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What Causes Asian Flush?

Asian Flush

Asian flush reaction is a condition in which an individual is afflicted with blotches associated with erythema after consuming alcoholic beverages. Individuals who experience the alcohol flush reaction are at a lower than average risk of alcoholism, but those who drink regularly have a higher risk of esophageal cancer. [1][2]

The Cause of Asian Flush

While the common belief is that this condition is caused by an inability to metabolize alcohol itself, the opposite is actually true. In fact, around 80% of individuals of Asian descent have the ADH1B variant for the enzyme that metabolizes alcohol (alcohol dehydrogenase), and nearly all Japanese, Chinese, and Korean individuals have he ADH1C variant.

Both these variants of alcohol dehydrogenase actually improves the efficiency at which the liver breaks down alcohol into it’s toxic metabolite acetaldehyde. The increased efficiency these gene variants is very significant, with the ADH1B variant causing an efficiency boost between 40-100 fold over those without the variant. This results in a much higher accumulation of acetaldehyde in those with these gene variants after alcohol has been consumed.

These mutations alone aren’t sufficient to cause Asian flush, however in about 50% of Asians the increased accumulation of acetaldehyde is made worse by another gene variant, the mitochondrial ALDH2 allele. Unlike the ADH1B and ADH1C variants which improve the ability of the liver to metabolize alcohol, the ALDH2 allele reduces the functionality of the acetaldehyde dehydrogenase enzyme, which is responsible for breaking down acetaldehyde. [3]

The end result of these mutations is that people affected are better at breaking down alcohol, but worse at breaking down it’s toxic metabolite acetaldehyde. This causes them to experience less of the pleasurable effects of alcohol, but more of the acetaldehyde-induced side effects. (And often worse hangovers.)

Asian Flush Symptoms

The most common and telling symptom of Asian flush is the presence of red blotches on the face, shoulders, neck, and in some cases the entire body. Beyond this, however, are additional symptoms caused by the buildup of acetaldehyde. These symptoms will be familiar to anyone who has had a severe hangover, as acetaldehyde also plays a critical role in causing hangovers. Such symptoms of Asian flush include nausea, headaches, sweating, and diarrhea.

Treating Asian Flush

While researchers now know the cause of the flush reaction, there is currently no known cure. Many different supplements and drugs are occasionally recommended, most of these mask some of the symptoms at best, but do nothing to address the underlying cause of the condition -- the liver’s impaired ability to break down acetaldehyde.

One of the main mechanisms of action of Dihydromyricetin, however, is to improve the ability of acetaldehyde dehydrogenase to break down acetaldehyde. Based on this, it is possible that taking DHM could actually offset the effect caused by the ALDH2 enzyme and allow someone with Asian flush to metabolize acetaldehyde at a faster rate.

Unfortunately there haven’t been any studies performed on Dihydromyricetin yet to test it for this purpose, and it is entirely possible that it’s normal effect on acetaldehyde dehydrogenase won’t also be present on the ALDH2 mutation.

Cited Sources

  1. The ADH1B Arg47His polymorphism in East Asian population and expansion of rice domestication in history.
  2. Alcohol Flush Signals Increased Cancer Risk among East Asians
  3. ALDH2, ADH1B, and ADH1C genotypes in Asians, a literature review.

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