Do you ever wonder why when you go out with your friends of Asian descent, some of them get very red just one drink in? Many people call it the Asian flush or the Asian glow, and it is a side effect of not having an active form of the enzyme aldehyde dehydrogenase; this enzyme breaks down alcohol and eliminates it from the blood. If alcohol stays in the blood too long it could lead to consequences, the most common side effects are facial flushing, nausea, and rapid heart rate (Edenberg, 2007). The buildup of alcohol metabolism metabolites can have dire consequences to the body, especially in the functions of DNA.
When you consume alcohol, your body processes and gets rid of the alcohol in various steps. First, your body utilizes a chemical known as an enzyme to break down alcohol into smaller components allowing the body for easy absorption. The alcohol consumed is converted into acetaldehyde through the enzyme called acetaldehyde dehydrogenase (ADH). Second, the acetaldehyde is converted into acetate using aldehyde dehydrogenase (ALDH). The end product, acetate, can then be converted into acetyl-CoA, whose primary function is to deliver the acetyl group to the citric acid cycle (Krebs cycle) to be broken down for energy production (González Hernández, et al., 2019).
The problem with me arises when the second step of alcohol metabolism is not achieved and my body is unable to break down acetaldehyde. Why is that? Well, in my genetic lineage I lack the active form of aldehyde dehydrogenase, therefore, I get a buildup of acetaldehyde, a toxic byproduct of alcohol consumption, in my body. Having a buildup of this toxin causes the consequences mentioned in the first paragraph. Additionally, long-term acetaldehyde build-up can cause long-term damage to the body, for instance, acetaldehyde impairs cellular functions and gene expression by forming complexes with proteins and DNA (Setshedi, et al., 2010). Acetaldehyde is a carcinogen that can increase cancer development through multiple processes, including interference with DNA replication, induction of DNA damage, and formation of DNA complexes (Mizumoto, et al., 2017).
So the next time you go out drinking, pay attention to those around you. You may be surprised at the number of people who have alcohol intolerance. If they refuse a drink, it may be because they know what an increase in acetaldehyde can do to the body.
References:
Edenberg, H. J. (2007). The genetics of alcohol metabolism: role of alcohol dehydrogenase and
aldehyde dehydrogenase variants. Alcohol Research & Health, 30(1), 5.
González Hernández, M. A., Canfora, E. E., Jocken, J. W., & Blaak, E. E. (2019). The
short-chain fatty acid acetate in body weight control and insulin sensitivity. Nutrients, 11(8), 1943.
Mizumoto, A., Ohashi, S., Hirohashi, K., Amanuma, Y., Matsuda, T., & Muto, M. (2017).
Molecular mechanisms of acetaldehyde-mediated carcinogenesis in squamous epithelium. International journal of molecular sciences, 18(9), 1943.
Setshedi, M., Wands, J. R., & de la Monte, S. M. (2010). Acetaldehyde adducts in alcoholic liver disease. Oxidative medicine and cellular longevity, 3(3), 178-185.
Van, you have answered my long lost question of why my best friend is redder then a strawberry every time we go out to drink. I was browsing through the interwebs and I stumbled across this company called Sunset. This company has invented a pill that incorporates three ingredients important in reducing the build up of acetaladehyde. In their mission statement they called the condition Asian Glow but I guess it the same thing. Anyway, the three ingredients are N-Acetyl-Cysteine, it binds acetalaldehyde in the stomach before it can travel into the blood stream. Second is Quercetin, it increases our bodies gluatathione levels to break down acetalaldehyde, and three, L-theanine, which reverses the depletion of glutathione caused by alcohol consumption. And together it is called Sunset. Maybe because you drink alcohol after sunset, but anyway this may be a cool option for you and your friends/family that are missing that enzyme. P.S. I have no idea if it is safe, but the idea sounds lifechanging.
