When I went to dinner with my boyfriend’s parents for the first time, I didn’t order a glass of wine. Not because I didn’t want one, and not because I was afraid of looking like a floozy, but because I was scared of what my face would do.
Like eight percent of the world’s population—most of whom are East Asians (Japanese, Korean, Chinese), some of whom are Ashkenazi Jews—I get the dreaded Asian “glow” or “flush.”
Meaning my face turns bright as a beet as soon as I imbibe any alcohol. This leads people to believe I’m drunk after a single drink—an embarrassing assumption at networking events or meetings, on dates or basically any time I want to leave a good impression.
When I plan to drink, I often turn to one of the most popular Asian-glow-prevention hacks: Pepcid AC. If I remember to take it an hour before drinking, it usually minimizes the redness. But, after using this strategy for several years, I began to wonder if it was good for me—after all, it’s not the medication’s purpose.
So I finally decided to investigate this whole Asian glow thing. What does it mean? Are there other consequences? Is it OK to take Pepcid all the time?
To answer my questions, I got in touch with Daryl Davies, Ph.D., director of the Alcohol and Brain Research Laboratory at the University of Southern California, and John Bowersox, a spokesperson who provided comments from the National Institute of Alcohol Abuse and Alcoholism (NIAAA), a division of the National Institutes of Health.
The first thing you need to know is the cause of Asian glow. When alcohol enters the body, it’s metabolized into acetaldehyde, a toxic chemical similar to formaldehyde (the stuff they use to preserve dead bodies). Acetaldehyde isn’t something you want floating around; it causes DNA damage and is carcinogenic.
It doesn’t last long, though, because an enzyme called ALDH2 swoops in to save the day, quickly breaking down the acetaldehyde down into the non-toxic compounds acetate and water.
At least, that’s how it works for most people. For the 560 million East Asians who get the glow, our ALDH2 enzyme is “inactive.” It doesn’t do what it’s supposed to, which means the acetaldehyde piles up in our livers and bodies.
If you have one copy of the inactive gene (like me), side effects include a flushed face, rapid heartbeat, headache or nausea. If you have two copies of the inactive gene (like my Japanese mom), the symptoms are even more severe, and you can’t really consume alcohol.
People like my mom don’t drink at all, but people like me? Many of us power through—sometimes with severe consequences.
Although overconsumption of alcohol can cause health problems for anyone, there’s an added layer of risk for victims of Asian glow. The “increased circulating toxic agents” cause greater irritation to your cells, which, according to Davies, puts you at a higher risk for peptic ulcers and esophageal and stomach cancer.
In fact, a 2009 study found “that individuals with one copy of the inactive variant are about 6-10 times more likely to develop esophageal cancer than are individuals with the fully active ALDH2 enzyme who drink comparable amounts of alcohol.”
Six to 10 times more likely—to put that in perspective, smoking cigarettes make you 15-30 times more likely to get lung cancer. But, depending on when it’s diagnosed, esophageal cancer can be far more lethal, with some estimating the American five-year survival rates to be a scant 15.6 percent.
Another study states people with a deficient ALDH2 enzyme “clearly have a higher associative risk for diseases such as esophageal cancer, coronary artery disease, myocardial infarction and osteoporosis,” as well as a potential associated risk with other health issues like “addiction, Alzheimer’s disease, pain, diabetes, stroke, Fanconi anemia and dermatitis.”
So what’s a glowing Asian to do? The answer is simple, but far from fun: Drink less. “The lower the consumption the better,” suggests the NIAAA. “You should try to avoid a pattern of drinking which would elevate acetaldehyde level greatly (some elevation can’t be avoided). That means no more than one drink at a time, consumed slowly over a long period of time.”
Davies recommends alternating each serving of alcohol with a glass of water, which is a good practice for preventing hangovers anyway. He doesn’t, however, advise treating Asian glow with Pepcid AC (or worse, Zantac).
“There aren’t controlled studies testing the safety of Pepcid when taken as an ‘anti-Asian-flush’ remedy,” he explains. “I think it would be safer to deal with the flush by drinking less. Your body is sending out a warning—take heed.”
That being said, drinking less doesn’t mean you have to cut out alcohol entirely. Davies and the NIAAA agreed my four glasses of wine per week probably aren’t a huge concern when it comes to cancerous side effects.
“In most instances, I would say no, you’re not at increased risk,” says Davies. “In fact, you’re probably healthier due to reduced stress and other factors. However, it’s all about genetics. Some individuals will be more susceptible to the side effects of alcohol than others will. It’s normally recommended that one drinks in moderation, and the benefits should outweigh the risks.”
The other thing you should do? Tell your friends who suffer from Asian glow. If they’re anything like me, they probably view it as a mere inconvenience—not as a genetic marker that could indicate they’re at a higher risk for cancer or other health problems.
Because, as good as tempranillo is, knowledge is even better.
Susan Shain is a freelance writer and digital nomad who’s been traveling (and eating) the world since 2008. Follow along @susan_shain or at susanshain.com.