A Relationship With The Asian Flush (Or How To Find Out That You Are An Alcoholic)
Lestari Hairul takes us on an adventure in binge-drinking buffered by youth and dogged by genetic limitations.
BY Lestari Hairul | Jan 12, 2017 | Food & Drink
It began when blood was threatening to turn into alcohol. My usual Asian flush extended farther than the confines of my face all the way down my arms and entire torso. I’m sure that if I had been even more intoxicated, I would have stripped my shorts off too, but propriety saved the eyes of the others in the public loo.
The tally ran through 10 straight hours of vodka shots, countless whiskies and coke, vodka Red Bulls, beers and innumerable flows of the vilest whisky straight down the gullet. I swear I could see my health bar level dwindling rapidly.
The red glow is a curse that’s supposed to be good for you. Studies on the flush reveal that those aff‚licted with it tend to have lower instances of alcohol abuse, attributed to the social embarrassment that a face turned quickly red produces; hence, less drinking.
But for someone whose need for a drink dominates, a flush is just a little annoyance, and with some mitigation plans, will hardly be a hindrance. Many different remedies can be found on the Internet, and I’ve tried almost all of them. But the fast-spreading, top-to-toe glow was an alarming, new thing.
Enter Before Elixir. I send emails and some money, and a few weeks later, a carton containing a six-pack of the stuff arrives at Esquire Singapore HQ.
Started by Texas-based Jen Du, who suffers from the red curse too, the orange-coloured drink is a piquant concoction of B vitamins, antioxidants, milk thistle and amino acids.
“It’s filled with complex nutrients, vitamins and compounds that need to be metabolised and broken down by the liver. That means the liver is not focusing on just metabolising alcohol that produces acetaldehyde. So this has the effect of slowing down the rate at which alcohol is metabolised, thus decreasing the rate at which acetaldehyde is produced,” says Du.
The flushing happens in individuals, usually of East Asian descent. According to Dr Richard Guan, a consultant gastroenterologist and hepatologist at Mount Elizabeth Medical Centre, “It results from an accumulation of acetaldehyde, which causes the dilation of blood vessels. The accumulation of acetaldehyde can either be due to an increased e“fficiency of the liver enzyme, alcohol dehydrogenase (ADH), that breaks alcohol down to acetaldehyde, or a deficiency of another liver enzyme called aldehyde dehydrogenase (ALDH2) that converts acetaldehyde to acetic acid.”
But if a bottle of the stuff can somehow decrease the rate of acetaldehyde production, then maybe I won’t have to keep saying I’m not drunk to complete strangers.
Before Elixir is hard to choke down at room temperature—there’s a burn to it. Its taste reminds me of the time I did the Master Cleanse as an idiot teenager. Spicy, though no spices are present, it has a sharp zing that would do better cold. I test by pre-gaming each time I go out to drink.
I struggle to gulp down one bottle, 30 minutes before a sake session. Even before I start drinking the booze, I am pissing a lot with a queasy stomach and a bit of a headache. One tiny cup of sake and my face is hot and flaming. The sake sommelier asks if I’m alright. I give a thumbs-up and he says drinking more is the only way forward. So I do. Through six different types of sake.
The next day, I drink a bottle an hour prior, figuring the ingredients may need some time to work before a wino lunch. Two glasses of white later, and my colleague is giggling at my pink face. I walk away after a steady six glasses. At least it’s just a pink, rosy glow this time.
Later that evening, I finish another bottle. I offer one to a colleague who’d already been scarfing down gin and tonics from 4pm and is already flushed with a light headache. Her flush goes away about half an hour in and so does her headache.
But I feel hungover instead, with a throbbing headache. The final count for the night includes more champagne, cocktails, two beers and three jägerbombs. I no longer flush, but that could be attributed to my normal flushing pattern: turn red for up to 90 minutes before turning pale again, even as I continue to consume greater amounts of alcohol.
The top-to-toe flushing hasn’t reared its ugly head since the initial binge session mentioned at the beginning of this story.
I do one final test a few weeks later, after going on a fitness binge. I’ve realised that my tolerance levels changed in the past whenever I jumped back into a gym programme. And in some weird rationalisation process, I decide that it may also affect my flushing.
I take a bottle again, about an hour prior, and go on my merry way. Whisky, champagne and a few cocktails, and I don’t turn red.
If this is starting to sound like an alcoholic nightmare, you’re right. The recommended daily limit for alcohol consumption is 24g‡ for men and 16‡g for women.
In the second-last experiment, the wine at lunch alone already far exceeded the limit. Now multiply sessions like that by, say, four to five times a week, add further units of alcohol to justify the weekend and times all that by four weeks.
