Why does my face turn red when I drink alcohol?

Picture this. It’s a Saturday night, and I’m at a dinner party with my friends, as you do when you’re over 30 and past the clubbing age.

My friend has cooked a lamb roast, and we’re all sharing a bottle of red wine. We’re all getting on famously. I’m sitting there, minding my own business, when one of my friends stares at me intently.

“Carla, why’s your face all red?” she asks, loudly.

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Everyone stops talking and looks at me. I check my reflection in my iPhone, and sure enough, my face is a bright, tomato-red and somehow puffy, too. My eyes are glazed and bloodshot.

My face feels really hot, as though I’ve been running a marathon, rather than eating a home-cooked dinner in the suburbs. I touch my cheek, and it’s burning. My heart is pounding, my eyes hurt and I’m breathing rapidly. I feel sick, and so embarrassed. I’ve only had three sips of my wine. What’s wrong with me?

The above scenario has happened to me so many times that I’ve just stopped drinking. Drinking alcohol makes me feel so uncomfortable, both physically and socially, that I don’t want to do it any more. My habit of having a rare drink – perhaps once or twice a month – had trickled down to nothing.

Which is a shame, because I think it is very sophisticated and lovely to have a glass of wine with your dinner, rather than, say, a chocolate milkshake.

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I’m not alone in these experiences, either. Known colloquially as the “Oriental flush”, turning bright red when you drink alcohol is often the bugbear of my Asian relatives and friends.

Australia is famous for its drinking culture, so when you don’t drink, you'd better have a good reason. Just this week, I was ordering an orange juice at a bar, when the bartender asked me if I wanted “something else in it, like vodka.” (Post continues after gallery.)

“No,” I said, “I’m kind of allergic to alcohol, so I don’t drink any more.”

“So… do you just get drunk twice as fast?” he smiled.

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“Yeah, something like that.”

“Well… what’s the problem with that?” he joked. “It sounds awesome, getting drunk for less!”

He graciously made me a non-alcoholic tequila sunrise – so, just a sunrise, I guess – and it was on the house, so I can’t complain. But, as you can see, it’s difficult to explain why I don’t drink.

It was particularly difficult to explain because I didn’t know or understand why my body was reacting in that way.

Luckily, Dr Veronique Chachay, a teaching and research academic from the School of Human Movement and Social Sciences at the University of Queensland, came to my rescue. Through her research, Dr Chachay investigates the effects of alcohol on our health.

Dr Chachay explained what I was experiencing was not an allergic reaction to alcohol. Well, there goes my one-stop explanation. So, what was wrong with me?

Evidently, my discomfort was due to the build-up of toxins in my body, as my body was not sufficiently metabolising the alcohol. And when she explained it like that, I really didn’t want to drink any more.

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The most shocking thing I learned from Dr Chachay was that my symptoms of having a red, hot face, swelling and discomfort were actually a signal that alcohol was damaging my body in a way that was more severe than I realised.

“This is unlikely an allergic reaction, but the effect caused by the build up of a product called acetaldehyde (AAL). Alcohol is metabolised first by an enzyme called alcohol dehydrogenase (ADH), which converts it to AAL. Then a second enzyme called acetaldehyde dehydrogenase (ALDH 2) converts AAL to a product called acetate,” Dr Chachay says.

In other words, when we drink alcohol, our body attacks it first with one enzyme (ADH), which then turns it into acetaldehyde. You may have heard of acetaldehyde before – it’s what causes the worst hangover symptoms, like huge headaches and vomiting.

For most people, another enzyme (ALDH 2) comes along to attack acetaldehyde, which is then turned into acetate. Acetate is used as one form of energy by the body.

However, for people like me, it’s a different story.

“When ALDH2 is not produced in sufficient amounts by the body, or is malfunctioning (due to genetic variations), acetaldehyde is not converted to acetate and builds up. This results in the symptoms you have described, because acetaldehyde is a toxin for the body,” concludes Dr Chachay.

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So this means that, because my body can’t metabolise alcohol properly, the acetaldehyde – which is a toxin – hangs around in my body for longer than it should, causing me to feel physical discomfort.