ReplyDeleteJosh, I definitely feel your friend’s pain, although I like to think of myself more as a tomato red rather than a strawberry red. I have heard of Sunset, although I never researched deep into it. After reading your comment, I was curious about the aspects of how N-acetyl-cysteine (NAC) contributes to acetaldehyde breakdown in the stomach, so I did a little research. I found that NAC is an amino acid and is a precursor for the antioxidant glutathione (Shi & Puyo, 2020). Glutathione is needed in order to break down acetaldehyde because ethanol consumption decreases glutathione secretion (Annie, et al., 2003). In a recent study done in rats, it was found that when rats were given NAC orally before ethanol intoxication, it led to a decrease in the severity of neurological deficiency and a decrease on the amnesic effects of ethanol consumption (Kurkin, et al., 2021). This could be due to an improvement of ethanol metabolism and a decrease in the severity of disorders associated with ethanol consumption, which could lead to an increase in glutathione secretion (Kurkin, et al., 2021). Orally taking Sunset could be a potential answer for quicker ethanol metabolism, but since there is no scientific study on the pills themselves, I am a little hesitant to try them out.
DeleteAnni, H., Pristatsky, P., & Israel, Y. (2003). Binding of acetaldehyde to a glutathione metabolite: Mass spectrometric characterization of an acetaldehyde‐cysteinylglycine conjugate. Alcoholism: Clinical and Experimental Research, 27(10), 1613-1621.
Kurkin, D. V., Morkovin, E. I., Osadchenko, N. A., Bakulin, D. A., Dubrovina, M. A., Gorbunova, Y. V., ... & Petrov, V. I. (2021). N-acetylcysteine relieves neurologic signs of acute ethanol hangover in rats. Research Results in Pharmacology, 7, 75.
Shi, Z., & Puyo, C. A. (2020). N-acetylcysteine to combat COVID-19: an evidence review. Therapeutics and clinical risk management, 16, 1047.
Super interesting read Van as my best friend is of Asian descent and gets the “Asian Glow” when drinking alcohol. I was reading your article and had never known about the missing enzyme, aldehyde dehydrogenase. I know my friend generally takes Pepcid or a TUM before drinking and this article encouraged me to investigate the reasoning behind taking these before drinking. Both are antacids and antacids have research on them tracking back to the 1990’s. Antacids are generally used for heartburn symptoms or gastritis. Antacids are over the counter as well and easily accessible (Singh & Terrell, 2018). However this doesn’t answer the question of why an individual might take an antacid prior to drinking alcohol to reduce the “Asian Glow” symptoms and redness. Antacids are histamine-2 blockers and prevent the flushing of the face by inhibiting histamines causing the glowing. This does not fix the problem of the Asian glow, but rather masks the symptoms. This was an interesting read because it indicated that there are some things that may mask symptoms but can not completely avoid symptoms entirely (Vuong, 2021).
ReplyDeleteSingh, P., & Terrell, J. M. (2018). Antacids.
Vuong, Z. (2021, September 13). Antihistamines prevent 'Asian flush' - alcohol-induced facial redness - but pose risks. Retrieved from https://news.usc.edu/112489/antihistamines-prevent-asian-flush-the-red-face-some-people-get-from-alcohol-but-with-huge-risks/
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DeleteDanielle, I too have tried taking Pepcid when I was 21 to try to get rid of the symptoms of my Asian glow, but to not avail. I still got extremely hot, it got harder to breathe, my face was still tinged red, although reduced, and my heart was beating out of my chest like I ran 20 miles. You are correct when you said that it only masks the symptoms, studies have shown that the histamine H2-receptor antagonist, such as TUMS and pepcid have been shown to successfully eliminate facial flushing symptoms, but these results are varied among individuals and it could still be dangerous if no one can obviously see the symptoms of acetaldehyde buildup (Ye, 2009). Physiologically the body causes vasodilation of the blood vessels, causing an increase in skin temperature and heart rate, causes facial flushing, nausea and headaches, it also narrows airways which could lead to detrimental health effects if ignored (Quertemont & Didone, 2006).The mechanisms on how acetaldehyde induces these symptoms are very complex, but to summarize the accumulation of acetaldehyde causes a releases histamine, a neuromodulator. It regulates the release of neurotransmitters like norepinephrine and epinephrine from the adrenal medulla, part of the sympathetic nervous system that induces your body’s ‘flight or fight’ response, this is the reason your blood vessels constrict and causes increased heart rate (Sheng & Zhu, 2018). An increased release of histamine, therefore, causes an immune response to fight off the accumulation of acetaldehyde, this is where facial flushing occurs because your body is increasing its temperature and blood pressure, it also causes bronchoconstriction making it harder to breathe (Kapalka, 2010). There are more extensive mechanisms to how your body handles an accumulation of acetaldehyde and maybe there is no one perfect cure to get rid of the Asian glow symptoms, but hopefully once more research is done on this topic medications could be manufactured so those with an alcohol intolerance can enjoy alcohol, that part is my wishful thinking.
