Drinking until you're red in the face

BY ARIKIA MILLIKAN
Associate Editorial Page Editor
Published March 5, 2008

For many college students, drinking is a way to relax. But for a certain subset of people, there's nothing relaxing about an after-class beer. Consuming even a single alcoholic drink brings them embarrassing or unwanted attention, and physical discomfort.

Clif Reeder
Your body has two primary enzymes to break down alcohol. Alcohol dehydrogenase converts alcohol into acetaldehyde, a toxic substance. Normally acetaldehyde is rapidly converted to acetic acid by acetaldehyde dehydrogenase, and eventually carbon dioxide an
Clif Reeder
Some people turn to over-the-counter remedies to treat the flush. (SHAY SPANIOLA / Daily)

"I get called tomato, cherry. Or I'll be compared to something red in the room," LSA junior Annie Layno-Moses said. "Like, 'Hey, you're as red as that girl's lipstick.' "

Layno-Moses experiences a condition known as an alcohol flush reaction. It is also commonly referred to as "Asian flush syndrome" or "the Asian glow" because it occurs frequently in certain Asian populations. Several studies estimate that about 50 percent of Chinese, Japanese and Korean people have this condition, weakening their ability to process alcohol. But these terms are somewhat misleading because any person can experience this reaction, regardless of their ethnicity.

As it turns out, whether or not someone gets a flushed face after drinking, and a slew of other symptoms including nausea, vomiting, increased heart beat and dizziness - is dictated by the same thing that determines most of our other physical traits: our genes.

When most people drink alcohol, enzymes in their guts break it down and turn it into things that the body can eliminate as waste or store for energy. But some people have genetic mutations that keep the enzymes from doing their job, causing acetaldehyde - a toxic substance - to build up in their blood when they drink.

Robert Winfield, director of the University Health Service, said certain ethnicities may be able to tolerate alcohol better than others for the same reason that men typically have a higher tolerance than women - they come equipped with stomach enzymes that are more efficient at processing alcohol.

There are different genetic variations that all result in complications with this enzyme, but what the exact effects will depend on the kind of hereditary machinery you're packing. As with other genetic quirks, you can thank mom, dad or both for this one. Each parent bequeaths a copy of the gene that codes for acetaldehyde dehydrogenase (ALDH2), the enzyme that breaks down alcohol's toxic byproduct, acetaldehyde. Drinking side effects differ in intensity, depending on whether a person has one, two or no mutant copies.

Studies suggest that the ALDH2 mutation that causes alcohol flush is dominant, so one dose of the mutant gene will result in physical symptoms. But the dominance is "incomplete" because the physical reactions of people with one normal gene and one abnormal gene differ. In some cases, such people experience hardly any symptoms - the regular copy of the gene picks up the defective copy's slack by making enough enzymes to eliminate the toxins before too much builds up.

People who have a double dose of mutated genes will almost certainly show flushing symptoms when they consume alcohol. Not surprisingly, it's almost unheard of for these homozygous individuals to end up as alcoholics. Large-scale studies throughout several populations have shown that there is less alcohol use and abuse among Asians.

The enzyme disorder is so effective in deterring alcohol abuse that some alcoholism recovery methods have tried to recreate it. Drugs like Antabuse that help recovering alcoholics stay off the bottle by recreating the effects of the genetic condition. Antabuse works by temporarily impairing the ALDH2 enzyme to create toxin build-up as experienced by people with the genetic mutation. When the drug leaves the system, the body is once again able to process alcohol.

If alcoholics can be convinced to ditch the bottle when they experience the physical symptoms of alcohol flush reactions, yet people who are genetically bound to the symptoms continue to drink, what does that suggest about other forces at play reinforcing the appeal of drinking? Never underestimate the power of peer pressure.

While some with the condition get embarrassed by their blushing phenotype or sick of feeling too sick, and quit drinking, others refuse to let their symptoms keep them away from the keg line.

Several Facebook groups bring together those who have the conditions to share possible remedies and alcohol flush pride. ("I get the Asian Glow/Flush... But I'm not fuck'd up dumbass!!," "I Rep the Asian Glow... so what?" and "Asian Glow is Damn Sexy").

Layno-Moses, who has one Filipino parent and white parent, said she continues to drink a few times a week even though her symptoms caused by the condition can be dangerously drastic. She said that for her, there is no in-between or tipsy - "It's either completely sober or completely drunk."

"One and a half shots and I'm wasted," Layno-Moses said. "It doesn't matter how much I drink or how often I drink, my tolerance doesn't change."

When Layno-Moses does drink within her limit, she experiences the symptoms typical of alcohol flush reactions, including hot skin, heavy sweating and fatigue.

"I definitely feel it in my stomach and I do get the Asian flush," she said, describing it as "very red skin, like I'm blushing, that lasts the entire night."

Layno-Moses said the most she has ever had to drink in one night was four shots, which resulted in her getting sick and experiencing a hangover for the first time.

Layno-Moses said her two brothers also experience the same symptoms. And while her parents undoubtedly have some combination of mutated alleles between the two of them, she said she hasn't really discussed the condition with them.

Mary Jo Desprez, administrator of the University's alcohol policy and community initiatives program, said most people who have the condition know about it from family get-togethers long before they have a drink.

"It's not something that typically pops out of nowhere unless your family members had never consumed alcohol before, but that's kind of a stretch," Desprez said.

That wasn't the case, though, for LSA sophomore April, who would only give her first name because she is under 21 years old. She was adopted.

