My Asian Flush Dictates My Drinking Habits — And I’m Not Alone

From the time I had my first sip of alcohol, my relationship with drinking can best be described as complicated. 

Not because I go overboard, feel sick the next day, or regret things I’ve said or done under the influence (although of course I have felt all of these at times). No, my discomfort and anxiety are primarily based on the physiological reaction that alcohol creates in my body.

A tomato-red face. Blotchy skin and bloodshot eyes. An elevated temperature, a pounding head and a skyrocketing heart rate. Sometimes the symptoms are quite minor but other times it’s bad enough that I would probably seek medical attention if I didn’t know the cause. 

The alcohol ‘flush’ or ‘glow’ affects a large percentage of people of East Asian descent, and refers to a physical reaction caused by the way our bodies break down alcohol. According to Dr Saw Hoon Lim, senior lecturer at the Department of Biochemistry and Pharmacology at The University of Melbourne, it is essentially caused by an enzyme deficiency.

"Alcohol is firstly metabolized in the liver by the enzyme alcohol dehydrogenase which converts alcohol to an intermediate product called acetaldehyde,’ she says. "Acetaldehyde is toxic and causes one to feel nauseous, make the heart beat faster and also causes your blood vessels to dilate. Normally, acetaldehyde is then broken down by another enzyme called aldehyde dehydrogenase-2 into harmless acetate and water. Many East Asians have a deficiency in the aldehyde dehydrogenase 2 enzyme, so acetaldehyde stays in the body longer, causing all those unpleasant hungover effects in addition to the facial flushing."

According to Dr Lim, this gene can occur in other ethnic groups too, but is extremely rare. I’m mixed-race, which I would have assumed might mean I wouldn’t be as susceptible, but apparently one defective copy of the gene is all it takes, and I've been gifted with a particularly bad reaction (thanks Mum!) This, combined with the fact that I grew up with a largely non-Asian social circle, has meant a lot of explaining over the years. Sometimes people aren’t aware of my ethnic background, or haven’t seen somebody get flushed from alcohol before, or don’t think I'm ‘Asian enough’ to have such a severe reaction. (Nice.) 

For 27-year-old Faye, who is Japanese/Australian and grew up in Tokyo, alcohol flushing was a lot more commonplace growing up and was never met with the shock or confusion that I've become accustomed to. It wasn’t until she moved to western countries that she started to feel self-conscious. 

"I first experienced flushing when I had some extra-boozy rumballs at about 15; it's such a normal side effect of alcohol consumption in Japan that I didn't feel confused or embarrassed about it," she says.

"I've often felt self-conscious about the visible sign of alcohol flushing since becoming a working adult in Australia and the UK though. In some of my previous workplaces, it was common to have a beer or G&T in the office towards the end of the working week — but for me half a glass would mean full face and eyeball redness and make me look inappropriately intoxicated."

"However, refusing a single drink on a Friday afternoon also felt inappropriately prudish, so a Korean colleague and I would offer to make the drinks so we could make ourselves non-alcoholic ones."

Like Faye, I have employed several tactics over the years to avoid becoming flushed or to make it less noticeable. Sometimes this means eating a big meal while slowly nursing one drink over a long period of time. Often, I’ll opt for mineral water or a mocktail and use the excuse of driving so that I don’t get peer-pressured to drink. I’m not a huge drinker anyway, so for the most part this is fine. 

Other times it’s less fine. Sometimes it’s frustrating and feels strangely lonely. Like the times in university when I would have a couple of drinks at home by myself before going to ‘pre-drinks’ at a friend’s house so that my skin would have time to react and then settle down a little before going out. The times I cover up as much skin as possible in case I get a blotchy reaction on my chest and limbs. The times I wear extra makeup just to try and proactively cover my face before it gets red. The times when my friends are having a casual drink, and I politely decline because it’s just not worth it for me.

So why do I even drink at all? 

To put it simply, I enjoy it. I do like having a glass of wine with my partner, giggly cocktail-induced conversations with random girls in bathrooms at bars, and dancing with no inhibitions after a few drinks with friends. I don’t need alcohol to have fun and enjoy socialising, but at this stage in my life there are certain situations that it does enhance. 

For Stephanie, however, the choice not to drink at all has been easier. The 26-year-old currently lives in the Tinderry Ranges and inherited the ‘Asian flush’ from her father, who is Chinese from Hong Kong.

"When I drink even a quarter glass of wine, I get flushed all over my face and in patches on the rest of my body, I get heart palpitations, can hear and feel my blood rushing around my body and head, get faint and dizzy, and feel as though I’m overheating," she says.

"My dad also has the reaction so I’m pretty sure we always knew I would have it too. It’s the biggest reason I don’t drink though — the reaction has gotten worse the older I get," she says.

"Now that it’s easier to find non-alcoholic alternatives that mimic alcohol I get fewer questions because it seems as though I’m drinking, but without all the nasty side effects."

"My twin brother, however, doesn’t care about the reaction and could be described as a regular Aussie drinker. He’s even managed to ‘extend’ the period between how much he’s drunk and when the reaction occurs… I think his body has built a tolerance somehow."

Like Stephanie, I believe my alcohol reaction is getting worse as I get older; in the future there probably will come a time when I stop drinking completely. For now, though, it’s a balancing act — sometimes alcohol can be a fun part of my social life, and sometimes it’s best to just avoid it. 

When it comes to drinking culture, I’m not the only one whose decision on whether to drink or not is impacted by the physical and social effects of the Asian flush. According to Faye, many Japanese people tend to drink less when they are in western countries than they would in Japan or other East-Asian countries, due to the reactions or judgement they may get from those who aren’t used to seeing the Asian flush reaction.

"The drinking culture in Japan is really active! There are lots of cultural expectations to drink at social and work-related events regardless of flushing," she says.

"I think Japanese people drink more in Japan, where flushing is a culturally appropriate response to alcohol, but those living abroad like myself tend to self-moderate and drink less in public because flushing means something else and makes us look ‘drunk’ when we might have only had a few sips."

"I have found that the flush limited my relationship with alcohol for long enough that I often just avoid drinking all together… now that I’m in my late 20s I feel much more confident refusing alcohol in social situations."

As I get older, while my reaction to alcohol does seem to be getting worse, I’m also finding it easier to turn down drinking on some occasions, and to drink on others and try to accept the fact that my body is different from my non-Asian peers'. It’s something I’m still working on, and it will probably take a while, but it’s liberating in a way. Understanding identity and ethnicity is a journey, and if accepting my Asian flush is part of that, then I'm all for it.