Why do Asian people turn red when they drink alcohol?

Q: I turn really red after drinking alcohol.  I’ve been told it’s because I’m Asian.  Is that true and if so, is there anything I can do to prevent it?

A:  Unfortunately, it is true and a fairly common problem – it’s estimated that 50% of people of Asian descent suffer from the “Asian flush” when drinking.  Some have it worse than just turning red; more severe reactions can include swelling, nausea, vomiting, chest pain, vertigo, palpitations and low blood pressures.   

The problem arises from an inactive enzyme called acetaldehyde dehydrogenase, which breaks down a toxic byproduct of alcohol metabolism called acetaldehyde.  When acetaldehyde accumulates in the body it causes the symptoms mentioned above.  While this can be annoying, there is no evidence to suggest any long-term side effects from the buildup.  The amount of alcohol needed to produce the reaction varies from person to person.

An article that I recently read in Time Magazine suggested that the reaction is actually a trait that evolved in the ancient Asian population to protect against alcoholism.  Recent studies do show that there is a much lower rate of alcoholism in individuals with the inactive enzyme, for obvious reasons.  In fact, there is a medication used to treat recovering alcoholics called Disulfiram (“Antabuse”) that blocks the acetaldehyde dehydrogenase enzyme to cause an artificial “Asian flush” reaction and therefore make drinking alcohol less appealing.

Inheriting the inactive enzyme is genetic, so one or both of your parents also probably has the condition.  Since there is no way (yet) to replace the inactive enzyme, the only way to avoid the flush is to avoid alcohol.  That may make for a lame New Year’s Eve, but at least now you know what causes your redness and you have a good excuse to abstain the next time your friends want to go out drinking. 

Adam Brandeberry, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)

photo: sloonart2008.blogspot.com