The truth about alcohol flushing, or “Asian Glow”

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truth asian glow

Like many an Asian out there, I turn pretty darn red when I drink. Not just a cute “oh she has a lot of blush on” kind of way. I mean, I sometimes get red and splotchy all over my entire body. It always starts in the face and then slowly spreads down, and before I know it, I’m as red as the nose on Rudolph the red nosed reindeer. Everyone around me tries to take my drinks away, thinking I’m far drunker than I really am, and I end up having to use the black and white filter on all my pics. Bummer. 

Seeing as many booze-filled parties are coming up in the next week, I think this is a perfect time to discuss “Asian glow” and how to slow the glow.

Facial Flushing

Reproduced from the PLoS article (Ref: Brooks P, Enoch MA, Goldman D, et al. The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption. PLoS Med. Mar 2009; 6(3): e1000050.)

So why do some people (mostly Asians) get alcohol induced flushing? The answer lies in biochemistry.The breakdown of alcohol is shown below. Simply put, some people don’t have the second enzyme to properly break down alcohol, so we get an accumulation of a bad intermediate product, acetaldehyde. Acetaldehyde causes facial flushing through histamine release, nausea, headache, increased heart rate. In fact, there is a drug we prescribe to alcoholics called disulfiram that does the exact same thing – it inhibits the second enzyme below, causing a horrible feeling whenever patients drink, making them want to quit.

Alcohol metabolism asian glow

Many Asians don’t have the enzyme needed to convert alcohol to acetate, so they get a nasty build up of acetaldehyde, causing nausea, vomiting, and general yuckiness.

Here is an EXCELLENT video from Vox describing this very process:

Have you ever taken Pepcid AC to combat the redness? Ever wondered why that works? Pepcid AC is an antihistamine, an H2-blocker, that blocks the dilation of blood vessels near the skin that causes flushing. Studies show that antihistamines like Pepcid AC or Zantac do effectively block the effect of alcohol-induced flushing, but the true interactions between these drugs and alcohol are not fully known.

In the medical literature (feel free to Pubmed it too, medical folk!) there is a lot of controversy over whether or not it’s dangerous to take antihistamines with alcohol. First generation antihistamines (Benadryl, Vicks, Dimetapp) should definitely not be taken with alcohol because it can cause excessive sleepiness from both. Second generation antihistamines such as Pepcid AC or Zyrtec do not cause drowsiness, but there are mixed reports in the literature about whether or not they actually raise the blood alcohol level. If you love taking pepcid AC to hide your glow, I urge you to space out your drinks so you can pace yourself appropriately in the absence of your usual flushing as a clue.

That being said, recent research published in PLoS found that Asians who flush with alcohol yet drink heavily anyways are at higher risk (up to ten-fold!) of developing esophageal cancer, especially squamous cell carcinoma. The thought is that without the proper enzyme to break down alcohol, Asians are more susceptible to DNA damage and therefore cancer from toxic by-products. It is thought that the flushing is meant to be a protective mechanism to prevent susceptible people from drinking too much, and therefore developing cancer.

What do I, an Asian who flushes with even a drop of alcohol, make of all of this? My advice is to listen to your body: if you start feeling sick with high heartrate, dizziness, nausea, total body itching and flushing, you need to stop ingesting more alcohol at that point. Also, if you glow with liquor, be safe and drink in moderation. Glowing is your body’s way of telling you that you’re not built to handle large quantities of alcohol and that you are at risk of developing cancer with excessive alcohol use. So even if Pepcid helps control your flushing, it will not prevent you from experiencing the cumulative carcinogenic effects of alcohol. I will say it again: drink in moderation.

The safest ways to combat alcohol induced flushing include not drinking completely or limiting yourself to a few drinks occasionally. You can use a mixture of green-tinted primers and foundations (see below) to hide the glow; many of these products are used regularly for people suffering from rosacea, which causes chronic redness and inflammation of the face. Of course, there are also those handy Instagram filters you can use to edit the photos to your advantage.

What experience do you have with alcohol-induced flushing? Any tips you have found to combat the glow?

PS In doing research for this article I found a product called “NoGlo” that claims to stop Asian glow through vitamins and nutritional supplements. I’m definitely skeptical.

* Correction: The original article published stated that Zyrtec and Claritin are sedating first generation antihistamines. They are indeed second generation histamines like Pepcid, and do not cause any drowsiness. Thank you to Dr. Hiroshima for pointing that out to me!

