Sunday, December 26, 2010

Black Out Korea

It’s 9:30 pm and my boyfriend and I are heading home from work. On the 15-minute walk home, we run into a middle-aged man, dressed smartly in a suit and tie and carrying a briefcase, completely smashed, singing to himself as he hobbles along. A few minutes later we run into another; this time we have to dart out of the way to avoid his staggering, which traverses the width of the subway overpass.

It’s not every day that we come across two entirely intoxicated businessmen on the short walk home, but it’s common to see scenes such as these in Korea. Drinking is a huge part of the business and work culture in Korea with work meetings often involving large amounts of booze and employees feeling an obligation to participate…heavily. Those with a higher tolerance for alcohol are often more successful in their work environment because they are able to last longer at meetings than their less tolerant coworkers.

I found it very strange the first time I attended a work function in Korea, the amount of alcohol that my otherwise conservative coworkers drank. Our foreign manager got drunk and proceeded to try and discuss work matters with us, which for me was bizarre and unprofessional, but for Koreans, completely normal. The director of our academy, generally hostile and unfriendly towards us, threw back shot after shot and transformed into bubbly and babbling, slurring her words all over the place, and finally calling it a night at 5:00 am after a trip to the local norae-bong, (karaoke room). The next morning it was work as usual, no embarrassment whatsoever at the shenanigans of the night before.

During nights out in bars or clubs, the same drinking habits of middle-aged Koreans can be observed in the youth. Once young Koreans enter university and experience their first taste of freedom from their parents, some go a little overboard. Of course, this is the same in other countries, but the type of pressure that precedes university for the average American or Canadian student cannot, in any way, shape or form, be compared to the suffocation that a Korean student experiences throughout middle school and high school. One night out in a nearby neighbourhood, I came across a young girl passed out right in the middle of the road. Cars were driving around her as her friends attempted to drag her out of there. Although this is the only Korean I’ve ever seen passed out in the middle of the road, Koreans passed out just about everywhere else is standard. At home, (for me at least), if one of your friends passes out at a bar, you take them home, and it’s a bit of an embarrassing ordeal for everyone involved. Here, however, they just cover them with a coat, and continue on with their night.

Check out this link for proof...

www.blackoutkorea.com

Shots, shots, shots, shots, shots…

Soju and makkoli are the drinks of choice in Korea. Soju, meaning “made of something burning”, is the most widely consumed alcoholic drink in South Korea. It is made by collecting the vapour of heated fermented wine, and is composed primarily of potatoes. It has an alcohol content of 25% and boy, does it give you a hangover, but you can’t beat the price (about $1.50 for a 250 mL bottle).

Makkoli is a milky beverage that has sort of a bittersweet taste, and is drunk from a small bowl. It is made from fermented rice and contains about 7% alcohol. The original flavor is not very nice, in my opinion, but it also comes in several fruity flavours, which are more appealing to us fussier drinkers (1).

Korea has a “wet” drinking culture, where a large amount of alcohol is drunk in spirit form. This style of drinking is similar to that of Russia or Finland (2). In recent years, there has been a notable shift from drinking mild fermented beverages with nutritious side dishes to drinking strong liquors without side dishes (1).

The stats

According to the World Health Organization, the rates of alcohol consumption per capita in adults have increased drastically over the past 50 years from 1.0 liter in 1960 to more than 8.0 liters in this decade. The present level of consumption parallels those of other developed countries.

I should mention that alcohol statistics for South Korea varied enormously from study to study, probably as a result of the figures coming from self-reports. The 3rd Korea National Health and Nutrition Examination Survey conducted in 2005 reported that 59.2% of Korean adults drink alcohol, which is “among the world’s highest, according to an article published by the American Heart Association (3).

As far as binge drinking goes, it all depends on interpretation of what constitutes a “binge”. The journal article mentioned above defined binge drinking as having 6 or more alcoholic drinks on one occasion, and by this definition, 20.4% of Korean males in the study were considered binge drinkers versus 3.5% of American male adults in a previous study, a significant difference (3).

Alcoholism

When it comes to alcohol dependence, South Korea has low rates. Again, the term “dependence” is hard to define, but the World Health Organization reports the numbers at 12.8% in males and 3.7% in females. The article mentioned a remarkable sex difference when it comes to lifetime prevalence of alcoholism in Korea: it is 20 to 30 times higher in males than in females. It is hypothesized that this may be related to Confucian teachings, which strongly influence Korean culture and state that women should not drink (1).

