昨晚我將新聞稿翻譯成中文，剛剛已經傳給台灣多家媒體、國健署、心健司等單位。也歡迎大家轉傳分享給媒體或親友。發文如下：

今天徵得華盛頓郵報記者Meeri Kim 同意可將昨天對台灣酒精不耐症的新聞報導翻譯為中文?載。

附上中文翻譯稿歡迎在貴報刋登。相信是有高度新聞價值，並對台灣的民眾會有增加健康新知的閱讀性。

台灣酒精不耐症衞教協會、台灣酒害防治協會理事長
陳哲宏敬啓

<美國華盛頓郵報> August 15, 2023 at 6:00 a.m. EDT
https://www.washingtonpost.com/wellness/2023/08/15/asian-glow-alcohol-gene-mutation-cancer-risk/
喝酒引起的臉紅症不僅只是一種不適，而是一個嚴重的健康警告。

這種反應是由一個基因突變引起的，帶有這種突變的人會因飲酒帶來很多疾病，包括多種癌症的風險。

Meeri Kim 報導/陳哲宏翻譯

在台灣長大的吳醫師小時後偶爾會看到父母親和祖父母只喝一兩杯酒，他們的臉就變得通紅。多年後，當他自己嘗試喝酒時，他也親身經歷了這種現象。

美國史丹佛大學醫學院研究導致喝酒臉紅反應基因突變的心血管研究所所長兼美國心臟協會主席 Dr. Joseph Wu (吳慶明醫師) 說：我的心跳會達到每分鐘 130 次，面部泛紅，三、四小時後，我可能也會頭痛。

全球大約 5億6千萬人，即總人口的 8%，帶有這種突變，其中絕大多數是具有東亞血統的人，因此這種反應也被暱稱為“亞洲紅”。據估計，45% 的東亞人在喝酒時會有這種臉部發紅的反應。對於一些人來說，這種不舒服的反應就足以阻擋他們盡量不去碰酒，但是許多人卻可以克服不適，甚至有時會藉著服用抗組胺藥物來減輕或壓抑這種不適的感覺。

然而，吳醫師等專家表示，出現酒精臉紅反應的人應該盡可能少喝酒，或是最好根本不喝酒。喝酒發紅和其他相關的症狀其實就是身體發出的嚴重警告，這表示酒精對人體的毒性極大，比其他許多物質的毒性更大。在中度、重度飲酒者罹患的多種嚴重疾病中，很多都和此被稱為 ALDH2*2 的基因突變有關。

增加許多疾病的風險

吳醫師說，當我年輕的時候，我們的認知只是喝酒臉紅反應似乎只是一種“困擾和不適”。 就像大多數人一樣，我並不知道它在醫學上對我們身體的影響。

康乃爾大學醫學院遺傳醫學系主任 Ronald G. Crystal 這麼說：“這是世界上最常見的遺傳性疾病之一，特別又是我們社會中的人群喜歡喝酒”。  “但是這兩件事加在一起，使這些人面臨心血管疾病、骨質疏鬆症、食道癌等疾病的風險大大提高”。

例如，攜帶 ALDH2*2 遺傳變異的人若只是適量飲酒（即男性每天兩杯，女性每天一杯），罹患食道癌的風險比未攜帶該突變的人高 40 至 80 倍。

這個風險是和劑量有正相關的關係，意味著每天喝更多的酒就會有更大的風險。ALDH2*2 變異不會使不飲酒者有罹患食道癌的風險。此突變也會使東亞人患頭頸癌、胃癌、心血管疾病、中風和骨質疏鬆症的風險增加。

是什麼原因導致喝酒臉紅反應？

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患有 ALDH2*2 變異的人身體缺乏幫助分解酒精功能的酵素。酒精通常在身體分兩步驟代謝。先由第一個酵素將酒精轉化為乙醛，乙醛這種物質對人體的毒性遠大於酒精本身的毒性。乙醛需要第二個酵素迅速將它轉化為無毒的乙酸，因為乙酸是一種可以被人體安全代謝的化合物。