The first time she drank her sophomore year of high school, she experienced the reaction. She said that when she drinks, it makes her so red that it's physically uncomfortable. "Most Asian people get it, but not as bad as I do," said April, who is Korean.

But April has figured out a partial remedy to the flush: Pepcid AC, 30 minutes before her first drink. She said the over-the-counter heartburn medication has reduced her outward symptoms from red blotches on her face, neck and chest to a pleasant, slightly pink glow.

Rackham graduate student J.C., who's 28 years old, takes a much different approach to her alcohol flush syndrome than most people with the condition. While a bad experience the first time she drank made her swear off alcohol completely, she'd never admit it.

J.C. only agreed to give her initials because she thinks future employers and colleagues in her native South Korea might think less of her for not drinking.

"What's really interesting in those societies is that people overcome their limitations by putting a lot of pressure on themselves," J.C. said.

In Korean society, she said there is often heavy social pressure in work environments to demonstrate superior drinking abilities.

"They would probably regard my explanation as a kind of excuse," she said.

In South Korea, about five college students die each year after being pressured by older students to binge drink, J.C. said.

"They don't take the symptoms seriously so they usually don't take them to the ER or get them medical help," J.C. said.

That pressure landed J.C. in the hospital when she was 19. At an initiation party for new students at her university in South Korea, two professors and 10 to 15 upperclassmen forced 50 underclassmen to take turns chugging buckets of alcohol.

"We did not have any right to say no," she said.

J.C. doesn't know for sure how much she consumed, but estimates that it was about the same quantity as two standard bottles of beer.

"There was a really huge social pressure that I felt," she said. "Because of that I just plugged my nose and finished it,"

That night, J.C. spent the night in the emergency room. Because of her body's genetic inability to process alcohol, she ended up with severe hemorrhaging in her stomach lining.

While J.C.'s experience was extreme, conflict also exists at the University between the common alcohol flush syndrome and social expectations for drinking in college. For many students, abstaining from alcohol - no matter what it does to their bodies - doesn't seem like an option. But as long as it doesn't put people in the hospital, there's nothing wrong with a few blushing beauties in the keg line.

"It's not something that typically pops out of nowhere unless your family members had never consumed alcohol before, but that's kind of a stretch," Desprez said.

That wasn't the case, though, for LSA sophomore April, who would only give her first name because she is under 21 years old. She was adopted.

The first time she drank her sophomore year of high school, she experienced the reaction. She said that when she drinks, it makes her so red that it's physically uncomfortable. "Most Asian people get it, but not as bad as I do," said April, who is Korean.

But April has figured out a partial remedy to the flush: Pepcid AC, 30 minutes before her first drink. She said the over-the-counter heartburn medication has reduced her outward symptoms from red blotches on her face, neck and chest to a pleasant, slightly pink glow.

Rackham graduate student J.C., who's 28 years old, takes a much different approach to her alcohol flush syndrome than most people with the condition. While a bad experience the first time she drank made her swear off alcohol completely, she'd never admit it.

J.C. only agreed to give her initials because she thinks future employers and colleagues in her native South Korea might think less of her for not drinking.

"What's really interesting in those societies is that people overcome their limitations by putting a lot of pressure on themselves," J.C. said.

In Korean society, she said there is often heavy social pressure in work environments to demonstrate superior drinking abilities.

"They would probably regard my explanation as a kind of excuse," she said.

In South Korea, about five college students die each year after being pressured by older students to binge drink, J.C. said.

"They don't take the symptoms seriously so they usually don't take them to the ER or get them medical help," J.C. said.

That pressure landed J.C. in the hospital when she was 19. At an initiation party for new students at her university in South Korea, two professors and 10 to 15 upperclassmen forced 50 underclassmen to take turns chugging buckets of alcohol.

"We did not have any right to say no," she said.

J.C. doesn't know for sure how much she consumed, but estimates that it was about the same quantity as two standard bottles of beer.

"There was a really huge social pressure that I felt," she said. "Because of that I just plugged my nose and finished it."

That night, J.C. spent the night in the emergency room. Because of her body's genetic inability to process alcohol, she ended up with severe hemorrhaging in her stomach lining.

While J.C.'s experience was extreme, conflict also exists at the University between the common alcohol flush syndrome and social expectations for drinking in college. For many students, abstaining from alcohol - no matter what it does to their bodies - doesn't seem like an option. But with friends who respect limits and understand the issue, college night-life can still be an option, with or without the booze. And as long as it doesn't put people in the hospital, there's nothing wrong with a few blushing beauties in the keg line.

Basking in the glow

Facebook has provided a sounding board for those with alcohol flush to vent, share stories and remedies and take pride in their symptoms. The following quotes were posted on the walls of related Facebook groups.

Nicole Tangie (Sudbury, ON) wrote: "I suffer from asian glow....after like a few sips i'm super red...it sucks and everyone thinks i'm already drunk.."

Marilyn Caylor (London) wrote: "Just drink in dimly lit bars & clubs, or show off and ask your white friends who don't hang out with Asians if they want to see a cool trick! I am half Vietnamese & half German, but still mutated, apparently."

Jason K (Australia) wrote: "werd drinking more is the best way. i go red for like 2-3 hours then im normal and still drink. i also heard that taking mylanta or any of those antacid tablets work wonders without any effect"

Hon-Wai Pang (Leicester) wrote: "i get weird experiences when taking pepcid ac.. the first time i took it i kept throwin up after having a couple of pints lol and then the second time i took it i got tired and almost fell asleep.. but overall it does help lessen the asian flush"