More on "the Asian flush" and its link to throat cancer from the New York Times.
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...
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 bin
ge 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 appear
s 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.
ence was that the average number of calories in the food was much higher than Korean food. People enjoyed appetizers and desserts. In Korea I eat the meal, mostly vegetables, and usually do not have dessert. The average size of a dish was much bigger than that in Korea.
. Since a dish is very big, it could be a good idea for two people to share it, but I knew it was a cultural thing, so I wasn't surprised. In Korea, we do not share food that much like before, especially younger people don't do it that much. But still, we sometimes order food and eat it together - it happens between close friends. Sharing has to be natural in Korea, because we have a lot of foods like big stews that we boil on the table during a meal. I think it's just a cultural difference.
one of my more advanced classes, I was surprised to find out that most of the students had not tried any of the foreign food discussed in the paper, even with some foods coming from places as close to Korea as China or Japan. This was shocking to me; I wouldn’t say Seoul, one of the biggest cities in the world, is lacking in the foreign food department. In the areas with a high concentration of foreigners, there is a wide variety of international cuisine, and even in the more “Korean” neighbourhoods, you can’t walk a block without passing a “Dunkin’ Donuts”, a “Paris Baguette”, and a “Pizza School” (not exactly international cuisine, but definitely indicative of Western influence). Yet, despite this international presence, most of the students seem to stick to a pretty traditional Korean diet for the majority of their meals, cooked by their traditional Korean stay-at-home moms.
tion is something that happens in middle and lower-income countries as they develop and become more industrialized. Cities grow and begin to offer imported foods from industrialized countries. Unfortunately many of these foods are heavily refined, high in added sugar and saturated fat and low in fiber (1). In other words, it is a shift to, essentially, the “Western diet”, resulting in malnutrition from a lack of high-quality nourishment as well as obesity.
mchi” for more info!) (3).
e markedly low in South Korea, but rates of overweight are quite a bit higher. In 1998, rates of obesity in adults were 1.7% for men and 3.0% for women (3), and ten years later, in 2008, data indicated that 4.0% of Korean men were obese versus 3.6% of Korean women (8). Rates of overweight in 1998 were 24.3% for men and 23.5% for women (3). Data from 2001, just three years later, shows overweight statistics of 29.6% in adult men and 25.9% in adult women (this is the most recent data I could find) (9).
South Korea is a country of tiny women and sometimes, even tinier men. The sight of anyone significantly overweight causes me to do a double take in the subway, and more often than not, it turns out to be a foreigner.
It’s a land of the “free size”, the one and only size available in most Korean-made clothing and probably for good reason: one size does generally fit all. I always thought that Koreans were just naturally small-framed, and to a large extent this is true; genetics combined with a (fairly) healthy lifestyle play a huge role, but what I didn’t realize is that the rates of eating disorders are high…and on the rise.
I guess I really shouldn’t be surprised, considering the tremendous value put on appearance here. Everywhere you turn, there’s a Korean looking in the mirror, glass (anything reflective!) at themselves; examining every bump and imperfection, adjusting their hair, make up, sometimes just unabashedly staring (and in the worst cases, popping their pimples…or even their boyfriends!). In Canada, I would be embarrassed to be caught catching a glimpse of myself while passing a mirror or taking a sultry self-portrait, but here, it’s entirely commonplace.
I’m not saying that appearance isn’t important; some Canadians could certainly take a little more pride in theirs (pajama pants in public…come on!), but when you have to send a photograph in with your resume to apply for a job, it’s not hard to see why Koreans might get hung up on their looks…and their weight.
Mirror, mirror on the wall…
As a result, plastic surgery is popular and widely accepted in Korea. I went with my Korean friend, (we’ll call her D), to get my hair done one Saturday afternoon, and was bombarded with advertisements for plastic surgery of all types as I flipped through a Korean magazine. When D started naming off all the different kinds 
of surgery that the Korean teachers at our academy had had done, I was exceptionally taken aback: double eyelid surgery, nose jobs, fat from the thigh injected into the forehead and cheeks (to make the face less flat), and even into the back of the head (to make the head rounder)!
Double eyelid surgery seems to be the big seller around here. If you’re wondering what the heck “double eyelids” are, they are the eyelids that non-Asian people have, i.e. not hooded eyelids (see the picture on the left). These surgeries are increasingly common: they’re often given as graduation gifts to girls from their parents after they finish high school.
The before and after pictures in the magazines suggested an interesting, if not disturbing, trend. To me, the before pictures looked very Korean, while the after pictures looked much more Caucasian, as if the person was only half Korean (see picture below). D told me that many Asian models and actresses who we in the West think of as being very beautiful, are seen in Korea as ugly, because they tend to have very “Asian” features, like sharp, defined cheekbones, small noses, and distinct almond-shaped eyes. I myself wouldn’t mind a nice delicate Asian nose, mine being a little above average in size, (maybe a slight understatement), but in Korea, I am often praised for having such a “high” nose, a term I much prefer to the usual ones I hear back home (usually more along the lines of “beakish”), although one little boy did tell me I looked like an elephant the other day (haha).
