"Asian" Flush Syndrome without flushing (or "Asian" lineage)?
July 28, 2014 10:49 AM   Subscribe

I went to a gastroenterologist recently who tentatively diagnosed me with Acetaldehyde Dehydrogenase Deficiency (which causes the so-called "asian" flush). I am caucasian with some Russian descent, and I do not get flushed when I drink. Are there any precedents for non-asian, non-flushing sufferers of this enzyme deficiency? Should I get a second opinion?

(some background: I am 29 and female, and have been dealing with certain hangover symptoms -- nausea, sometimes vomiting -- for as long as I have been drinking, though they vary in intensity. As unbelievable as it may seem, I didn't know until recently that these symptoms were irregular in most drinkers. In college and even high school I would binge drink on occasion. I now never drink more than 6 drinks in one weekend night, and usually around 4. My peers drink the same and are fine the next day. There is no apparent correlation between the number of drinks, hydration, food ingested before drinking, and the symptoms. They come and go, and I only really see an improvement in "tolerance" when I go without drinking for a week or more. And yes, I am actively starting to phase drinking out until I find a solution, if I am lucky to)
posted by qzar to Health & Fitness (27 answers total) 1 user marked this as a favorite
Four to six drinks would definitely be enough to make me feel queasy the next day. Are you sure this is a medical issue?
posted by infinitywaltz at 10:57 AM on July 28, 2014 [11 favorites]

"There is no doubt that alcohol reactions do occur in European, and presumably all other non-Asian populations. Their intensity seems to vary, but for the mos tpart they are not as obvious as the AFR. In a few cases a cause or mechanism is reasonably clear but in most there is no known cause; acetaldehyde is central to the Asian AFR but its significance for alcohol reactions in Europeans is still uncertain ... "

Whitfield JR, Acute Reactions to Alcohol, Addiction Biology, 1997 (2), 377.
posted by Comrade_robot at 10:59 AM on July 28, 2014 [3 favorites]

Six drinks in one night is not a small amount, that's definitely more than enough for a hangover! Also I think there are people who aren't necessarily less affected by the alcohol but they just don't care so much about the hangover. I hate the headache/stomachache/fatigue/dehydration but some people do much better powering through it.
posted by radioamy at 11:00 AM on July 28, 2014 [4 favorites]

Out of curiosity, what are you looking to gain by getting another opinion and confirming/denying your diagnosis? According to Wikipedia there is no cure or prevention so I'm not sure unfortunately if that would help you.
posted by radioamy at 11:02 AM on July 28, 2014

Have you tried drinking the same amount alongside copious amounts of water? 4-6 drinks is definitely enough to get dehydrated, which could be causing the ick.
posted by jessicapierce at 11:03 AM on July 28, 2014 [1 favorite]

When you say there is no correlation with number of drinks, do you mean this happens even when you only have one or two? If it's only happening when you have 4+ drinks, I agree that that alone explains why you get hangovers.
posted by Enchanting Grasshopper at 11:09 AM on July 28, 2014 [3 favorites]

I always assumed the typical hangover (even when drinking 3 glasses of say, wine) involved repressing the urge to vomit the next morning. This all came about because I casually brought up my hangover stomach woes with a few friends who were nothing short of flabbergasted by the regularity of my symptoms, claiming that hangovers are terrible but very very rarely involve the urge to vomit (or acting on this urge) for them, and certainly not for an average drinking night's worth (I live in NYC, last call is at 4AM... we are very heavy drinkers). But another thing I have since noted is how there are others like me who experience regular nausea the morning after drinking as 'few' as 3-4 drinks, who like me, assume this is normal hangover material. It is apparently not. And yes, I have tried drinking one glass of water per drink, and I have still gotten sick the next day.
posted by qzar at 11:17 AM on July 28, 2014

Nausea is and has always been par for the course for me when it comes to hangovers, which is a big reason I rarely have more than 2 drinks in one evening. Maybe your friends have especially strong constitutions.

Regardless, I don't think there is a solution here other than to stop drinking so much, no matter what your official diagnosis is.
posted by something something at 11:19 AM on July 28, 2014 [2 favorites]

claiming that hangovers are terrible but very very rarely involve the urge to vomit

At the college I went to, heavy drinking was the norm. Not only did people drink to the point of vomiting (so they could keep drinking, of course!), but hurling was a regular feature of the day after's hangover, usually greeted with relief, since it meant you could go get some good greasy food for breakfast before class.

Some of us, though, at whatever age, just don't metabolize alcohol as "well" as other people, regardless of your ethnic or racial background. The easiest way to manage this is to eat well, stay hydrated, and drink less.
posted by rtha at 11:28 AM on July 28, 2014 [5 favorites]

You say you have a bit of Russian ancestry. It is possible that you have a remote bit of Asian ancestry via that route. It would not be unprecedented for that to be the case, i.e. you could have Acetaldehyde Dehydrogenase Deficiency via that route.

