olimay: (Default)
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.
olimay: (Default)
I reread Duff's article about How to Deal Effectively With Peer Pressure and the JADE heuristic, and it's a great tool for avoiding needless conflict when others are trying to use peer pressure on you.

JADE is for what you're trying to avoid:
  1. Justifying

  2. Arguing

  3. Defending

  4. Explaining

It is a good heuristic. There are other times and places it might be worth having a deeper conversation, especially if this is going to be a long-term, recurring thing. There are some cases where it might be better to justify, defend, or explain--e.g. in a situation with legal consequences. (Talk to your attorney.)

Duff gives some caveats about these principles being used to defend harmful behaviors. A lot of stuff can be twisted around.

How should you respond to peer pressure? When someone tries to get you to do something you don't want to do:

  • Have a handy catch phrase that affirms your position (Duff uses the example, "I choose what goes in my body")

  • Say NO kindly and politely the first 3 times

  • The 4th time, make it clear that you would like them to respect your decision.

  • Practice saying NO before it happens

The strategy is from Andrew T. Austin.

This also applies to when you've done something wrong. When you've done something wrong:

  • Genuinely empathize and apologize for harm

  • Only if you are absolutely sure you will follow through state you will do differently; don't deepen the problem through broken promises (otherwise this procedure will become recursive)

  • Until you are sure you can keep your word, make the changes in secret

All of this is pretty helpful for me. I've had trouble dealing with peer pressure in the past; my usual response is to feel ashamed for saying no. I'm embarrassed at coming across as stubborn when people just want me to have fun. So I avoid situations where there might be peer pressure. That is a lot of situations. When I do myself into social situations I have in the past expressed this embarrassment and frustration as anger.

The concrete technique of saying no kindly and politely three times before asking people to respect other people's decisions is very helpful.

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