(*Check out this website for a look at the different types of plastic surgeries in Korea. Make sure not to miss the section titled "Reason why Asian nose is not beautiful"...absolutely disgusting. http://www.vipps-clinic.com/nose/content/c1_0101.php)
My friend D has been pressured many times by her mother to get a number of facial surgeries, but has resisted (rightly so; she’s a beautiful girl)! Not only that, but her mother has suggested she get injections to decrease the size of her fat cells, and even sent her to a “fat camp” when she returned from university in the U.S. to shed the extra pounds she had gained while living there.
These are not the only disturbing stories I’ve heard. A friend told me that a friend of her friend, a Korean girl, found it unbearable to live in Korea as an overweight person. She said that it was difficult to make friends; no one would speak to her, and that sometimes she was even ridiculed in public by strangers. She ended up moving to the United States, where she happily reported back that she finally felt accepted and had made friends.
The Westernization theory: popular but true?
A recent survey of more than 13,000 people worldwide found that Koreans are among the most weight-conscious in the world, with 28% weighing themselves weekly, the largest number next to Americans (1). It’s not alarming then, in a collectivist society where being overweight or obese is rare and where adhering to the norm is imperative, that eating disorder numbers are on the rise.
It was difficult for me to find actual statistics in English on disordered eating in Korea, but what is clear from the few journal articles that I’ve read, is that rates in Korea are now similar to those in the West (2).
The only journal article I found worth mentioning is a trans-cultural comparison of disordered eating in Korean women of various backgrounds: second-generation Korean Americans, Korean immigrants to the U.S., and native Koreans. The study was conducted to examine the theory that Westernization of South Korea is to blame for the increasing levels of eating disorders in Korean women, a position that is popular in recent research.
“According to Westernization, individuals in non-Western cultures are adversely affected by an introduction to Western beliefs and ideals, including the thin ideal. Eating disorders among Koreans may be caused by attempts to emulate the West as it is portrayed through media.” (2)
This particular study, however, disputed this hypothesis as it found that even though Korean Americans had the most exposure of the three groups to Western ideals and norms, they had the lowest rate of disordered eating when compared to women born in Korea (2).
Korea, j’accuse!
The authors of the article suggest that the blame may lie beyond Westernization, and may perhaps be more related to Korean culture than to Western culture.
Although only 0.2% of South Koreans list Confucianism as their religion, Confucian ideology is still largely influential on other religious practices (namely Buddhism and Christianity as the primary religions in South Korea) and on Korean culture as a whole (3). According to traditional Confucian gender roles, a woman serves her family by getting married into a prominent family. While matchmakers rate men primarily by occupation, women are rated mainly by looks, which leads parents to place great value on their daughter’s appearance, often over their abilities. This, coupled with the importance of self-restrictive behaviours in Confucianism, suggests a link between the ever-present Confucian ethical thought in Korean culture and eating disorders (2).
Regardless of the root causes, whether they be of Western or Asian origin, eating disorders in Koreans continue to climb, but hopefully with the right education and the appropriate prevention and treatment programs, the numbers will fall, and “free size” will no longer make the heavy girl feel imprisoned in her own country.
Sources
(1) Lee JY, Asia One Health. Koreans Among Most Weight-Conscious. http://www.asiaone.com/Health/News/Story/A1Story20100903-235376.html. Access date: September 23, 2010.
(2) Jackson SC, Keel PK and Lee HY. 2006. Trans-cultural Comparison of Disordered Eating in Korean Women. Int J Eat Disord 39: 498-502.
(3) Wikimedia Foundation Inc. 2010. Religion in South Korea. http://en.wikipedia.org/wiki/Religion_in_South_Korea. Access date: September 23, 2010.
You have to hand it to the Koreans for being so creative with this one crop, but the question that I have is,
, white rice is rice that is milled in order to remove the husk, the bran layer, and the germ from the original grain. Now, it is absolutely necessary to remove the husk in order to make the rice edible, but the removal of the other layers is purely a matter of taste. Unfortunately, removing these layers means removing most of the rice’s nutrients as well. On the left is a summary of what is lost (2).
is changing people’s attitudes towards white rice. For many, brown rice is associated with backwardness and poverty, not to mention the fact that people have come to acquire a taste for white rice, myself included (7).How better to start off this blog than by writing about kimchi. Kimchi is considered by most to be the national dish of Korea, some even going as far as to name it as the one thing that is representative of Korea.
This ‘some’ that I speak 
of are the elementary and middle school students at the private academy where I currently teach English in Seoul, South Korea. When asked to write a journal entry about what they thought represented Korea best, an overwhelming number of them picked kimchi.
They didn’t write about how tasty of a dish it was, however; every single one of them wrote about the health benefits. Now as a child of 8 or 9 years old, I certainly do not remember being concerned about the nutritional content of what I was eating, let alone writing in my diary about it. When I was 8, my chief concern when it came to food was how to convince my mom to start buying “Fruit-by-the-Foot” for my lunch; probably one of the least nutritious snacks of the 90’s (don’t be fooled by the “fruit”).