I have one bottle left, but my totally unscientific experiment has come to a close. Before Elixir works for some—if taken correctly—but my keeping count of all that I’ve drunk as a way to track this “experiment” has brought to light another issue instead. My initial concerns were aesthetic—about the flush— but they’ve now turned to thoughts of mortality.
Dr George Goh, a consultant at the Department of Gastroenterology & Hepatology at the Singapore General Hospital, explains that the incidence of alcohol abuse is relatively low in Singapore. A 2012 Singapore Mental Health survey indicated a lifetime prevalence of 3.1 percent and 0.5 percent for a 12-month prevalence of alcohol abuse.
“We have limited data on alcohol-related liver disease in Singapore,” says Dr Goh. “In one of our studies on liver cirrhosis based on SGH patients (representing end-stage liver disease), alcohol-related aetiology accounted for 11.2 percent of the patients with cirrhosis.”
But that said, Dr Richard Guan also mentions that “alcohol-related liver disease is not commonly seen in a specialist liver clinic locally, giving the impression that it is not a common problem, at least not as common as liver diseases caused by chronic viral infections.
This can be because alcoholics don’t think that they have a problem. By the time they present at a specialist clinic, they are usually in the late stages of the condition with complications.
In our region of the world, liver diseases are usually due to viral infections (hepatitis A, B, C). Fatty liver is becoming a major problem, and this is due to overeating. All the above mentioned conditions make the liver more susceptible to alcohol injury, and alcohol aggravates the above liver conditions.”
There’s more to the red face than possibly looking a wee bit too drunk. Or if you go by another tale, you might be convinced that the redness signifies good liver health. Not quite, as demonstrated in a Japanese study that showed the higher risk of ALDH2-deficient individuals developing oesophageal cancer.
“East Asians have two main variants of the ALDH2 gene, one active variant and the other inactive variant,” says Dr Ang Soo Fan, a consultant medical oncologist at the National Cancer Centre.
“Individuals with only one copy of the inactive variant can become tolerant to the unpleasant effects of acetaldehyde, which puts them at about six to 10 times more likely to develop oesophageal cancer.”
And the clearest indication of a likely ALDH2 deficiency? The Asian flush, of course.
Here’s more bad news: if you smoke on top of drinking, your risk of developing oesophageal cancer go up. Eat a lot of processed meat and those containing nitrosamines? You’re on the up and up! As it also turns out, according to Dr Ang, since liver and nervous damage are related to chronic alcohol consumption, short-term measures like taking milk thistle, antioxidants and similar “detox” blends won’t cure or reverse the problem of you effectively soaking your liver in alcohol constantly. Cirrhosis is the resultant effect of your liver giving up because of that treatment, and it increases the risk of liver cancer.
Things are looking grimmer and grimmer; the bottles of B vitamins and milk thistle on my desk look particularly useless now.
Professor Pierce Chow, senior consultant surgeon at the National Cancer Centre, explains, “Although a number of animal studies demonstrate that milk thistle can be helpful in protecting the liver, human studies have revealed mixed results. Some early studies suggest that milk thistle may help to prevent liver inflammation or liver cancer, but there are no published clinical trials on silymarin, the medicinal compound in milk thistle, for preventing or treating cancer in humans.”
He continues, “Antioxidants are a double-edged sword. A recent study published by researchers at the University of Hong Kong discovered that antioxidants promote the growth of liver cancer cells, and thus, recommended against taking high doses of antioxidant supplements. In mouse models of liver cancer, excessive reactive oxygen species (ROS), or free radicals, caused more oxidative stress, while excessive accumulation of oxidative stress is harmful to cancer cells and lowers the growth rate.”
Consumer genetic testing
I make one last pit stop. To curb the possibility of my body breaking down by 40, I consult COMO Shambhala Urban Escape’s nutritional therapist, Josephine Ng, who is a DNALife practitioner. A few swabs and my cells are off to a lab in the UK to be analysed. The detailed report identifies certain genes that may indicate the risk of developing chronic illnesses like cancer but it’s not exactly a predictive and definitive test of what you will die of. Ng draws up a nutrition plan and some exercise suggestions, based on my results and I feel a little pacified.
But that, coupled with the advice from all the doctors quoted here, are standard suggestions. Alcohol in moderation, get rest, don’t smoke, less stress, eat nutritious food and exercise. Basic stuff we’ve been hearing all our lives.
Here’s another oft-said by everyone from alcohol companies to Before Elixir: drink responsibly. Taking flush or liver cleanse remedies aren’t panacea. They merely fix the symptoms aesthetically if at all, and though there may be claims of health benefits perhaps there’s more sense to not override your body’s warning signals. Guess I do have to cut back after all.
Before Elixir starts from SGD10. To arrange for a DNA test and analysis with COMO Shambhala Urban Escape, contact firstname.lastname@example.org.