12 Comments on The truth about alcohol flushing, or “Asian Glow”

  1. Justine
    May 31, 2015 at 7:54 pm (2 years ago)

    Great article, thanks for sharing! I’m Chinese and was adopted into a white family, so my parents didn’t know about alcohol flush syndrome and that it might affect me. I only heard of it from my doctor when she saw that I would be turning 21. The first few times I drank, I had no reaction. No noticeable flushing or any other adverse physiological changes so I figured I must have won the genetics lottery. Fast forward a little later to when I had my first shot (or two, hehe..) of tequila. Any way, I turned really red and felt a tightness in my chest so I stopped drinking the rest of the night. Since then I’ve avoided tequila and when I do drink I’ve only ever noticed a mild flushing/warmth in my face from time to time. It seems to depend on what I drink, how much I drank and in what time span, what I’ve eaten before I started drinking, and how much water I have in between drinks. Do you know of any instances where the severity of the “Asian Glow” may be different or fluctuate due to the factors that I’ve listed above? Or perhaps if some symptoms are worse in some people than others? I can’t really find any other explanation online for the mild symptoms I seem to experience.

    Reply
    • Ann
      August 14, 2015 at 7:02 pm (2 years ago)

      There’s definitely varying degrees to this intolerance. I get red no matter what I drink; I can have had a can of beer and will flush. On the other hand, I’ve known people who get red from drinking two sips of alcohol to people who only get red when drinking certain types (wine, hard liquor).

      Reply
      • Joyce
        August 15, 2015 at 11:12 pm (2 years ago)

        Hi Ann, very interesting. I’m also in the class that turns beet red whenever I have a drop of any type of alcohol, but I’ve never met anyone with flushing selective to certain types of alcohol. I’m guessing that may be due to the specific ways their bodies process or react to certain ingredients in various spirits.

        Reply
  2. Justin Pierson
    July 6, 2015 at 10:24 pm (2 years ago)

    32 year old white guy here who also suffers from the flush. I notice the more hydrated I am before drinking the better I do.

    Reply
    • Joyce
      July 27, 2015 at 5:34 pm (2 years ago)

      Justin, that makes sense! Staying hydrated helps with decreasing hangovers the next day as well. Water does so much good…

      Reply
  3. Eda
    December 24, 2015 at 7:23 pm (1 year ago)

    Whenever I really to get red, I drink lots of cold water plus I grab ice cubes and rub it in my face. It really helped lessen the redness. But I stop drinking the moment I started to have palpitations. I find it really scary most especially when I’m starting to experience difficulty in breathing.

    Reply
    • Joyce
      December 25, 2015 at 12:02 am (1 year ago)

      Hi Eda, it’s definitely a good idea to listen to your body and if you start to feel sick to your stomach or have problems breathing then that’s your body telling you it has had enough!

      Reply
  4. That's right. I'm, "That Guy".
    January 14, 2016 at 5:02 am (1 year ago)

    Simple answer. Marijuana. Get on with it.

    Reply
  5. Dave
    March 16, 2016 at 2:49 pm (1 year ago)

    Great article!

    My friends and girlfriend were always asking me if I was okay every time we went out drinking until they got used to it. I get flush with a few drinks. But I have been taking benadryl and moderating my drinks for a while now. I maybe drink twice – three times a month now (4 – 5 drinks max over the course of a night) with better, less red results. I am not a big drinker anymore as college has come and gone. I just like the occasianal drink or two while I’m out to dinner. Also I am just finding out about Pepcid and Zantac today which I will try next time so it doesn’t make me sleepy.

    BTW I am 25 years old, white male of Polish, Russian, and Ukrainian decent.

    Reply
    • Joyce
      March 20, 2016 at 1:42 pm (1 year ago)

      Interesting, thanks for sharing Dave!

      Reply
  6. Gordon
    December 27, 2016 at 9:14 am (5 months ago)

    Ok hmmm… The metabolite that is of concern here is aldehyde, less so with the actual alcohol. CA is a consequence of chronic alcohol ingestion at high levels. The increased risk of CA probably because of you not developing aversion that supposed to have developed because of your flushing. So, taking h2 blockers and binging may not be so bad if you do not do it that often. You should be more concerned of the more immediate effects like having a fatty liver more than cancer.

    Reply
    • Joyce
      December 27, 2016 at 9:36 am (5 months ago)

      Definitely chronic alcohol intake leads to cirrhosis of the liver which can lead to liver cancer. The main focus of the article is on what is less well known and studied, meaning the flushing reaction and health implications of that.

      Reply

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