Probiotics for Alcohol Flushing

Probiotics for alcohol flushing may seem like an odd idea. After all, rosy cheeks seem to infer good health and attractiveness. Makeup manufacturers want you to believe that rosy cheeks are always desirable. However, there is one type of rosy cheek (and entire face) flushing that is not only cosmetic, but may be a serious risk factor for some cancers and heart-rhythm disruptions. It is the rosy glow you DON’T want.

The type of rosiness you want to avoid is the alcohol flushing response in which the entire face takes on a reddish appearance. Fortunately, early research shows that some probiotics for alcohol flushing may be able to help.

Who Is Affected by Alcohol Flushing?

Approximately 36% of East Asians show a response to drinking alcohol that includes entire facial flushing, nausea, and tachycardia, an elevated heart rate. East Asians are not the only populations affected by some degree of this phenomenon, however. Genetic SNP's (single nucleotide polymorphisms) in either the cytosol (intracellular fluid) ALDH1 or mitochondrial ALDH2 enzymes are mostly to blame, and these may happen in any ethnicity.

Why Does Alcohol Flushing Occur?

An inherited deficiency in the enzyme aldehyde dehydrogenase 2 (ALDH2) is the predominant cause of alcohol flushing. Here's why. Consumable alcohol is ethanol. When consumed, it is metabolized first in the digestive tract, but mainly in the liver, into a mutagen and carcinogen called acetaldehyde by the enzyme alcohol dehydrogenase (ADH), for which there can be genetic variants. Acetaldehyde is then metabolized to acetate, mainly by the enzyme ALDH2 for which there can also be genetic variants.

You can see that a decrease in functioning ALDH2 can cause undesirable acetaldehyde levels.

The excess aldehyde then wreaks havoc in the body, causing histamine release, DNA damage, and other cancer-promoting activities including chromosomal damage. Interestingly, one of the first medications for alcohol use disorder in the US was disulfiram, and its mechanism of action is to inhibit ALDH1 so that the consumer experiences a severe reaction.

The Influence of Microbes and Probiotics for Alcohol Flushing

One of the cancers that is associated with the greatest risk from alcohol consumption is esophageal cancer, and it unfortunately is one of the deadliest. Other cancers include oral, pharynx, and larynx.

Hmmm, oral, pharynx, larynx, esophagus… all are part of the upper aerodigestive tract, and all have their own microbiomes. More and more evidence for carcinogenic potential points to the metabolism of ethanol to acetaldehyde by microbes in these areas.

If ethanol metabolizes to acetaldehyde and causes histamine release, then aren't antihistamines the answer for ALDH2-deficient individuals? From a cosmetic standpoint, maybe, but from a health standpoint, definitely not! Antihistamines may blunt the histamine response, but they do nothing for the underlying cause. Only abstention from ethanol is the solid answer. It should be noted that cigarette smoking also dramatically increases acetaldehyde levels in saliva.

If you are homozygous for ALDH2, your best protection is to never indulge in alcohol because you have extremely low ALDH2 activity. ALDH2-deficient individuals should not smoke either since smoking increases salivary acetaldehyde levels, and definitely not smoke and drink alcohol.  

If you are heterozygous for ALDH2 variants and want to drink alcohol, then your intake should be extremely low because moderate and high consumption results in significantly increased odds ratios of developing esophageal cancer.

You may get mild flushing and other symptoms and insist on having alcohol. Are there probiotics for alcohol flushing? It turns out that many Lactobacillus and Bifidobacterium species encode ADH or ALDH enzymes to mediate alcohol and acetaldehyde metabolism.

Which Probiotics for Alcohol Flushing Work?

There was a study performed to test probiotics for alcohol flushing. In a small, randomized, double-blind, placebo-controlled crossover clinical trial funded by the probiotic manufacturer, 27 healthy-weight males aged 19-65 years old without ALDH2 variants, and 27 with heterozygous status were assigned to receive either the Duolac ProAP4 probiotic for alcohol flushing or placebo for 15 days with subsequent crossover after a 28-day washout. The alcohol challenges were at the end of days 15 and 58, provided thirty minutes after meals, and were given at 0.8 g per kg of 1:1 Absolut Vodka:water .

DuolacProAP4 contains L. gasseri CBT LGA1, L. casei CBT LC5, Bifidobacterium lactis CBT BL3, and Bifidobacterium breve CBT BR3. It was given at a dosage of 500 million CFU/day divided into 2 doses, one after breakfast and one after dinner.

Primary outcomes were measurement of alcohol and acetaldehyde in the blood after the alcohol intake with or without the probiotics for alcohol flushing. Blood levels of alcohol and acetaldehyde were significantly downregulated by probiotic supplementation in participants with heterozygous genotype, but not in those without variants in ALDH2 genotype. However, there were no marked improvements in hangover scores between the two groups.

The conclusion of the study was that the probiotic supplement has a potential to downregulate alcohol and acetaldehyde concentrations, but their effects depend on the presence or absence of polymorphism on the ALDH2 gene.

This study was very interesting because it showed that although in vitro lab studies and in vivo rat studies showed high potential for the probiotics to lower blood alcohol and acetaldehyde concentrations by influencing the genes that metabolize them, the reality in humans is that the effects are dependent on the SNP's a person carries.

Even with the probiotics, the participants with variants still had higher alcohol concentrations that the participants without variants. However, the variants probiotics group had significantly lower liver enzymes than the variants placebo group. This shows that the probiotics helped protect the liver from the effects of alcohol.

Although many Lactobacillus and Bifidobacterium species encode ADH or ALDH enzymes to mediate alcohol and acetaldehyde metabolism, taking a probiotic is not a free pass to drink as much alcohol as you want. Besides increasing aldehyde concentrations in the body, alcohol has other deleterious effects on the body, one of which is free radical production.

Alcohol has been shown to deplete glutathione, the body's stellar antioxidant, particularly in the mitochondria, which cripples the body's ability to deal with free radicals caused by alcohol consumption. Supplementing with liposomal glutathione from my Wellevate supplement dispensary or Fullscript supplement dispensary may help attenuate some of the free radical damage, but it is not an absolute protection.

If you consume alcohol, please act responsibly, take measures to protect your body against the damages it can cause, and definitely avoid the rosy glow associated with it.

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