I, a person who is mostly of German/British Isles ancestry and appears very Caucasian, seem to have a bit of Central Asian ancestry via either from an ancestor from the Austro-Hungarian empire or, alternately, via a little bit of Russian ancestry way back on the maternal line. I know about this through having done DNA testing for ancestry purposes.

(Anecdotally, I don't have Acetaldehyde Dehydrogenase Deficiency but do have a very low tolerance for alcohol, which seems to run in my mother's family, and in no way could I drink 4 - 6 drinks without adverse effects. People's tolerances for alcohol vary.)
posted by gudrun at 11:35 AM on July 28, 2014

So it appears that my initial assumption was correct, and that drinking 3 drinks in one night usually leads to vomiting the next day. It just feels uncanny because in my circle (friend, professional, familial), I am definitely in the minority. I guess the majority of these NYC-folk have above-average tolerance if they can drink upwards of 4 drinks and not be particularly nauseous the next day? Thanks for the feedback.
posted by qzar at 11:38 AM on July 28, 2014

Since hydration and # of drinks has been addressed, have you seen any correlation with the kinds of drinks?

Specifically, do you see more problems with wine or cocktails with fruit than vodka or gin?

I don't have a medical reason to give you, but I've noticed for myself that I cannot drink wine or have cheap cocktails with fruit or some kind of corn syrup based cocktail mix without a horrible hangover, even if I'm drinking a water/alcohol ratio of 2 to 1 or I only have one drink. For some reason, drinks that are fruit based produce almost instantaneous nausea and often vomiting in me. Half a beer bottle size worth of hard apple cider once sent me to the hospital because I was so dehydrated from throwing up. For whatever reason, I just can't metabolize those kinds of drinks. Give me a regular whiskey or a gin and tonic (tonic without corn syrup, mind you!) and appropriate hydration and I can drink all night without that effect. So half a glass of wine (and water) for me = hangover of death while 3 shots of tequila (and water) = fun hey ho party time.

It might be worth paying attention if specific kinds of drink are more apt to produce that reaction.
posted by barchan at 11:39 AM on July 28, 2014

No idea about your actual question, but if you actually have problems getting rid of acetaldehyde, it seems like thiamin (aka vitamin B12) and/or cysteine (also a readily available food supplement) should help (works in rats and my anecdotal experience).
posted by themel at 11:40 AM on July 28, 2014

Echoing others, regardless of whether or not you live in NYC, four to six drinks is more than enough to cause hangover symptoms in plenty of people.

Your friends might be surprised because they are unusually strong drinkers, but they also might be surprised because you are drinking to the point of making yourself sick on a regular basis.

There is such a thing as alcohol intolerance, however the reaction is usually closer to the time you consumed alcohol than the next morning.

I would guess that people who can't drink more than 4 drinks without feeling ill the next morning are not going to be drinking on a regular basis as much as those who don't. So perhaps taking a poll of the people you know who drink heavily on a regular basis is not a good basis for comparison.
posted by inertia at 11:44 AM on July 28, 2014 [3 favorites]

Women also have significantly lower amounts of Acetaldehyde Dehydrogenase. So, that's a likely factor as well.

While water is important for me in preventing a hangover, I also need to replenish my electrolytes. I try to drink several pints of water when I get home and often mix in a packet or 2 of EmergenC or ElectroMix (both made by the same company).
posted by quince at 11:48 AM on July 28, 2014

barchan makes a good point. My dad always told me not to drink cheap liquor because it will make you feel sick. My mom said to be careful of sweet fruity drinks.

Also agree with quince - we keep "emergency electrolytes" (Gatorade or Vitamin Water) hidden in the closet so we have them on hand for after drinking.
posted by radioamy at 12:44 PM on July 28, 2014

I'll test out different alcohols. Not that this ultimately matters, since (as one commenter aptly pointed out) this has no bearing on my own condition, but my friends usually outpace me on a given night out, and we drink the same stuff. And I usually leave the bar earlier to mitigate next day nausea. But everyone here is right, drinking this much is unhealthy as shit, no matter how you're doing it. It's just hard to realize when everyone around you is behaving this way.
posted by qzar at 1:10 PM on July 28, 2014

I agree with your friends and think it is strange that you have those symptoms after 3-4 drinks. That amount makes me feel slightly crummy, but never close to wanting to throw up. I think people answering up thread are being slightly obtuse, frankly.

Seconding B12.
posted by Buddy_Boy at 2:24 PM on July 28, 2014 [4 favorites]

Just another data point... My brother and I both have nausea-type hangovers, while most of our peers are luckier and seem to get headaches instead, so I've been assuming there's a genetic component and our family just drew the short straw. We're English, with nothing more exciting in the family tree than the odd Scot. Standard hangover descriptions (all the complaints about sunlight being too bright, loud noises hurting and so on) don't ring true to me at all; that's what I get with a migraine, not a hangover.
posted by ManyLeggedCreature at 2:24 PM on July 28, 2014

... and (on non-preview) while I (37F, but my alcohol tolerance hasn't changed much in my thirties) certainly feel hard-done-by when four pints leaves me actually throwing up the next day, that's not to say it never happens. If you're like me then the trick is to avoid drinking so much so fast that you feel properly drunk; merry is safe, drunk is likely to make the next day miserable.

