PSA/ Health Alert: For people who turn red when they drink

This post is a PSA of sorts to any wine drinkers out there who turn red when they drink - experiencing what has been colloquially termed “Asian Flush” or “Asian Glow” (because about 30-50% of people of East Asian descent seem to experience this problem) but can affect drinkers of many different genetic backgrounds. I came across a study published by the medical journal PLoS Medicine that finds that alcohol drinkers who are subject to this condition are at a greatly increased risk of developing esophogeal cancer; the study was published in 2009, so it’s not news, but it was news to me, so I thought I’d share it with any wine lovers who may be reading this who experience the flush response to drinking alcohol.

For those who are averse to tracking through the details of the article about the study, here’s my super-simplified, in-a-nutshell-but-I’m-not-a-doctor version. If you are a person who turns red when they drink, but can actually drink at some level of comfort, you may well have an inherited deficiency in an enzyme necessary to properly metabolize alcohol (called aldehyde dehydrogenase 2, or ALDH-2). Apparently, alchohol in alcoholic drinks is metabolized in 2 steps: step 1) from ethanol to acetaldehyde and then step 2) from acetaldehyde to acetate. People who experience the flush reaction but can drink more than a nominal amount of alcohol turn red and experience other symptoms when their ALDH-2 deficiency causes them not to be able to metabolize acetaldehyde quickly enough.

The problem is, acetaldehyde is a known carcinogen. According to the study, people who experience the flush reaction have an increased risk of esophogeal cancer even if they drink only moderate amounts of alcohol; the New York Times article about the study notes: “An ALDH2-deficient person who has two beers a day has six to 10 times the risk of developing esophageal cancer as a person not deficient in the enzyme.” Heavy drinkers have it even worse - the NIH article about the study explains: “Notably, these studies showed that individuals with the inactive variant who drink the equivalent of 33 or more U.S. standard drinks per week have a 89-fold increased risk of esophageal cancer compared to non-drinkers.” Moreover, although the incidence rate of esophogeal cancer seems low (from less than 2% up to about 4% in most countries from what I’ve read), the survival rates are low - the PLoS study cites five-year survival rates of 15.6% in the United States, 12.3% in Europe, and 31.6% in Japan.

So what’s a wine lover to do if they do experience the flush reaction when they drink wine? To eliminate the increase in risk completely, you’d have to cut out alcohol from your consumption entirely. If that’s not an option, I would encourage drinking less often, and drinking lower-alcohol wines. Perhaps you can drink less wine per week, take more days off from drinking any wine, or replace that 16% alchohol fruit bomb with a refreshing moscato d’asti or a wonderfully mineral and complex riesling that clocks in at only 8% alcohol. Whatever you decide, please keep your health in mind whenever you indulge in the enjoyment of a wine hobby.

Links:

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000050" onclick="window.open(this.href);return false;

http://www.nytimes.com/2009/03/21/health/research/21alcohol.html?_r=1" onclick="window.open(this.href);return false;

http://www.nih.gov/news/health/mar2009/niaaa-23.htm" onclick="window.open(this.href);return false;

I don’t have time to read the study, but I certainly hope they have not confused causation and correlation.

I wonder if the enzyme could be taken as a supplement?

Jim, I don’t think they’ve confused the two concepts - the study discusses a strong link between the risk and alcohol consumption, etc. Please let me know if something I wrote implies otherwise, as I’d like to fix it if I’ve mischaracterized anything.

Poppy, I wonder the same thing- or perhaps no one has thought there was enough of a market for it. Perhaps the China market will change that.

Oh I wasn’t implying that at all, Alan. I am just very skeptical of much of what goes for science these days.

Cheers, my friend.

I get flushed on occasion but not every time that I drink. I spoke with my doctor a while back who recommended Pseudoephed or an anti-histamine to prevent it. He believed that I was slightly allergic to alcohol. I doubt that helps the cancer issue but if you don’t want to turn red it sure works. Thought I’d let you know.

If antihistames work for you, I wonder if your redness might not be related to the condition mentioned in the article, or if the medication is masking the symptom without addressing the cause.

Thanks for your posts, Chris and Doug. I believe antihistamines can reduce the redness but as Doug suggests, it may be only masking the problem as it relates to increased cancer risk. The PLoS paper included this statement: “Furthermore, anecdotal evidence indicates that some young people view the facial flushing response as a cosmetic problem and use antihistamines in an effort to blunt the flushing while continuing to drink alcohol [28]. This practice is expected to increase the likelihood of developing esophageal cancer.”

Taking enzymes as supplements (like a vitamin pill) generally can not work because the enzymes are protein – your digestive system sees them as a bit of hamburger and rips them up into amino acids.

What is confusing is that of course we have Lactase which is an enzyme that is sold in pill form. But Lactase can work outside the body, one strategy is to add it to your milk before you drink it. When you take a lactase tablet the enzyme is active in your stomach and gut for a short time before it gets destroyed.

The Acetaldehyde is not produced in the gut but in the cells, I think mostly in liver cells, so the enzyme would need to be closer to the site of action, and that just isn’t possible.

MODS → shouldn’t this be moved to the Asylum where it won’t scroll off every five minutes??

Thanks Frank, that’s a very helpful explanation.

Mods, perhaps we can leave this in Wine Talk for a few more days (would like for the weekday crowds to see it) then maybe move it to Wine 101 for longer term exposure?

I wonder if this is mostly Chinese or if it also affects Japanese, Korean, Thai?

I can probably look it up. This is a nice article but nothing about ethnicity.

http://en.wikipedia.org/wiki/Alcohol_flush_reaction" onclick="window.open(this.href);return false;

only my ears turn red when i drink (but shhhhhhh, only my wife has noticed this). i wonder what could cause this???

Thank you for posting this. I have been concerned about this issue. I am 1/2 Filipino…and I turn red when I drink…but, not as much as I use to. I recently had an upper GI…and found out that I have minor esophageal erosion…and was told I have GERD. (Gastro-esophageal Reflux). I was placed on Prilosec and Tums…Definately an eye-opener for me…

As an ABC, I suffer from this. I find that N-acetyl cysteine or NAC (easily available online or at Whole Foods or any supplement store) helps with this a lot if drinking at a leisurely pace. NAC is used in hospitals for tylenol (acetaminophen) poisoning which is toxic to the liver. For acetaldehyde, the NAC increases cysteine and glutathione levels in the liver, both of which scavenge acetaldehyde.

http://www.vitacost.com/NSI-N-Acetyl-Cysteine" onclick="window.open(this.href);return false; (no affiliation, but I like vitacost’s house brand NSI and their prices)

Not orally no.

See my above post for n-acetyl cysteine which is about as close as one can get to an oral otc/supplement anti-acetaldehyde pill.

Okay, since we’re all confessin’ here, I get flushing (“wow, have you been out in the sun?”) about 90% of the time - sometimes with just one sip. Interestingly, this never occurred prior to ~'05. Have GERD as well, and been on Prilosec for many years. Endo in '06 showed no Barrett’s.

It can affect all Asians. Some, a higher percentage than others.
Note that while predominant in Asians, non-Asians can carry this enzyme deficiency as well.

Cary, your avatar got me, because Ken Vastola used it for about a year.

And I know what “ABC” means but was having a big problem figuring out how it applied to Ken…

I see you’ve added kanji to the image which might help.

Take. Aciphex.it has a healing.esophagus affect

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Or is that effect

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