DeleteKapalka, G. M. (2010) Chapter 4-Substances Involved in Neurotransmission. Practical Resources for the Mental Health Professional. In Nutritional and Herbal Therapies for Children and Adolescents, 71-99.
Quertemont, E., & Didone, V. (2006). Role of acetaldehyde in mediating the pharmacological and behavioral effects of alcohol. Alcohol Research & Health, 29(4), 258.
Sheng, Y., & Zhu, L. (2018). The crosstalk between autonomic nervous system and blood vessels. International journal of physiology, pathophysiology and pharmacology, 10(1), 17.
Ye, L. (2009). Alcohol and the Asian flush reaction. SURG Journal, 2(2), 34-39.
Van, your post is super intriguing and definitely offers a very applicable understanding of how a deficiency of aldehyde dehydrogenase can affect individuals of Asian descent. In reading through your post, I was wondering if different types of alcohol (beer, wine, liquor, etc.) have differing effects on the degree of symptoms associated with an aldehyde dehydrogenase deficiency. I’m assuming so but was interested in if the different ingredients used to make certain spirits (such as barley, wheat, corn, hops, malt, potatoes, etc.) and their associated biochemical make-ups play a role in the detoxifying ability of aldehyde dehydrogenase. More specifically, when I was studying abroad in Thailand, my Thai friends really avoided wine with high degrees of tannins in it (due to their possible interaction with aldehyde dehydrogenase), but drinking sake was totally okay.
ReplyDeleteJoe, that is an interesting theory, I would have to do more research on the ingredients and the body’s ability to metabolize it in order to answer your questions more succinctly; but, I do know that your body metabolizes all alcohol the same way, whether its sake, soju, wine or a mixed drink, all of these drinks will be converted to acetaldehyde and eventually acetate, how quickly the alcohol is metabolized may be a better angle to answer your questions. It is not the ingredients that affect the body’s ability to metabolize acetaldehyde, it is the rate of alcohol consumption and the amount of alcoholic content in the beverage. Regarding your Thai friends and their avoidance of wine but their inclination towards sake could be a drinking preference, sake does have a higher alcohol content in one shot than a single glass of wine. Normally sake, undiluted, will have an alcohol content of about 18%-20%, but when diluted will go down to 15%, while wine typically contains an alcohol content of about 9%-13% (Rath, 2020; Britton, et al., 2016). Through my readings and comprehension, a higher alcohol content, such as sipping on sake, leads to quicker accumulation of acetaldehyde concentration in the body due to the high alcohol content, this allows an individual to feel “drunk” much quicker than sipping on a glass of wine.
ReplyDeleteBritton, A., O’Neill, D., & Bell, S. (2016). Underestimating the Alcohol Content of a Glass of Wine: The Implications for Estimates of Mortality Risk. Alcohol & Alcoholism. Supplement, 51(5), 609–614. https://doi-org.dml.regis.edu/10.1093/alcalc/agw027
Rath, E. C. (2020). THINK PIECE: Known Unknowns in Japanese Food History. CENTER FOR ASIA PACIFIC STUDIES, 34.
