Topic: Scientific reason for why we turn red
posted by (daisy - email) on Thu, November 18, 2004 @ 09:19:01
I'm taking Medical Genetics at my school and wrote a paper on the "asian flush." I'll try and be concise. Ok so here is how alcohol is metabolized by your body: after you drink alcohol, 80% is absorbed into the stomach and rest in your small intestine. Ethanol is metabolized in the liver: ethanol --via alcohol dehydrogenase--> acetaldehyde --aldehyde dehydrogenase(ALDH for short)--> acetate --> acetyl COA ïƒ CO2 + H2O. The rest, about 2-5%, is excreted unchanged in breath, urine, and perspiration. We have 2 types of aldehyde dehydrogenase enzymes: cystolic ALDH called ALDH1 and mitochondrial ALDH called ALDH2. There are 2 alleles for ALDH2 enzyme: ALDH2*1 which is normal and ALDH2*2 which is a mutant. They differ by a single amino acid (so it’s a single point genetic mutation). The mutant ALDH2*2 codes for an inactive or less active ALDH2 and therefore cannot metabolize acetaldehyde as well as someone who has ALDH2*1. About 30-50% Asians have ALDH2*2 whereas 0% of Europeans and Africans do not. Since persons who are genetically deficient in ALDH2 cannot breakdown acetaldehyde to acetate, the pathway stops because it cannot continue and there is an accumulation of acetaldehyde. This build up of acetaldehyde causes a flush reaction (disulfram-ethanol reaction). Accumulation of acetaldehyde levels may also inhibit conversion of dopamine to norepinephrine via dopamine beta hydroxylase. This leads to hypotension and the body responds by increasing heart rate, thus the rapid heart rate experienced by persons with ALDH2*2. The symptoms of the ‘Asian flush’ are flushed-face, rapid heart rate, and nausea. If you are homozygous (rare) ALDH2*2/2*2, then your symptoms are very servere; ALDH2*2/2*1 moderate; ALDH2*1/2*1 no symptoms. Acetaldehyde is carcinogenic and neurotoxic. Those who have ALDH2*2, there is a higher concentration of acetaldehyde in salvia and that increase the risk for oral and esophageal cancer. Hope that helps! =)
So you either need an enzyme or something to help break down acetaldehyde to acetate (or to flush out acetaldehyde from blood) or a H1, H2 antagonists. ...
posted by (Dan Chen - email - url) on Wed, November 24, 2004 @ 10:29:48
There appears to be a lot of dis-information on this log- perhaps a FAQ is in order?
The flushing syndrome seen in asians after alcohol consumption has nothing to do with allergic reactions. The aldehyde being a carcinogen issue, is mostly theoretical- a study trying to link the two actual found an inverse correlation.
The bottom line summary- Many asians have *fast* enzymatic activity for the first breakdown step of alcohol- up to 100x faster than most caucasians. This produces aldehyde. Some asians have *fast* breakdown of aldehyde as well (up to 40% of asians). You know these asians as people that not only don't flush, but they can drink like fish. Most Asians still have active breakdown of aldehyde, but because they breakdown alcohol so fast, they can't keep up. This is called shunting of alcohol to aldehyde. Aldehyde causes flushing and that "thick headed" feeling.
As far as I can tell, it is unclear yet, why H2 blockers can prevent this. There are many possibilities, but I think the most likely is thatthey just slow the absorption of alcohol in the stomach. As long as you are one of the ~40% of asians that flush, but still have adequete breakdown of aldehyde, that slowing of absorption will slow the shunting and allow breakdown of the aldehyde as it is made.
(ps- I do not study these pathways in the lab, but I am a Stanford MD and a molecular biologist)
Further thoughts are welcome.
Dan
From Kenny Liu, MD:
Common symptoms -- aside from turning beet-red -- are: becoming tachycardic (racing heart), tachypneic (fast respiratory rate), and pruritic (itchy).
-- From http://endeavor.med.nyu.edu/~strone01/doctor.html :
Yes, it is true. The metabolism of ethanol (alcohol) is one of the simpler biochemical pathways in the human body. As seen in the figure, once ethanol has entered the bloodstream, it travels to the liver where hepatocytes (liver cells) transform it into a compound called acetaldehyde using the enzyme alcohol dehydrogenase. Acetaldehyde is than transformed into acetic acid with the aid of another enzyme, aldehyde dehydrogrenase. Both of these reactions form the electron carrier NADH which can then enter the electron transport chain to form ATP, the body’s primary source of energy.
Some people of Asian descent (perhaps as much as ½) carry a “defective” copy of the gene for aldehyde dehydrogenase which works slower than normal, causing a bottleneck effect during the metabolism of ethanol. The net result is a build-up of acetaldehyde, which can lead to flushing, nausea, malaise, and headache, a reaction sometimes referred to as “Asian flush”. However, this does not contribute significantly to decreased alcohol tolerance, as ethanol is broken down at nearly the same rate.
Some scientists have speculated that the relatively low incidence of alcoholism among those of Asian descent may be a result of this mechanism. In effect, they feel too sick to continue drinking before they actually become drunk.
Pharmaceutical companies have actually capitalized on this effect in the development of a drug called disulfiram, better known as Antabuse. This drug inhibits aldehyde dehydrogenase, resulting in the same symptoms as above. It is meant as an aid in the treatment of chronic alcoholics. If regularly taking disulfiram, they can rapidly feel very ill following the consumption of alcohol which, in theory, helps prevent them from resuming their habit.
The (almost) Doctor