患有喝酒臉紅反應的人所產生第二個酵素 （即線粒體內的乙醛去氫酶 ，ALDH2) 的活性非常低。 ALDH2 酵素的缺乏會導致酒精無法正常代謝，而使具有毒性的乙醛在血液中快速積聚。

“乙醛已被世界衛生組織列為第一級致癌物，因為它已被證實會導致人類的癌症，”史丹佛大學亞洲人健康研究教育中心國際主任 Dr. Che-Hong Chen (陳哲宏博士) 說： “即使只喝兩罐啤酒，人體血液中的乙醛就已經達到了致癌的濃度。”

在他的實驗室中，陳博士使用一個簡單的酒精 (乙醇）棉片來測試受試者是否患有 ALDH2 缺乏症。他用酒精沾溼在OK 繃的棉片上，然後將OK 繃貼在皮膚上 20 分鐘。如果皮膚產生的乙醛累積就會使帶有ALDH2*2突變的人血管擴張，在和酒精接觸的部位產生一個紅色斑塊。這也就是喝酒導致臉紅發生的原理。

但此酒精棉花測試的準確度約只有70% 至 90%。如果想要有更確切的答案，個人可以去 例如23andMe 或 Ancestry 等基因檢測公司進行 DNA 測試。

服用抗組胺藥有幫助嗎？

抗組胺藥可能會防止皮膚潮紅，因為它可以抑制血管擴張，但這種藥物對降低血液中的乙醛濃度並沒有任何作用。陳博士說，在他所工作的大學中有的學生經常會在外出喝酒前服用 Pepcid AC 或 Zantac等藥物來避免亞洲人喝酒臉紅帶來的不適。

陳博士說“服用藥物來預防喝酒臉紅反應基本上可以說只是麻痺不愉快的感覺，這樣你就可以喝更多的酒。其實這更加危險”。 “這好比你的身體有一種疼痛感來警告你停止喝酒，你卻故意把它抑制。”

缺乏對ALDH2*2基因變異的認知

ALDH2*2 的突變被認為是起源於中國東南部的一位原始者，他/她生活在 距今約2000 至 3000 年前。從那裡，此突變傳播到其他東亞國家。如今，不同國家的盛行率各不相同，例如韓國（30%）、中國（35%）、日本（40%）和台灣（49%）。

儘管這麽多人群普遍存在有喝酒臉紅的反應，但酒精的攝取量仍在繼續增加。東亞地區的飲酒者比例已從 1990 年的 48.4% 上升至 2017 年的 66.9%。韓國的暴飲問題尤其突出、嚴重，而中國在過去三十年中的酒精消耗量是激增的。東亞地區因酒精引起的癌症負擔是世界上最高的（以因該疾病損失的生命年數來計算）。此地區也是全球因酒精引起的癌症比例最高的地區，佔 所有癌症的5.7%。相較之下，北美洲的比例只為3.0%。

專家表示，最大的問題是缺乏對 ALDH2 缺乏症及飲酒危害的認識。

身為 ALDH2*2 變異攜帶者的陳博士表示“我是一位遺傳學家，但連我都不知道這個突變”。 “當我回到我的故鄉台灣時，我發現很多人和我一樣都不知道”。

各種誤解包括認為喝酒臉紅反應僅僅是一種不便，甚至很多人認為這意味著肝臟功能強壯。許多人仍然認為適量飲酒有益健康，但最近的研究顯示這種觀點是錯誤的。

教育人們有關喝酒臉紅反應的正確知識

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陳博士於 2017 年在台灣成立了一個非營利組織，旨在向台灣民眾宣導喝酒臉紅反應對健康的影響。「台灣酒精不耐症衞教協會」與政府合作，促進有關 ALDH2 缺乏症和飲酒的公衞教育。此協會於2019年5月9日，利用中文“59”與“無酒”的諧音共同和政府發起了第一個「台灣無酒日」。

