Adapting to AGS Part 4: Speed Reading Labels To Avoid Alpha-Gal

Alpha-Gal Syndrome(AGS) is a potentially life-threatening allergy to the oligosaccharide galactose-alpha 1, 3 galactose (alpha-gal) commonly found in non-human mammal products and sometimes carrageenan.  Because alpha-gal can contaminate any product derived from mammals and no labeling laws exist to aid consumers who need to avoid it, reading labels and searching for a product that can be safely consumed is a real chore.  Thankfully, there are strategies that can help cut down on the amount of time it takes to work through all the brands on the store shelf quickly to find the one that will work!

A Note On Tolerance Levels

The first thing to be aware of when dealing with reading labels is personal tolerance levels.  Not everyone with alpha-gal syndrome needs to avoid every possible source of it as different types of ingredients have different concentrations.  As a result, the tips here will be of more use to some people than others as we cover strategies for even the most sensitive. Most people will only need to avoid pure meat products to prevent noticeable reactions, which means labels need only be checked for meat extracts, broths, flavorings and the meat itself.  Some patients find beef and/or pork-based gelatin to be an issue, and must also avoid gelatin related ingredients.  Others may also react to carrageenan, an extract from red algae that also happens to sometimes contain alpha-gal or molecules similar to it.  Some people find they cannot tolerate some or all milk products.  Even more sensitive are those who can not handle products derived from lanolin such as common vitamin D3 (the vegan version is fine), and the most sensitive report they must be especially vigilant against any minute trace source, including things as obscure as "sugar" which can sometimes be filtered through bone char (partially carbonated cattle bones).  Keep in mind your own tolerance level when formulating a custom strategy.  For more on finding your personal tolerance level check out our article here.  For learning more about mammal-derived ingredients, check out our resource reviews here.

It Takes Time

When faced with a large number of potential brands, it can take ages to go through each one trying to find a product that is both safe and cost-effective.  However, by first looking for easy to spot items on the label that increase or decrease the likelihood of mammal products being used, the time reading can be cut down significantly.  Independent certification symbols on the front of the package can be quickly scanned to instantly rule out some products without needing to take them off the shelf.  Other symbols can indicate that a product is less likely to have a problem ingredient, and those can be read first.  No independent certifier seems to be entirely comfortable with the idea of their symbol being used as the sole means of avoiding allergens, but as a tool for selecting what products to examine more closely first, they can be invaluable.

Kosher Classifications

Kosher is a certification that is found on a plethora of products and ensures animals and ingredients are handled in specific ways, but also limits what ingredients can be used and combined by sorting them into 3 categories: meat, milk (dairy) and neither (parve/pareve).  This certification alone is no better than an unmarked product for avoiding alpha-gal, but the secondary category designation can be extremely useful.  Many manufacturers will use "K" (potentially followed by "M", "D" or "P") for kosher, but it is worth noting that the letter "K" can not be trademarked and anyone can use it on a label with no legal binding, so it is important to make sure you find a symbol that belongs to a well regarded kosher certifier (see below) when scanning for a Kosher product to rule in, but when used to rule out a product for containing dairy or meat, such letter only designations can still be handy! Kosher Parve (K-P) is especially relevant for AGS as it is a food that contains no mammal meat or dairy with the possible exceptions of beef gelatin and other flavorless mammal ingredients that come from nonfood sources such as beef hide gelatin, lanolin based vitamin D3 or bone char processed sugar.  Which ingredients are given exceptions comes down to which certification group is behind the mark.  Most certifiers block mammal based rennet from use in hard cheeses, but not soft cheeses(confusing, but good to know).  Different certifiers may also work to different degrees to prevent cross-contamination (see below). Kosher Dairy (K-D) is a food that contains a milk product of some sort plus anything that would qualify as parve(see above), but not meat products.  If someone is sensitive to dairy, looking for a kosher dairy (K-D) marking can warn them instantly that a product isn't safe, even if it isn't trademarked because companies use "KD" to warn that a product either contains dairy or is processed on equipment that also handles dairy.  Since these marks are usually on the front of the package, checking for them first can save time as they can be written off as unsafe without even needing to pull them off the shelf.  If dairy is something you tolerate, kosher dairy can be treated just like kosher parve (above), but that also means you should not trust uncertified versions to be accurate when ruling in a product. Kosher Meat (K-M) is sometimes listed as just plain kosher (K) and is a product that may contain mammal meats and derivatives plus anything that would qualify as parve (see above), but not milk products.  A "K-M" or "KM" on a label indicates that the product contains some kind of meat or shares equipment with something that does.  Products with this labeling may still be safe if the meat in question is non-mammal, but if the choice is between reading a "KP" and a "KM" product first, read the "KP" first to save time.  Again, the letters alone are not legally binding, but since this one acts as a warning, they remain good indicators for avoidance.

