…the general idea is that flushing is an indicator of Aldh2 deficiency. Though flushing does not prove an aldh2 deficiency. Aldh2 deficiency has been linked with an increase in the risk of esophageal cancer for those with moderate to high alcohol consumption, though moderate to high alcohol consumption is already a risk factor regardless of aldh2 status. The majority of these studies have been done in Asian populations.

The take home message I got from a quick look at the literature is that if you’re white and don’t drink heavily, don’t worry about flushing. And for the record, this is not medical advice. I’m a Ph.D., not an M.D. (though I did have to spend more time in school than the M.D.s [emot-words.gif])

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[/quote]
…I can partially keep it in check by taking n-acetyl cysteine an hour or so before consumption. It (either by itself or by conversion to cysteine and then glutathione) helps bind with the acetaldehyde…[/quote]

You’re making my head hurt. Nightmares of Stryer…

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The incidence of esophageal cancer in the USA is 0.005% or 5/100,000 people.
Your chance of getting in a fatal car wreck in your lifetime is pretty high. Close to 2% in some studies or 2/100.
Food for thought.

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a big risk for esophageal cancer is untreated GERD–gastroesophageal reflux disease, often precipitated or worsened by alcohol. So, if you have heartburn, get to your GI guy for endoscopy and treatment before you get Barrett’s esophagus and then cancer.

alan

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Good thoughts, Doctor.

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Interesting that it’s spread across populations like that. My mother always had it but she’s German. Must be one of the outliers.

I get it too, but not from wine so much as acid - citrus, strawberries, white wine. Can get it from simply thinking about those things.

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A noted test that some clinicians are using for inclusion in ALDH2 deficiency clinical trials, besides a history of ethanol/ facial flushing, is the following:

1 ml of 70% ethanol upon a 15 X 15 mm lint pad with adhesive tape backing. Place on upper, inner arm. Wait 7 minutes, and remove. Check for erythema for next 10-15 minutes. If erythema on skin exists, clinically, it is considered a positive ALDH2 deficiency.

How I did it:

1 ml of 75% ethanol (Everclear)
A 15 X 15 mm cut-up ‘cotton round’ (Used for removing make-up)
Medical tape backing

For me, results are negative.

I do have mild rosacea, so I’m chalking up the flushing as a part of that alone.