I shall be trying B12!
posted by ManyLeggedCreature at 2:29 PM on July 28, 2014

Do you weigh less than your friends? The smaller you are, the bigger affect alcohol has on you.

Do you tend to drink sweet cocktails? Dark liquor (rum, whiskey, etc)? Wine? Try switching to gin and tonics or vodka tonics and see if that helps. Sugary alcoholic drinks can really do a number on some people.

It could also be blood-sugar related. A night of drinking can make you temporarily mildly hypoglycemic. Try eating something protein-heavy after drinking before going to bed to ward off a morning blood-sugar crash.
posted by erst at 2:54 PM on July 28, 2014

I am an older woman of 59. I can no longer drink without horrible consequences. 4 hours after my last alcoholic drink, my heart starts pounding rapidly-- obviously if this is at night I don't sleep. My doc tells me this is common in older women who lose the ability to metabolize ETOH and no longer make alcetaldehyde dehydrogenase. I never was able to drink much without nausea but this is different. I find that vodka soda works better than anything with sugar, even wine-- you might try that.
posted by chaoscutie at 3:13 PM on July 28, 2014

6 drinks in a night would probably make me black out, unless I spaced them out over a very long time, and I would most certainly vomit, and feel like hell the next day. And that is why my limit since I stopped trying to impress anyone (i.e. after college) is 2 drinks, maybe 3 if I'm having a particularly wild night, and even that might make me feel kind of off the next day.

For reference, I weigh 130 lbs. One drink is enough to make me feel tipsy unless I am sipping it.
posted by treehorn+bunny at 4:31 PM on July 28, 2014

qzar: "So it appears that my initial assumption was correct, and that drinking 3 drinks in one night usually leads to vomiting the next day. It just feels uncanny because in my circle (friend, professional, familial), I am definitely in the minority."

I don't see anyone saying that 3 drinks in one night usually leads to vomiting the next day. I see people saying that 5 or 6 drinks in a night could lead to feeling queasy the next day. Routinely having to repress the urge to vomit the next day, after having 3 glasses of wine the night before, is not a particularly typical reaction to alcohol.
posted by desuetude at 5:39 PM on July 28, 2014 [1 favorite]

I think this is a little bit of column A and a little bit of column B. I am a 34-year-old female, 5'8" and weigh about 175. I can no longer drink nearly as much as I used to, and on some days, I can drink 6 or so beverages with no hangover. On other days, 3 drinks is too many. It depends on an infinite number of factors — what I'm drinking, how quickly, what I've eaten that day, my water intake, my exhaustion level, etc. etc.

But you should also consider that many, many Russians also have Asiatic genes, and it's not outside the realm of possibility that you have this disorder.
posted by Brittanie at 6:02 PM on July 28, 2014

I've also been tentatively diagnosed with aldehyde dehydrogenase deficiency, but I'm Asian, so I'd be surprised if my doctor's casual observation was anything other than 100% correct. I've heard the condition is also fairly common amongst Ashkenazi Jews, so if you've got any Jewish ancestry, the genetic cards may not be in your favor, but I'm a little surprised by the description of your symptoms and total lack of flushing, which makes me wonder about your diagnosis a bit.

When I drink, I flush bright red after a few sips, deep purple after a few more, and then proceed to get very nauseated and fatigued if I persist in drinking out of some masochist urge. I've been told by others that it's like I get instantly hungover, but I have to take their word for it because I never actually get drunk, just sick. There is no happy buzz for me between first sip and toilet hugging. Admittedly, mine is a fairly extreme case; my siblings can have a drink or two and even get a little tipsy before succumbing to the effects, but it's never a "morning after" situation, more like an icky "later that evening" tragedy. Six drinks would be pretty gnarly for my siblings, but it would probably land me in the hospital with alcohol poisoning. And I would probably never be able to drink that much anyway without someone calling an ambulance because of the horrifying shade of eggplant I'd turn after the second drink, so if you can choke down that much booze without any consequence until the next day? I'd say you sound pretty normal and shouldn't worry about any "deficiency" label.
posted by Diagonalize at 7:10 PM on July 28, 2014

I'm about 135 pounds and I have a pretty low tolerance for alcohol compared to most people I know - I can't drink more than 2-3 drinks without feeling queasy the next day. Also experience the faster heartbeat and insomnia with it, and sugary drinks exacerbate the problem. It got worse as I got older. In college, I could probably have 5-6 and be okay. I also have Eastern European heritage, don't know if that has anything to do with it. It does stink when friends are enjoying a few cocktails or glasses of wine and I can only have one, but.. on the other hand it's cheaper, and healthier to cut back, so I just try to deal with it and stop myself from ordering round #3.
posted by citron at 10:40 AM on July 29, 2014

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