Kosher Certifiers

Different Kosher certification groups have different policies and most are not strict enough to be usable for allergy avoidance without also checking the rest of the label, but they can be an excellent time saver when picking which product to read the ingredients on first.  Kosher certifiers generally require that equipment be well cleaned between processing the 3 different certifications, but some are more vigilant about cross contamination than others.  Below are a few summaries on different kosher certifiers, their symbols and what they do and do not cover.  Please follow the links and read more about them in case their certification rules have changed.

Orthodox Union (OU) Kosher	OU Kosher is one of the world's largest kosher certifiers.  When they certify hard cheese, any rennet used must be microbial, not mammal stomach-derived, which is helpful for those not sensitive to dairy.  However, this is NOT true for soft cheeses.  Flavorings with hidden sources of dairy and meat are not given parve status.  Kosher beef gelatin can be found in parve products and other trace sources are not discussed, so watch for those.  Shared equipment and cross contamination are only sometimes addressed.  More about the OU's stance on allergies can be found here.  "OU D" is used for dairy containing products or those at high risk of cross-contamination.  The OU uses a plain OU for parve and sometimes meat.
OK Kosher Certification	OK Kosher is another large, commonly seen certifier.  We did not find clear statements about cheese or trace sources by this company, but it is likely that kosher beef gelatin can be found in pareve products and mammal rennet in soft cheeses, so watch for those and other trace sources like bone char sugar and lanolin.  OK Pareve status requires kosherized cleaning before production when equipment is shared with dairy containing products.  When not cleaned they use "OK D" or "OK DE"(dairy equipment) as an extra warning.  Shared equipment with meat leads to "OK M" status even when no meat is in the ingredient list, which is great for avoiding alpha-gal cross-contamination.  OK uses a plain OK symbol to indicate pareve.
Other Well Regarded Kosher Certifiers and Symbols	There are a lot of different kosher certifiers, so many in fact that they have their own periodical.  This well organized alliance maintains a detailed listing of certifiers they feel uphold high levels of scrutiny.  If you see one of these symbols, it is likely trustworthy, though the extent of cross-contamination permitted from one certifier to the next may vary.  Some of these certifiers may actually be more vigilant in preventing cross contamination and trace sources than the industry leaders, so it pays to visit their websites should you happen to find one on a product line you're interested in.  This is also a great resource for learning more about kosher standards.

Vegan vs Vegetarian vs Cruelty-Free

Potentially an even bigger time saver than Kosher certification, but a lot less frequently seen are label terms and certifications that directly relate to animal product use: vegan, vegetarian and cruelty-free.  Many labels simply state that they are vegan or vegetarian (usually near the ingredients or on the front of the package), but such statements are only held responsible by truth in advertising laws.  Since the definitions are somewhat subjective, this means independent certification is a bit more reliable as the certifier's definitions can be looked up and verified.  Like kosher certifiers, often a single certifier will have several similar symbols for the different levels of certification, one for vegan, one for vegetarian and/or one for cruelty-free, so it's important to know which one you are looking at. Vegetarian labeled or certified products simply lack animal products that result in the death of the animal. This means milk products and lanolin remain concerns.  For someone who is not dairy sensitive, this is a very good label item to look for.  However, some vegetarians are stricter than others, so the uncertified version is not entirely reliable and individual certifiers should be checked to see what they do and do not protect against.  Bone char processed sugar is especially controversial among vegetarians, and while an independently certified vegetarian product's sugar is unlikely to be bone char processed, the uncertified statement is not so dependable. Cruelty-Free certification simply ensures animals are not tested on or abused, but does not always eliminate all mammal-derived ingredients (making it a bit like a variant on vegetarian).  Several companies that provide vegan or vegetarian certifications also offer cruelty-free certification, so it is important to recognize the difference between the marks as cruelty-free is not specific enough to be of much use in avoiding alpha-gal containing products. Vegan products usually are void of all animal-derived products, though some certifiers are more forgiving of cross-contamination than others.  A vegan certification is especially helpful in picking the first product to examine as, for the most part, only carrageenan needs to be scanned for.  The term "vegan" is a bit more agreed upon than "vegetarian" making uncertified vegan claims somewhat more reliable than uncertified vegetarian claims.

