I’ve gone most of my drinking life without bothering to ask the internet what causes ‘Asian flush.’ If you don’t know what ‘Asian flush’ is, it’s sometimes called ‘Asian glow’, ‘that-thing-where-my -face-gets-really-red-when-I-drink’ or sometimes even ‘excuse-for-drunk-people-to-feel-my-warm-face.’ If anything, I felt like I’d being doing the research all my life; every Friday night starting the same way—heart pounding in my chest and ears, brain aching, and my entire body red and itching like a burlap sack with a bad rash.

But then that fateful night came. I got bored enough to look up the medical mumbo jumbo about ‘Asian flush.’ To my dismay, it became pretty clear that the medical risks of Asian flush are more serious than just looking like a saggy red potato-skin face in party selfies. But fear not, drinking buddies! Not much has really changed in my drinking habits—especially since my research uncovered that taking famotidine-based antacid meds (say that three times fast) at least hides the flush.

If you’re reading that last sentence and thinking, “What? How! Tell me how!” first of all, hello fellow brother or sister of the flush. Don’t worry, I will, by explaining what the whole Asian flush thing really is. First, let’s make it clear that the proper term isn’t ‘Asian flush.’ It’s ‘alcohol flush reaction’ (AFR), because non-Asians can suffer from AFR, too.

So what causes AFR?

Let’s start with the most visible symptom of AFR—the redness, of course. In some people, it’s so bad that it spreads from head to toe, at which point your whole body feels like it’s covered in hives. It’s triggered by your body releasing histamines. Essentially, it’s an allergic reaction, where your body increases blood flow and body temperature to try and flush out the thing you’re allergic to. Relax, you’re not really allergic to alcohol. Just a broken down version of it—acetaldehyde (ADH).

Our stomachs break alcohol down in three stages. At the second stage, alcohol is turned into ADH. Everyone is allergic to ADH, because ADH causes cancer. Fortunately, most people have no problem breaking down ADH. Unfortunately, some people—including a fraction of Asians—have gene variations which not only slow down the digestion of ADH, but also speed up the production of it.

Both factors allow ADH to build up, hang around, and circulate throughout the body to cause flush and that oh-so-lovely increased cancer risk. Victims of both variations get the worst of AFR, while luckier people who only suffer from one or the other get milder AFR.

There are ways to mask AFR

I’m not talking about makeup, but that works too. Feel free to try it out, guys. Otherwise, this is where that famotidine antacid (sound it out slowly) comes in. If you lower the acidity of your stomach, alcohol will break down slower, and so ADH doesn’t accumulate as quick and cause flush as usual.

So, AFR-sufferers can take a famotidine antacid (I use Pepcid AC to good effect), on an empty stomach, and about forty minutes before drinking, to have a much better time, with much milder flushing, headaches, the itchy hives feeling and so on.

Catch 22

Careful, though. The antacid only manages the extra ADH accumulation over a longer period of time. No matter what, if you suffer from AFR and consider yourself a regular drinker, you are up to 10 times more likely than regular drinkers without AFR to develop esophageal cancer. Of course, according to the internet everything causes you cancer these days. This increased risk, though, has the scientific research to back it.

Still, I say not much has changed for me because, knowing all this, I still drink.

I think it’s fair to say that knowing these risks won’t stop many brothers and sisters of the flush from enjoying a drink or ten. But, for those who decide to ease up or even quit, good for them and good luck to them. The science is with you. Society, though? Maybe not so much.

Alcohol plays a big part in socializing (even succeeding?) in Shanghai and the world. So going dryer than the driest gin martini isn’t without its challenges, because, society tells you come on, it’s just one drink. Just have one. You’ll enjoy it, for now. But is ‘for now’ all that really matters?

Me, I don’t know. I do know one thing. If one day I find myself middle-aged and stricken with esophageal cancer, I’ll be much less bitter about it since I’ll know it’s because I chose to not be lame by not quitting drinking in my twenties.

by Kenny Ong