Hello Van! I found this post very relatable as I am also of Asian descent and get the Asain Glow along with tachycardia everytime I consume alcohol. Having these symptoms after one sip of alcohol often leads to quite a conversation with friends. Funnily enough a few days ago one of my friends sent me a link for an Asian Flush Patch that is supposed to mitigate the Asain Glow. After reading your blog post I could not help but inquire about whether you have heard of these or know anyone who has tried them? I personally had never heard of them and thought it sounded a bit like a scam, but it did get me wondering if there has been any research done on how to minimize the reaction Asians experience with alcohol consumption.
ReplyDeleteI could not find any scientific papers that have researched the Asian Flush Patches and as far as I could tell they are more of a commercial product and have not been FDA approved. However, I did come across a study that investigated the effects of brimonidine 0.33%. This gel is FDA approved for those with Rosacea, a condition that causes erythema in the skin. However, it has not ever been evaluated for the Asian Glow. Brimonidine is a selected alpha 2 adrenergic agonist that induces vasoconstriction (Yu, et al. 2020). Yu and his colleagues hypothesized that if someone of Asian descent applied this medication to their face prior to consumption of alcohol they could decrease the Asian glow because the mechanism of action for brimonidine causes vasoconstriction in the body. Interestingly they did find a marked reduction in alcohol erythema at 60 minutes, 90 minutes, and 120 minutes after applying the medication (Yu et al, 2020). They proposed that this medication could be a safer method, in contrast to antihistamines, to minimize the effects alcohol has on those of Asian descent. What was interesting about them posing that, is that from everything I researched Asian Flush Patches use antihistamine as their main ingredient. Antihistamines have been found to be helpful in reducing the glow, but they also have a sedating effect, which in combination with alcohol poses other issues. Though this study only evaluated 20 people their results did come up with statistically significant data. So, with more studies it is possible there could be something made and FDA approved to help with the Asian Glow.
Lastly, I was thinking about how we have been studying epigenetics. I was wondering if in all your research for this blog, you came across anything that suggests there are environmental factors that could turn on the gene to activate acetaldehyde dehydrogenase?
Yu, W. Y., Lu, B., Tan, D., Aroyan, C., Shinkai, K., Leslie, K. S., Fox, L. P., Yu, S., Neuhaus, I. M., Grekin, R. C., & Arron, S. T. (2020). Effect of Topical Brimonidine on Alcohol-Induced Flushing in Asian Individuals: A Randomized Clinical Trial. JAMA dermatology, 156(2), 182–185. https://doi.org/10.1001/jamadermatol.2019.3508
Jenai, thank you for your insightful comment. As for your question on epigenetics, I did not do much research on this topic but I did after reading your comment, and here is what I found. It turns out that alcoholism can be determined by not only the genetic component of an individual but by the intricate relationship between genetic and sociocultural factors as well. In a peer-reviewed article, they found that despite having a genetic defect for the gene that encodes for the enzyme, aldehyde dehydrogenase (ALDH), studies of various East Asian populations have consistently reported that some individuals with inactive enzymes were moderate to heavy drinkers. However, there are no supporting literature reviews/studies to explain how heavy alcohol drinkers with an inactive ALDH enzyme can adapt to the accumulation of acetaldehyde and suffer the consequences of the Asian flush (Lee, et al., 2014). But there is evidence that social influences can have an impact on the amount of alcohol an individual consumes, especially when influenced by peers and the media. Being a K-Drama addict I can see how drinking is normal acceptance into Korean social life, if you are depressed go drink some soju. Celebrating something? Go drink some soju. Out for a work party? There’s plenty of soju to go around. These media perceptions play into the minds of their audience allowing them to think that drinking is the cultural norm, and doing so would gain their acceptance into society regardless of the Asian flush phenomenon and how it could potentially negatively affect their health.
DeleteLee, H., Kim, S. S., You, K. S., Park, W., Yang, J. H., Kim, M., & Hayman, L. L. (2014). Asian flushing: genetic and sociocultural factors of alcoholism among East asians. Gastroenterology Nursing : The Official Journal of the Society of Gastroenterology Nurses and Associates, 37(5), 327–336. https://doi.org/10.1097/SGA.0000000000000062
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