Vegan, Vegetarian and Cruelty-Free Certifiers

Here are a few of the more common certifiers for vegan, vegetarian and cruelty-free, what their symbols look like and a summary of what they do and do not cover when it comes to avoiding alpha-gal.  Please follow the links to the certifiers' websites for the latest information regarding their rules and regulations.

Vegecert	Vegecert has 2 levels of certification.  The company provides a detailed list of what they ban for their vegan certification, and the vegetarian list is exactly the same, but with exceptions for shellac, dairy, eggs, and bee products.  This company works with manufacturers to develop optimal procedures and cleaning programs to eliminate cross contamination making this one of the stronger vegan certifications.  They are able to do this by piggybacking off of a sister Kosher certification group's infrastructure.  The 2 levels of certification look alike except for the word difference, so watch out for that.
The Vegan Society	The Vegan Society does not allow any animal products in the ingredients of certified food, but does not demand that cross contamination be avoided.  They do encourage cleaning between the handling of animal and vegan products, but that may not be enough for allergies.  A warning about cross-contamination risks for some animal products is required, but mammals are not among them making this certification less valuable for those who need to avoid alpha-gal.
Vegan.Org	Vegan.org does not allow any animal products in the ingredients of certified food, and they require extensive cleaning between vegan and non-vegan foods with the goal of minimizing cross contamination.  Companies are required to provide details of their process for review.  Ingredient verification is required for things like sugar which must not be processed with bone char making this a good way to avoid it without needing to go organic.  Edit 9/15/2018  after several reported allergic reactions, vegan.org confessed in a letter to a person with AGS that they do not actually require products be free from cross contamination.  This is in direct contrast to how they present themselves.  This certification should be considered no better than non-certified vegan food at this time.
American Vegetarian Association (AVA)	The AVA has 3 levels of certification.  The vegetarian version is used for products that may contain eggs or dairy, while the vegan version can contain no animal products at all.  "Recommended" is used for tools they endorse such as cookbooks.  They state that they are very strict and any modification of a recipe or process must be reported immediately for reevaluation.  Their website is not clear about how they feel about cross contamination beyond that they want strict avoidance.  The 3 labels look alike except for the word difference, so watch out for that.  They certify restaurant menu items as well as products.
People For The Ethical Treatment of Animals (PETA)	PETA has 2 levels and several symbols/logos.  The important part of any of their symbols is the text.  "Cruelty-free" does not mean animal ingredient free, so it isn't helpful for avoiding alpha-gal, but the "cruelty-free and vegan" marks indicate a product that the manufacturer has given PETA a written statement claiming the product is free from all animal ingredients.  Cross contamination is not discussed on the PETA website, so their symbol is likely not useful in avoiding it.  It is probable that when the symbol appears without text it is the same as "cruelty-free".  This certification is primarily found on nonfood products.

