June 7, 2021

Why Your Face Turns Red When You Drink

Any alcohol consumer (and that includes both devoted alcohol fans and occasional social drinkers) has a few funny stories up their sleeve where drinking is concerned. Most of us have been initiated into maturity with alcohol, and even if we haven’t, we definitely haven’t managed to reach adulthood without smelling at least a whiff. Drinking alcoholic beverages goes as far back in human civilization as the beginnings of grain cultivation, and it remains fully embedded in most cultures around the world to this day.

But despite alcohol being an old favorite at social occasions, we can’t be naive about alcohol consumption. The facts are that there are a lot of side effects associated with heavy drinking, and some that actually occur even after a single glass.

Are you one of those people who’ve been accused that they can’t hold their liquor? Do you get drunk easily? Or do you experience an unusually strong reaction to alcohol?

A lot of people report that they get flushed as soon as they start drinking. For some it doesn’t end there - headaches, hypertension, even body rashes and breathing difficulties. Has it ever made you think you might be allergic to alcohol?

If it has, you are not alone, and there is definitely science behind it. Found out below why your face turns red when you drink.

What happens to your body when you drink alcohol

In order to begin to answer your questions we’ll have to dive in the subject of alcohol metabolism.

Alcohol gets metabolized in several ways: a small amount is broken down in the kidneys, excreted by the lungs (which is why breath tests work) or eliminated through sweating, but the most prominent process your body uses to get rid of it happens in the liver.

Alcohol metabolism in the liver

A properly functioning human body uses two liver enzymes to break down the ethanol found in your body: alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). They work in tandem - the first one breaking down ethanol to acetaldehyde, and the second further metabolizing acetaldehyde into acetate. Once acetate, or acetic acid gets broken down to water and carbon dioxide, the body can eliminate it without too much fuss.

With modest to moderate drinking, a healthy human body has enough time to metabolize everything efficiently and voila - alcohol is no more.

However, alcohol metabolism (although it sounds simple thanks to our wonderful explanation here) doesn’t work the same for everybody. It depends on a variety of factors such as:

  • - How capable is your liver when it comes to metabolising alcohol (how effective are the liver enzymes responsible for the process, which we’ll get into a bit later)
  • - The presence of food in the stomach (food can substantially slow down alcohol absorption because it prevents it from passing too quickly into the small intestine)
  • - The concentration of alcohol in your drink of choice (highly concentrated beverages such as spirits are more quickly absorbed)
  • - Body type (the more fat and muscle you have to absorb the alcohol, the harder getting drunk is - that’s probably why heavier and more muscular people seem to hold their liquor better, at least anecdotally)
  • - Age
  • - Sex
  • - Ethnicity (ahem, “Asian” flush)
  • - How frequently you drink alcohol (you develop a tolerance over time)
  • - The amount of alcohol you’re drinking over a period of time

If you are drinking a lot, and downing drink after drink, your body will not be able to metabolize the alcohol to keep up with your drinking pace. In turn, the level of acetaldehyde in your blood will increase and result in a histamine release that in turn induces a flushing reaction.

If you’re wondering what’s the deal with acetaldehyde, let us tell you the stuff is no joke. It’s a toxic substance usually up to no good - the longer it stays in your body, the worse its effects are. Dr. acetaldehyde is what’s behind everything you usually associate with being drunk - the nausea, the slurring, the headache, and the inevitable hangover the morning after. And as if that’s not bad enough, it’s also carcinogenic. Science has made it clear that there’s definite correlation between acetaldehyde and heightened cancer risk.

Drink too much, too quickly and you’ll hinder your body’s ability to deal with the ethanol properly, or to put it simply - you’ll get hammered.

Now, since we established the basic science behind getting wasted, the question that remains is this: Why do you get the symptoms even before you have the chance to get drunk? You don’t see your friends getting an embarrassing flush after as little as a few sips or a single glass, so why do you?

Well, there are two options: you either have a histamine intolerance, or it’s probably the infamous genetic condition that affects mostly Asians (especially East Asians), and goes by the name of Asian flush. In either case, both are interconnected, and we’ll explain exactly why.

The not so funny condition that goes by the name of ALDH2 deficiency

The most likely reason behind the instant-red face you get when you drink is a genetic condition - and it has to do with your alcohol metabolizing enzymes.

According to research, different people can carry different gene variations of the ADH and ALDH enzymes involved in the process of alcohol metabolism described above - and some of them work less efficiently than others.

Some people - 80% of Asians to be more exact - have a variant of the ADH gene that is actually a little too effective in converting alcohol to acetaldehyde. - sometimes up to 100 times more effective than usual. That’s good right? Well, not exactly.

