ALDH2-deficiency, Antabuse, and Cancer Risk

I saw this article in a couple of places before it dawned on me what
the implication is:


href="http://www.nytimes.com/2009/03/21/health/research/21alcohol.html">Drinkers'
Red Face May Signal Cancer Risk

By NICHOLAS BAKALAR

Published: March 20, 2009



People whose faces turn red when they drink alcohol may be facing more
than embarrassment. The href="http://health.nytimes.com/health/guides/symptoms/skin-blushingflushing/overview.html?inline=nyt-classifier"
title="In-depth reference and news articles about Skin blushing/flushing.">flushing
may indicate an increased risk for a deadly href="http://health.nytimes.com/health/guides/disease/cancer-throat-or-larynx/overview.html?inline=nyt-classifier"
title="In-depth reference and news articles about Cancer - throat or larynx.">throat
cancer, researchers report.



The flushing response, which may be accompanied by nausea and a rapid
heartbeat, is caused mainly by an inherited deficiency in an enzyme
called ALDH2, a trait shared by more than a third of people of East
Asian ancestry -- Japanese, Chinese or Koreans. As little as half a
bottle of beer can trigger the reaction...



The article is base on a study published in PLOS Medicine: href="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.1000050">The
Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal
Cancer from Alcohol Consumption
.


The alcohol in beverages is ethanol: two linked carbon atoms with an
hydroxyl group on the end, and all the remaining bonds linking to
hydrogen atoms.  The first step in breaking down the alcohol is to
convert it to acetaldehyde, which is toxic.  This is done by an
enzyme, alcohol dehydrogenase.  Most people quickly convert the
acetaldehyde into acetic acid, using the enzyme, acetaldehyde
dehydrogenase. (ALDH2 is one type of acetaldehyde dehydrogenase.) 
Acetic acid is the acid in vinegar.  It is not toxic, at least in
modest quantities such as would be seen after drinking ethanol. 



If the second conversion takes place slowly, then the toxic
acetaldehyde hangs around, causing problems. 



The point they make in the article, is that this accumulation of
acetaldehyde increases the risk for cancer.  So, people who are
genetically deficient in acetaldehyde dehydrogenase need to avoid
alcohol, in order to avoid increasing their risk for cancer.



The thing is, Antabuse
(disulfiram) blocks
acetaldehyde dehydrogenase.  I know this sounds strange, but there
are people out there who take Antabuse, but still drink alcohol. 
They simply learn how much they can get away with.  Based upon the
study, it would appear that they are increasing their risk for cancer
when they do this.



Note that the study does not directly prove that there is such a risk
from
Antabuse; it merely gives a strong theoretical reason to believe that
the risk exists.



Now, this may not matter in the long run.  Presumably, they would
not be prescribed Antabuse unless the risk from their alcoholism is
life-threatening.  Antabuse already is known to be risky. 
Thus, the risk of cancer might not change the outcome of the
risk-benefit equation.  That is, even with this newly-recognized
risk, it is likely that the benefits still would outweigh the risks.



However, when the risks and benefits are being compared, it would be
good to include this risk in the  overall balance. 


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How do I get test to find out if I am ALDH2 enzyme deficiency?

By Daniel Milla (not verified) on 24 May 2009 #permalink

From the text of the PLOS article:

Our goal in writing this article is to inform doctors firstly that their ALDH2-deficient patients have an increased risk for esophageal cancer if they drink moderate amounts of alcohol, and secondly that the alcohol flushing response is a biomarker for ALDH2 deficiency. Because of the intensity of the symptoms, most people who have the alcohol flushing response are aware of it. Therefore clinicians can determine ALDH2 deficiency simply by asking about previous episodes of alcohol-induced flushing. As a result, ALDH2-deficient patients can then be counseled to reduce alcohol consumption, and high-risk patients can be assessed for endoscopic cancer screening. [emphasis added]

What is the condition called when you can not tolerate alcohol. My daughter is 24 years old, 5 ft. in height, weights 100 lbs. When she drinks alcohol she gets intoxicated with drinking only a couple of mixed drinks. For a couple of years I contributed it to her small frame, but was wondering if she had some type of deficiency that caused this intolerance.
If she drinks any more than 3 mixed drinks its like she gets "sloppy drunk". This just concerns me, because I don't feel like its normal. I've heard of a deficiency but, can not recall.

By Anonymous (not verified) on 18 Jul 2009 #permalink

So what do you call a full body flush, added with radiating heat, slight swollen-ness, and a burning, painful itch [wherever it is red] that lasts for almost a week from a very small amount of alcohol?

By Anonymous (not verified) on 31 Aug 2009 #permalink

I just discovered this term today and looked it up because the name itself was descriptive enough that I knew I have it. Another puzzle piece that fits neatly into place with the others seeming to depict auto-immune disfunction. Anonymouse Aug31, I feel we have a lot in common. We should get together and... not have a drink.

You bring up a very good point about Anti-buse. Someone would need to review how many people who develop Esophageal Cancer were on Antibuse at any time to see if there is a connection.

I have this syndrome in spades and have for 40 years. At 61, I cannot drink any alcohol at all. Even a tablespoon will give me uncomfortable flushing and I can't imagine what a glass of wine would do at this point. I am not oriental and my doctors are skeptical of my self-diagnosis. I have auto-immune problems as well (PMR) and I feel that this is all interconnected at some point. What specialists do I need to see?

By Andrea Hofmeister (not verified) on 24 Jan 2011 #permalink

I saw this on another website and this scares me a little bit.
I started getting red in the face, and get red blotches on my neck and chest area.That is all that happens though. I don't get hot, or have trouble breathing. This only started happening about 3 years ago in my mid 30's. It happens more with hard alcohol, sometimes with wine and never with any kind of beer. I do take pepcid ac which helps but I only take it if I know I will be drinking hard alcohol in a social situation. Do I have to be concerned about this also, or is mine a different case?

I have the same thing as kim but im only 26
An it started happening when i turned 22