研究顯示一個人如果了解飲酒相關的健康風險就足以使其減少飲酒，或暫時減少飲酒行為。 一項2010 年針對 200 名亞裔美國年輕人進行的研究發現，傳達對 ALDH2*2 變異的遺傳知識和醫學健康信息可導致30 天調查期間中飲酒頻率和數量顯著減少。

該研究的作者加州大學聖地亞哥分校的心理學家Dr. Tamara Wall 說“我們目前不知道這是否會產生長期影響，但我認為人們如果了解自己的基因組成是會有幫助的”。 “人們必須意識到，如果他們飲酒又攜帶這種基因變異，他們就會比沒有攜帶這種變異的人面臨更大的風險。

‘Asian glow’ from alcohol isn’t just a discomfort. It’s a severe warning.
The reaction is caused by a genetic mutation that has been linked to diseases, including cancer, in those who consume moderate to large quantities of alcohol

By Meeri Kim
August 15, 2023 at 6:00 a.m. EDT


https://www.washingtonpost.com/wellness/2023/08/15/asian-glow-alcohol-gene-mutation-cancer-risk/


People who experience alcohol flush reaction should drink as little as possible or ideally not at all, experts say. (Washington Post illustration; Pexels)

Growing up in Taiwan, Joseph Wu watched his parents and grandparents enjoy alcohol on occasion, their faces turning a glaring shade of red after only one or two drinks. When trying alcohol for himself years later, he experienced the phenomenon firsthand.

“My heart rate goes up to 130 beats per minute, I get facial flushing, and three to four hours later, I’ll probably get a headache,” said Wu, director of the Stanford Cardiovascular Institute and president of the American Heart Association, who studies the genetic mutation that causes what is known as alcohol flush reaction.

About 560 million people, or 8 percent of the global population, carry this mutation, with the vast majority being of East Asian descent — hence the nickname for the reaction, “Asian glow” or “Asian flush.”

An estimated 45 percent of East Asians get the “glow” when drinking. For some, the unpleasantness is enough to abstain from alcohol. Many others push through the discomfort, sometimes with the help of an antihistamine to lessen the effects.

Experts such as Wu, however, say that people who experience alcohol flush reaction should drink as little as possible or ideally not at all. The redness and other symptoms may be thought of as a severe warning from the body that alcohol is extremely toxic to this individual, much more so than to many others.

The associated mutation, known as the ALDH2*2 variant, has been linked to a staggering number of diseases in those who consume moderate to large quantities of alcohol.

Alcohol flush reaction seemed like a “nuisance and a discomfort” when I was younger, Wu said. “Like most people, I wasn’t aware of the medical implications,” he said.

“This is one of the most common hereditary disorders in the world, and people in our societies like to drink,” said Ronald G. Crystal, chair of genetic medicine at Weill Cornell Medical College. “But the combination of these two things puts these individuals at risk for cardiovascular disease, osteoporosis, esophageal cancer and more.”

For example, someone with the ALDH2*2 variant who drinks in moderation — defined as two drinks a day for men and one drink a day for women — has a risk of esophageal cancer 40 to 80 times higher than a person without the mutation who consumes the same amount.

It is a dose-dependent relationship, meaning that more drinks per day translates to an even greater risk. The ALDH2*2 variant does not influence esophageal cancer risk in nondrinkers.
The mutation has also been associated with an increased risk of head and neck cancers, gastric cancer, coronary artery disease, stroke and osteoporosis in East Asian populations.

What causes the alcohol flush reaction?

A positive alcohol-induced skin erythema reaction as an indication of ALDH2*2 deficiency is seen. (Che-Hong Chen)

People with the ALDH2*2 variant lack a functional enzyme that helps the body break down alcohol. Alcohol is normally metabolized by the body in two steps. One enzyme converts alcohol into acetaldehyde, a compound significantly more toxic to humans than the alcohol itself. A second enzyme then quickly converts acetaldehyde into acetate, a compound that can be safely metabolized by the body.