The ADH gene can only get busy with breaking down ethanol to its toxic by-product, acetaldehyde. As we explained before, the second enzyme is actually the one responsible for clearing your body of any acetaldehyde build up. The only problem with that is the fact that Asian flushers almost always carry an inefficient gene variation of the ALDH2 enzyme called ALDH2*2, which doesn’t break down acetaldehyde the way it should. It’s carried by 8% of the human population - equivalent to 560 million people who are unable to enjoy alcohol like the rest of us.

The result? A lot of toxic acetaldehyde in your bloodstream that the body can’t get rid of. And you remember what we said about acetaldehyde.

Asian flushers come in all shapes and sizes. They can have fast ADH or slow ALDH2, or a particularly nasty combination of both enzyme variants that is so bad at breaking down ethanol it makes them turn a shade of purple reminiscent of Violet turning into a blueberry at the Willy Wonka factory.

Why are people deficient in the ALDH2 enzyme?

The reasons for the condition are genetic - Asian flush is something you inherit from your parents. Every third person of East Asian descent will have the deficient ALDH2 variant, and a high percentage has an overactive ADH to go with it, hence the name. But despite the fact that the condition is most prevalent in (East) Asians, other ethnic groups also have it, only not nearly as often.

The alcohol flush symptoms can vary from mild to severe, depending on whether you’ve inherited one or two of the problematic gene variants. Some people inherit the gene from both parents, some from one parent - which usually means that they suffer more moderate symptoms.

Histamine intolerance

Another reason why you might flush after drinking certain alcohols is histamine intolerance. This might sound a little counterintuitive, but histamine intolerance is actually not a sensitivity to histamine. It’s a sign that you’ve developed too much of it.

Histamine is the chemical responsible for allergy symptoms - it allows more blood to flow to different parts of the body, causing the telltale flush. It takes care of several bodily functions such as communicating messages to your brain, metabolizing food as part of the digestive process, and what’s most relevant to our subject at hand: it’s the common immune response your body uses to alert you of foreign pathogens. Your body has histamine receptors all over, and their task is to detect any problems and raise alarm.

When your body can’t break down histamine properly, or when your histamine levels get too high, it can affect your normal bodily functions. If you have a histamine intolerance you can also be prone to experiencing flushing symptoms when drinking certain types of alcohol - especially drinks like wine that are high in histamines themselves.

Whenever your experience symptoms that make you think you might be allergic to alcohol, it’s also advisable to figure out whether you have any food allergies. After all alcohol is not the only ingredient in alcoholic drinks (it would be fatal if it were). Grains like wheat, rye or barley; yeast or grapes.

The funny relationship between histamines and acetaldehyde

The same deficient ALDH2 enzyme that doesn’t manage to deliver when it comes to breaking down alcohol is also one of the enzymes in charge of processing histamine.

So, the verdict: if you have a genetic defect in your ALDH2 enzyme, your body often can’t deal with the histamines when you drink either. What happens is when the enzyme works overtime to try to deal with the ethanol in your bloodstream, histamine builds up, causing blood vessels to dilate. Next thing you know your face is bright red.

In short: what you can actually do about your Asian flush red face

At Reset and Sunset, we’ve covered ALDH2 deficiency on so many occasions, that it’s best if we point you to a whole list of priceless resources - Want a full blown Asian Flush 101? Try  Reset’s Asian Flush & Asian Glow: Cures, Remedies, Supplements - where we discuss everything related to the condition: from all the details on why and how it happens, to stuff you can do about it.

Some people skirt around their little Asian glow problem by taking the same antihistamines they would take for an allergy in order to stop themselves from turning red. Even if such self-prescribed, generic drug cocktails work, they only work in masking the effects - not at curing the cause, and they lull enthusiastic drinkers into a false sense of security while the acetaldehyde continues to linger in their blood.

The thing is that if you have a case of Asian flush - you have it for life, unless you live to see a breakthrough in science that will make it possible to find a cure for it. In the meantime, you can lighten up because, according to the National Institute on Alcohol Abuse and Alcoholism:

“People who carry gene varieties for fast ADH or slow ALDH, which delay the processing of acetaldehyde in the body, may tend to drink less and are thus somewhat “protected” from alcoholism”

But then, “they may be at greater risk for other health consequences when they do drink.”, because of the high levels of acetaldehyde that happen after drinking. Such as cancer, like we said.

Not so keen on not imbibing for health reasons? If being “somewhat protected from alcoholism simply doesn’t cut it for you, and you’d rather take your drinks just like any other person (without facing a greater risk for anything), you may want to consider supplementing. This is where our Sunset pills come into play.

At Reset, we always want to spark a discussion about Asian flush and Asian glow. If you have any comments, or want to share your experience living with Asian flush/Asian glow, be sure to  drop us a line!

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