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Since I turn red, experience tachycardia and often nausea when I consume ethanol, I might be at a higher risk of esophageal cancer, says this one paper. The symptoms mean I am either ALDH2 deficient or ALDH2 low activity, so I metabolize a highly toxic byproduct of ethanol, acetaldehyde, much slower than other people. It accumulates and gives me annoying symptoms that people bug me about in social gatherings.

Acetaldehyde is responsible for the facial flushing and other unpleasant effects that ALDH2-deficient individuals experience when they drink alcohol. Importantly, there is now direct evidence that ALDH2-deficient individuals experience higher levels of acetaldehyde-related DNA and chromosomal damage than individuals with fully active ALDH2 when they consume equivalent amounts of alcohol, providing a likely mechanism for the increased cancer risk.


This is from: "The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption"
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000050

I read about this the first time in 2009, but I didn't change anything because I read it completely wrong. It explains there are two types of people who experience flushing--people who don't have ALDH2 activity, and people who have some but very low ALDH2 activity. I mistakenly read it to mean that some people get the flush, but don't increase their risk of cancer. And somehow I dropped myself into that category. (I probably saw what I wanted to see. Somewhere, I probably didn't want to be grouped with those pitiful people who can't drink.)

Here's what it actually says. The first group:

ALDH2 Lys/Lys homozygotes are unable to consume significant amounts of alcohol. As a result, they are protected against the increased risk of esophageal cancer from alcohol consumption. This observation also provided evidence for a causative role for ethanol in esophageal cancer, and a key role for acetaldehyde in mediating this effect.


And the second group:

ALDH2 Lys/Glu heterozygotes experience a less severe manifestation of the flushing response due to residual but low ALDH2 enzyme activity in their cells. As a result, some are able to develop tolerance to acetaldehyde and the flushing response and become habitual heavy drinkers, due in part to the influence of societal and cultural factors (see below). Therefore, paradoxically, it is the more common low-activity ALDH2 heterozygous genotype that is associated with greatest risk of esophageal cancer from drinking alcohol.


So the first group gets so sick they can't really even drink. That means something completely different from what I thought. Good lesson to read the damn thing.

The first case sounds like my dad. He drinks some wine, and within half an hour is very sick. That's why I grew up with neither of my parents drinking. Even when I saw members of my extended family drinking, it seemed weird and vaguely bad.

I'm not a regular drinker, but I've drank a fair amount during college and living in NYC. I feel sick fairly quickly, but it often seems I "sober up" quicker than other people consuming the same amounts. No one in my mothers' family has the flushing response. So I'm probably in the second group.

I can't really evaluate how good this research is. One commenter remarked that if low ALDH2 activity increases cancer risk, then other cancers should . It does seem compelling enough to take precautions.

It's not that hard to quit, since I don't really have drinking habits to begin with. I have a fair intellectual and cultural interest in alcoholic beverages for a while. But I don't remember the side-effects of drinking ever being pleasant. I always thought of it as something I had to put up with to be social, or to be true to the cultural phenomenon. I have wished for some way to (often imagined) peer pressure and social shame on many occasions.

If I stand by this decision to quit, I'll need to confront the social stigma. More than any actual pushback from others, it's the stigma I've internalized that is most daunting. Some folks may joke around, but the people I care to associate with are all very respectful of personal decisions, especially when they have to do with health. On the other hand, my internalized worry about being thought of as lame or weak was powerful enough to cause me to misread this thing in the first place.

I'm glad I checked back on this. Aside from the important opportunity to avoid cancer, it's also given me the opportunity to ponder my own choices and motivations. Even if my symptoms were innocuous, would it be the right decision to drink alcohol when I don't like the side effects the substance has on me? When I know I'll be feeling physically sick while everyone else is having fun?

"You don't have to do it if you don't want to," seems like obvious advice, but in practice it can be very hard on both ends. Sometimes what you want is a confusion of conflicting principles and preferences.

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