Drinking and Driving

We all know the stereotype surrounding Asians and their less than sterling driving skills and, having lived here for almost a year now, I can’t deny that there may be a smidgen of truth behind it. It makes sense then that this tendency for reckless driving, coupled with large amounts of binge drinking, leads to some major trouble on the roads. The rate of car accidents caused by drunken driving in Korea is about 10 times higher than any other developed country. On top of that, the number of alcohol-related traffic deaths has risen by an average of 12.7% every year (1). I myself have witnessed a late night/early morning hit-and-run here, presumably alcohol-related, where a vehicle stopped at a red light was hit from behind by another car that raced away with a damaged and smoking hood, narrowly missing a pedestrian crossing the street. Scary stuff.

The Asian Flush

I couldn’t write a blog about alcohol in Korea without mentioning “the Asian flush”, the red blushing of the skin that occurs in some Asians when they drink alcohol. This reddening in the cheeks and face is caused by a build-up of acetaldehyde in the body, a compound that is normally broken down during alcohol metabolism by the acetaldehyde dehydrogenase 2 enzyme (ALDH2) (4). A polymorphism in the genes that encode for this enzyme, termed the ALDH2*2 polymorphism, is prevalent in Asian populations but extremely rare in non-Asian populations (5). I couldn’t find any reliable statistics for the proportion of Koreans affected by this enzyme deficiency, but it appears to be anywhere from 25 to 50% of Koreans.

Curiously enough, there appears to be a link between the ALDH2*2 polymorphism and protection against alcoholism. It appears that the defect in the normal conversion of acetaldehyde to acetate causes a greater sensitivity to alcohol and accordingly, lower levels of alcohol consumption (5). This explains Koreans’ intolerance to alcohol and low alcoholism rates. It seems that the red glow that embarrasses many people of Asian descent may actually be a blessing in disguise when it comes to alcohol dependence.

One of the things I will miss the most about Korea is being able to drink anywhere: in the bars and clubs open all night long around the city, in convenience stores, on the street, in the park…but I will not miss the puke-filled sinks of the popular clubs or the sight of completely incapacitated individuals of all ages passed out on the street. Much of Korea’s drinking culture appears to be the result of the enormous pressures of everyday life in Korea, whether is be as a stress release from a demanding, holiday-free job, as a display of newfound freedom after a student’s long and grueling journey to university, or as a necessary step in gaining a new business client. It’s a unique drinking culture, but one that I feel warrants some serious scrutiny of the root causes of some of its more detrimental drinking practices.

Sources

(1) World Health Organization. 2004. Country Profile: Republic of Korea. WHO Global Status Report on Alcohol 2004.

(2) Khang YH, Lynch JW and Kaplan GA. 2005. Impact of economic crisis on cause-specific mortality in South Korea. Int J Epidemiol 34: 1291-1301.

(3) Sull JW et al. Binge Drinking and Mortality From All Causes and Cerebrovascular Diseases in Korean men and Women: A Kangwha Cohort Study. 2009. Stroke 40: 2953-2958.

(4) Wikimedia Foundation Inc. 2010. Alcohol Flush Reaction. http://en.wikipedia.org/wiki/Asian_flush. Access date: December 26, 2010.

(5) Wall TL, Carr LG and Ehlers CL. 2003. Protective Association of Genetic Variation in Alcohol Dehydrogenase With Alcohol Dependence in Native American Mission Indians. Am J Psychiatry 160: 41-46.

4 comments:

  1. Thanks Tess. I'm really enjoying your posts. You mentioned that the characteristic flush in Koreans is not prevalent in Caucasions, but Caucasions often develop a permanent flush after years of heavy drinking. Is the cause similar? Do you know if a caucasion drinker having a red complexion is also an indicator of better health protection from drinking? I know several people with that flush and it's not caused by a naturally 'ruddy'complexion.

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  2. Great information again, Tess! Something I would never have thought of on my own so you're helping to open up the world to us, thanks. Jeannine

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  3. Thanks for reading! I looked into the alcohol flush in Caucasians and unfortunately, I couldn't find any recent information on it. I did find a study from 1994, however, that was done on 200 Caucasian medical students. It found the cause of alcohol flushing to be different in Caucasians than in Asians: there was no build-up of acetaldehyde in the Caucasian subjects as there is in Asians, but there WERE lower levels of erythrocyte ALDH activity, similar to Asians.

    In another study I looked at, low erythrocyte ALDH has also been found in alcoholics and their non-alcoholic family members, which suggests that it does not offer protection against alcohol protection as it does in Asians. The first study did mention that alcohol intake did not decrease in the Caucasian subjects with alcohol flushing symptoms as it usually does in Asians.

    You can find the article for free if you'd like to take a look (Identification and Characterisation of Alcohol-Induced Flushing in Caucasian Subjects).

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  4. Great post. I'm curious if the Asian Flush can be used a a valid excuse not to drink much. There seems to be some valid health concerns related to the buildup of acetaldehyde. Are Korean's not aware of the increased risk of various forms of Cancers or they just ignore it due to the pressures of drinking?

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