What is kimchi, anyways?
Before I go any further, I should probably explain what kimchi is, and what it is, at the most basic level, is fermented vegetables. Cabbage is the most common form, but radish, cucumber and other vegetables are also used. Of course, you can’t discount the various seasonings, often spicy, that are used in its production as well.
Kimchi is eaten with virtually every traditional meal as a side dish, and when I say ‘every meal’, I mean it. My little ones (6 and 7 year-olds) tell me that they eat kimchi every day for breakfast along with their morning rice (they didn’t understand what cereal was even after a lengthy explanation). And no Korean 
astronaut would dare venture into outer space without his daily dose of kimchi: ‘space kimchi’ was developed for the first Korean astronaut to take into space with him.
Koreans are infinitely proud of this dish (heck, they even have an entire museum devoted to kimchi here in Seoul), if not sometimes disillusioned about it, (some of my students think everyone knows and loves kimchi, and I, for one, had never even heard of it before coming to Korea).
Is this pride justified? It’s definitely an acquired taste…do the health benefits check out? (At least one of the students wrote about kimchi “curing cancer”. I can’t imagine that that one’s true, although, according to the marvelous world of Wikipedia, one study found that chickens infected with avian flu recovered after eating the same bacteria as that found in kimchi…hmmmm…) (1).
What’s living in your kimchi….?
Although maybe not the most obvious nutritional characteristic of kimchi, being a slight microbiology nerd, (and I really mean slight), I looked into the microbial content of kimchi. I knew lactic acid bacteria was typical in the fermentation process, but what I didn’t know is that kimchi has a lactic acid bacterium all of its own, Lactobacillus kimchii sp. This species has been shown to have antimicrobial activity, i.e. stop or decrease the growth of microorganisms, especially the bad, pathogenic, disease-causing ones and those involved in spoilage (2). Bacteria can be on our side too despite its wicked reputation! Not only do lactic acid bacteria fight the bad guys, but they have also been shown to modulate the immune system (i.e. balance it out), lower cholesterol levels, and have been shown to be involved in anticancer activities (maybe my little ESL friend wasn’t so far off after all…) (3).
The basics
So enough on the bacteria, and let’s move on to the basics. I read in a study that Korea has the highest vegetable intake in all of Asia, 40% of which is through ingestion of kimchi (4). This shows you just how important it is to a Korean diet.
Here are some of the basics:
(These are very general, of course, as there are many different kinds of vegetables used in kimchi.)
· High in fiber
§ (Helps keep you “regular” and takes bad cholesterol with it when it leaves the body)
· Low in fat
· Excellent source of Vitamin C 
§ (Used in the formation of collagen, a component of the skin, bone etc. and is an antioxidant, i.e. protects certain cells in your body from attack)
· High in thiamin (Vitamin B1)
§ Important in metabolism as well as in the formation of neurotransmitters)
· High in riboflavin (Vitamin B2)
§ (Also important in metabolism)
· High in calcium
§ (Extremely important mineral: is the structure behind your bones and teeth and is involved in muscle contraction, nerve functioning, blood clotting, blood pressure…and the list goes on)
· High in iron
§ (Involved in proteins that carry out oxygen transport…you may have heard of hemoglobin…and plays a major role in the immune system) (5)
Overall, it’s a pretty healthy little dish, especially one that, if you’re Korean, you’re probably eating two or three times a day. Not so surprising then that kimchi was named as one of the “World’s Healthiest Foods” by Health magazine (6).
So maybe it’s a good idea to do like the Koreans do, and not only replace “cheese” with “kimchi” when posing for photos, but start using it to add a little spice to your meals. Eating it multiple times a day may be a bit much at first, but kimchi is a healthy addition to any boring meal, and will probably leave you with a lot more to smile about than cheese.
See Wikipedia’s kimchi page for some interesting external links if you’d like to read more (http://en.wikipedia.org/wiki/Kimchi)!
Sources
(1) Wikimedia Foundation, Inc. 2010. Kimchi. http://en.wikipedia.org/wiki/Kimchi. Access date: June 23, 2010.
(2) Yoon JH et al. 2000. Lactobacillus kimchii sp. nov., a new species from kimchi. International Journal of Systematic and Evolutionary Microbiology 50: 1789-1795.
(3) Park HD and Rhee CH. 2001. Antimutagenic activity of Lactobacillus plantarum KLAB21 isolated from kimchi Korean fermented vegetables. Biotechnology Letters 23: 1583-1589.
(4) Lee MJ, Popkin BM and Kim S. 2002. The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet. Public Health Nutrition 5(1A): 197-203.
(5) Korean Embassy. 2000. Food in Korea. http://www.asianinfo.org/asianinfo/korea/food.htm#KIM%20CHI. Access date: June 25, 2010.
(6) Health Media Ventures, Inc. 2010. World’s Healthiest Foods: Kimchi (Korea). http://eating.health.com/2008/02/01/worlds-healthiest-foods-kimchi-korea/. Access date: June 28, 2010.
