The Danger of the Asian Flush

"Bacchus has drowned more men than Neptune."

Giuseppe Garibaldi

Remember this recent post? And this January 2008 one where I experimented with writing like a typical idiotic ah-beng blogger? Both featured the girlfriend after she had imbibed a glass or two of spirit, and I have to say I am liking what alcohol does to her looks. Her eyes takes on a bedroom softness, her mannerisms become ever-so-slightly off and her complexion acquires a healthy rosaceous glow which rivals Pomona's.

But you know what they say about all things good and fun. Being the naturally curious amateur scientist I am, I did some homework on the side... and as it turns out, that healthy blush isn't so healthy after all.

If you turn red easily after drinking alcoholic beverages, read on because this should concern you gravely.

To quote myself: "...she would light up redder than Chinese New Year if she had so much as a few small sips of an alcopop"

If I may cut to the chase; that redness or "alcohol flushing response" may indicate a significantly increased risk for oesophageal cancer. The oesophagus is that stretch of the gastrointestinal tract which connects your pharynx to your stomach, by the way - and the pharynx is the intermediary between your mouth and your esophagus (and I'm explaining this because I habitually assume that everyone around me are idiots). And cancer of the oesophagus is not one of those feel-good cancers which unites families in triumphant battles against the odds in schlocky, heartwarming Hallmark TV films. It's a bad ass fucker of mothers in the gangster underworld of cancers. At the time of diagnosis, two-thirds of all patients with oesophageal carcinoma would already be incurable. Your chance of making it alive through your first 5 years? Less than 10%.

"No so bad ass once you're out huh, Mr Scary Cancer of the Oesophagus between the Pharynx and the Stomach?"

For the purpose of this article, I shall employ the colloquial term Asian Flush from this point onwards.

The Asian Flush is very common and I'm sure everyone of us knows someone who would react this way to liquor. Statistically, more than a third of all oriental Asians - a group which includes the Chinese, the Japanese and the Koreans - display these characteristic stigmata of turning red, becoming nauseous and having increased heart rate when drinking alcohol.

And now a biology joke: What does the H in Jesus H. Christ stands for?

Haploid. The H stands for Haploid. If you didn't get the joke, pay close attention hereafter because you might have trouble following my explanation of why only some and not all Asians respond to alcohol this way.

We humans have 46 chromosomes in our genome or rather, 23 pairs. We get 23 from our Moms and 23 from our Dads and thusly, we are diploid. It follows that we also possess a pair of genes each which code for an enzyme called the aldehyde dehydrogenase 2 (ALDH2) which gets rid of aldehyde, a product of alcohol breakdown in our bodies which causes the flushing response in the first place. Aldehyde also damages our DNA and promotes cancer growth. In a East Asians who experience the Asian Flush, either one of both copies of this enzyme-coding gene are defective.

Now, let's just denote the working copy of the ALDH2 gene with a big A, and the good-for-nothing fucked up copy with a small a. Below, I've created a simple table representing the 3 groups of people we all categorically belong to,

Which genotype are you?

Paradoxically, the aa people actually has a smaller chance of getting cancer than the Aa folks, believe it or not. That's because their extremely unpleasant reaction towards alcohol actually discourages them from drinking much at all. Disulfiram, the drug which is used to help alcoholics quit drinking works using the same principle: it blocks the action of the ALDH2 enzyme and causes a buildup of aldehyde in a person's body, effectively recreating the noxious effects of a serious case of Asian Flushing or hangover i.e. redness of skin, accelerated heart rate, nausea and vomiting, shortness of breath, throbbing headache, and mental confusion just to name a dozen.

Why would anyone drink if drinking's no fun, right?

As for the Aa heterozygotes (ignore this big sciencey H-word if you don't know what it means), they are sometimes capable of building up a tolerance over time to the worst of the Asian Flush symptoms by the sheer stubborn determination of their inner frat boys. Or inner party girls, as the case may be. This group of people can and will drink, and as a result, expose themselves to the worst possible risk of oesophageal cancer. Phoebe, from my own clinical assessment, is most likely an Aa although it's probably fair for me to inform everyone that she drinks very, very infrequently - and even then, drinks little.

Remember that even if you manage to acclimatise your body to the effects of alcohol and you would no longer go red like a lobster in the boil, your heightened likelihood of getting cancer is NOT eliminated - it's merely masked. And how much increased risk are we talking about here? Well, if you are Aa and drinks; you are more than 10 times more likely to strike the big C lottery than an AA who drink as much as you do. In Japanese and Taiwanese studies, it was found that 58% to 69% of all oesophageal cancer cases could be attributed or blamed on drinking by people with the Aa genotype.

Wow, I say to that. Just wow.

Oesophageal cancer in the upper third of the oesophagus, as seen through an upper gastrointestinal scope.

So, to summarise this post in easy talking points,

• If you turn red, feel nauseous and experience an increased heart rate after imbibing just a small quantity of an alcoholic beverage, you are experiencing the Asian Flush.
• If you are an Asian Flusher and still insist on drinking, you are putting yourself at a crazy high risk of getting oesophageal cancer.
• Oesophageal cancer is one of the worst cancers you can get. It can't be bargained with. It can't be reasoned with. It doesn't feel pity, or remorse, or fear. And it absolutely will not stop, ever, until you are dead.
• Even if you manage to overcome the Asian flush by simply training your body to get used to the idea of liquor - and even if you no longer turn red - the risk of cancer insidiously remains. Watching you. Biding its time.
• Quit drinking if you don't want to die a horrible and painful death.

Oesophageal cancer; this time in the lower third of the oesophagus. No place is safe.

If you are interested, there's also the so-called Flushing Questionnaire to help determine if you are one of those ALDH2 deficient people. It consists of two simple questions,

1. Do you have a tendency to develop facial flushing immediately after drinking a glass (about 180 ml) of beer?
   
2. Did you have a tendency to develop facial flushing immediately after drinking a glass of beer in the first one or two years after you started drinking?

If you answer "Yes" to either one or both questions, you are considered to be ALDH2 deficient and drinking, as a pastime, is not a very good idea for you. If you're not partial to beer, the same questions hold true for either two-thirds of a glass of vino or a single shot of the hard stuff like brandy, vodka, whisky, tequila, gin, rum and many other ecstatic etceteras.

And that concludes my presentation for today. Now I shall go pour myself a stiff one and drink to your health. Cheers, readers.



P.S. The last time I wrote an overtly medical public service announcement about a common health-related issue was back in 2007 and it was a short article titled Let's Talk Shit. I was only a second year med student at the time and the post was about how squatting when you defecate is so much healthier than sitting. Yeah, I've been weird that way for a long, long time.



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