People with alcohol flush reaction produce a version of the second enzyme, mitochondrial aldehyde dehydrogenase 2 (ALDH2), that has very low activity. This ALDH2 deficiency leads to alcohol not being metabolized normally, and acetaldehyde — essentially, a poison — builds up in the blood.

“Acetaldehyde is classified as a Group 1 carcinogen by the World Health Organization, meaning it has been proven to cause cancer in humans,” said Che-Hong Chen, country director of the Stanford Center for Asian Health Research and Education. “Even with just two cans of beer, the amount of acetaldehyde in their blood is already reaching carcinogenic levels.”

In his laboratory, Chen uses a simple ethanol patch test to determine whether subjects have an ALDH2 deficiency. He applies ethanol to a Band-Aid and places it on their skin for 20 minutes. Acetaldehyde causes blood vessels to dilate — essentially, what causes the flushing to occur -- and those with the mutation will have a red spot in that area. The ethanol patch test is approximately 70 to 90 percent accurate. To know for sure, individuals may take a DNA test from 23andMe or Ancestry.

Can an antihistamine help?
An antihistamine might prevent skin flushing, since it reduces blood vessel dilation, but the medication does nothing to lower acetaldehyde levels in the blood. Chen said that college students at his university commonly take Pepcid AC or Zantac before going out drinking to avoid the discomfort of Asian glow.

“Taking a drug to prevent alcohol flush reaction basically numbs the unpleasant feeling so you can drink more, which is even more dangerous,” Chen said. “Think of it as your body having a pain sensation to tell you to stop drinking.”

Lack of awareness
The ALDH2*2 variant was thought to originate from a single founder in Southeast China who lived 2,000 to 3,000 years ago. From there, the mutation spread to other East Asian countries. Today, the proportion of carriers varies across countries such as South Korea (30 percent), China (35 percent), Japan (40 percent) and Taiwan (49 percent).

Alcohol intake continues to increase despite the widespread nature of alcohol flush reaction in these populations. The prevalence of drinkers in East Asia has risen from 48.4 percent in 1990 to 66.9 percent in 2017. South Korea notably has a binge-drinking problem, while China has seen a surge in alcohol consumption over the past three decades.

East Asia has the largest absolute burden — measured in the number of years lost because of the disease — of alcohol-attributable cancer in the world. It is also the region with the greatest proportion of cancer cases that can be traced back to alcohol, at 5.7 percent. In comparison, North America has a proportion of 3 percent.

The biggest problem is a lack of awareness about the dangers of drinking with an ALDH2 deficiency, experts said.

“I’m a geneticist, and even I didn’t know about this mutation,” said Chen, who is an ALDH2*2 carrier. “When I visited my home country of Taiwan, I realized that so many people were unaware like me.”

Misconceptions include thinking that alcohol flush reaction is a mere inconvenience or even signifies a strong liver. Many people still believe that a moderate amount of alcohol is good for your health, which recent research shows is false.

Educating people about alcohol flush reaction

Chen founded a nonprofit organization in 2017 to inform the Taiwanese public about the health implications of alcohol flush reaction. The Taiwan Alcohol Intolerance Education Society collaborates with the government to promote education around ALDH2 deficiency and alcohol consumption. Together, they launched the first National Taiwan No Alcohol Day on May 9, 2019. In Mandarin, “5-9” is a homophone for “no alcohol.”

Research suggests that knowing one’s alcohol-related health risks is enough to reduce consumption, at least temporarily. A 2010 study of 200 Asian American young adults found that conveying genetic feedback and medical information specific to the ALDH2*2 variant resulted in significant reductions in 30-day drinking frequency and quantity.

“We don’t know if there are long-term effects, but I think that people knowing their genetic makeup is helpful,” said study author Tamara Wall, a psychologist at the University of California at San Diego. “People have to be aware that if they drink with this variant, they are putting themselves at greater risk than people without.”