What to watch with ADH1B and fatigue?

ADH1B encodes alcohol dehydrogenase, which catalyzes the first step of alcohol metabolism. Carriers of the fast variant (ADH1B*2, common in East Asians) convert ethanol to acetaldehyde very efficiently. Acetaldehyde is toxic and causes facial flushing, nausea, headache, and fatigue – even after small amounts of alcohol. If you have this variant and still drink regularly, the sustained acetaldehyde burden can contribute to chronic fatigue, oxidative stress, and increased cancer risk (especially esophageal cancer). Watch for heightened fatigue after drinking, consider minimizing or avoiding alcohol, and monitor liver function, vitamin B12, and folate levels, as acetaldehyde impairs nutrient absorption. The evidence linking ADH1B to fatigue is mechanistic and supported by epidemiological studies, but not established as a clinical diagnosis. A DNA test alone is insufficient; symptoms and drinking behavior matter more.