Basically, Acetaldehyde is the gross, big, drunk guy at the party, and everyone wants him to leave, because he is loud and dangerous, bashing into people and shouting. He calls himself Ace on Facebook. Everyone knows the Enzyme brothers are the best ones for talking him into leaving the party. The problem is, only one Enzyme brother is at the party, and Ace will only listen if both of them are there. Everyone is texting and calling the brother who isn’t at the party, but he’s not turning up, so everyone is stuck with disgusting Ace causing a scene. And that, my friends, is what’s going on in my body when I drink. (Post continues after gallery.)

But, why does this seem to happen in particular to my Asian friends and relatives? Is alcohol… racist?

Dr Chachay suggests it’s all in the genes. “It is common in the Asian populations to have a variation in the ALDH2 gene (this is called a polymorphism of the gene), which makes its function less efficient or makes this enzyme less abundant in the body. Hence the build up of acetaldehyde and the symptoms you are experiencing,” she explains.

How disappointing – there’s either not enough of that second enzyme, ALDH2, in my body, or when it’s there, it doesn’t work properly. If ALDH2 was a faulty item of clothing, I would totally get a refund on that crap.

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I was also curious to know why the severity of my symptoms changed, according to what I was drinking. For example, the symptoms are most extreme if I drink red wine, whereas if I have a gin and tonic, it’s bearable.

Dr Chachay says that it’s all to do with the amount of alcohol that is consumed. A glass of wine can have three times the amount of alcohol that a gin and tonic would have.

"Additionally,” she says, “there may be some other compounds in red wine that you may be sensitive to, such as histamines and sulphites.”

Desperate to join in with drinking at parties and dinners, I’d previously Googled solutions to my red-face problem. Some swear by taking over-the-counter medication before drinking – I’ve tried it, and it doesn’t work. Others suggest purchasing special drops to put in your drink, which I’m too scared to try.

I asked Dr Chachay if she knew of solutions, and she said, “Not that I know of.” Looks like I’ll need to stick to my orange juice for now.

Offhandedly, I wondered to Dr Chachay if my physical reactions to alcohol meant that I should avoid it. Was my burning, extremely red face a sign that alcohol was having a worse effect on my health, compared to my friends who could drink without turning bright red?

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In all honesty, her answer shocked and horrified me, and I was so glad that I’d asked.

“Yes definitely, it is best to avoid alcohol, because your body is not able to metabolise it adequately,” she warned. “The build-up of acetaldehyde is not good, and can lead to the damage usually associated to long-term alcohol intake.”

This was terrifying to hear, and it made me glad that my fear of turning red had made me stop indulging in alcohol.

Dr Chachay likened my situation to having a food intolerance, or allergy: “It is similar to the situation of being lactose intolerant or having coeliac disease where one is allergic to gluten: one must adapt their diet to maintain health.”

As for what to say to people when they ask why I’m not drinking, Dr Chachay had a great tip.

“Knowing what causes this reaction and knowing how to explain it can be a great topic of conversation! You will teach something to people in these social situations,” suggests Dr Chachay.

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There are plenty of reasons not to drink, Dr Chachay observes, such as “religion, cultural backgrounds, health choices, past addiction, weight management, and so on.”

“So it is a matter of not being ashamed, but identifying with others who don’t drink.”

There are also plenty of fun, non-alcoholic alternatives like mocktails, alcohol-free wine, tea and coffee.

It's a hard choice to make. Despite the uncomfortable symptoms that I experience, I still enjoy the taste and social pleasures of alcohol. However, after hearing about the true damage that alcohol can cause me in the long term, I've decided to give it up for good.

I feel like I'm lucky. We know that ultimately, alcohol is bad for us; I'm lucky that my body lets me know that, loud and clear. And that's nothing to be red-faced about.

The Glow Tip: Suffer from blotchy, irritated or red skin whether you've been drinking or not? Ultraceuticals Ultra RED-Action Complex ($45)  is super handy for those times you need to soothe skin fast (i.e all the time). Even better, it's free from nasties too.

Does your face also turn red when drinking? Or, do you have a friend who goes red? Has this story changed the way you think about drinking? Let us know in the comments!