Other Certifications to Look for When Reading Labels

USDA Organic

USDA Organic is a USA government certification that ensures most of a product is made of organic ingredients.  Because organic meat is rare right now, that can help reduce the likelihood of there being mammal products, but it does not eliminate them.  Some animal sources are also directly banned by the organic label.  Activated charcoal and tocopherols must be sourced from plants meaning bone char is not a concern when this label is found on sugar or sugar-containing products. The organic label does make some exceptions for non-organic ingredients and that can mean mammal exposure.  These exceptions include animal manure used as fertilizer on crops, a variety of crop production substances and a variety of livestock production substances, yeast grown in non-organic substances and animal enzymes, animal flavors and other microbes grown in non-organic substances, gelatin, intestine casings and whey protein may also be used.  A list of post-harvest non-organic substances that can be used in organic products can be found here. It was decided in 2016 that Carrageenan would be banned from use in organic products, but the rules on the books have yet to be updated and won't be until 2018 unless the carrageenan industry manages to reverse the decision. Any ingredient found in an ingredient list preceded by the term "organic" must also follow these rules, even if the end product is not certified organic.

Non GMO Project

The Non GMO Project is an independent certification to minimise the presence of GMO's in a product.  There aren't any GMO livestock yet, but non-GMO meat must come from animals fed only non-GMO crops which means meat and especially processed meat byproducts are somewhat less common in items that exhibit this certification.

Avoid Non-Dairy and Seek Dairy Free

Non Dairy on a label in the USA does not actually mean free from dairy.  As strange as that sounds, the labeling came about during an era where health concerns were less valued than marketing and instead is intended as a warning.  Non-dairy means it is made from byproducts rather than true milk and was intended to protect the dairy industry.  Today, advertisers spin it as a positive since such products often are lactose-free, but that isn't helpful for someone with a true allergy to milk.  If non-dairy is on a label and you are sensitive to milk products do to AGS, you can skip over the item since it almost certainly contains milk byproducts. Dairy Free, on the other hand, is what one would expect it to be.  It actually means the product is free from dairy products and can be used to avoid dairy-based allergens.  It won't prevent other mammal products from being in the ingredients, nor does it block carrageenan (and sadly carrageenan is often what is substituted for the dairy), but it does mean that any ingredients in the list that are "sometimes derived from milk" are not going to have been in this case.  Unfortunately, the only thing legally binding this term in the USA is "truth in advertising", which makes it a bit weaker than independent certifications.

Other Label Items Of Value

Allergy Warnings although not always on the front of the package, are good to locate and read for those who are sensitive to dairy.  Unfortunately, mammal products are not yet part of the required listings, so this information isn't of much use to those who can handle dairy. If you find an allergy warning that begins with the text "Contains", and it lists "milk", you can skip reading the rest of the label and put it back, but if it does not contain "milk" you'll need to read the rest of the label.  Some manufacturers do not include a separate allergy block and instead put allergens in parentheses after one or more ingredients in the ingredient list such as "Whey(Milk)".  The best manufacturers put the warning in both places and highlight the word "milk" somehow to make it stand out.  Unfortunately, due to allergies being thought limited to proteins, milk products that do not contain protein do not need to be called out in the USA, so no allergy warning can be used to rule in a product as safe for sensitive AGS cases.  For example, if something is labeled vegetarian and shows no milk warning one still needs to check the ingredient list to be sure no milk byproducts were used.  Furthermore, allergy warnings such as these legally required ones do not cover cross-contamination. Some companies elect to warn consumers about possible cross contamination by using terms like shared equipment or facilities, but such warnings are completely voluntary and unregulated.  They do still work as an item to scan for first though since such a product can be eliminated right away when the warning is found. Vitamin D3 for those sensitive to lanolin products can be an issue, and normally it appears on the ingredient list, but for some reason, lawmakers decided it was okay to leave it out of the ingredient list if the product manufacturer instead listed it in the nutrition block as "from added cholecalciferol".  Aside from being a rather irksome source of mystery reactions, the presence in the nutrition block does make it stand out right away once known about and thus it can be used to quickly filter and put back a product.  Vitamin D3 occurs naturally in a variety of foods, so it's the "from added cholecalciferol" that needs to be watched for, not simply D3 being on the list.  The exception to this is vegan certified foods as a vegan form of cholecalciferol is available.  Unfortunately, unless labeled as such, cholecalciferol is almost universally made from lanolin.  Don't confuse vegan with vegetarian in this case either, lanolin is vegetarian.  The main products one is likely to see this on are vitamins and supplements, orange juice, breakfast cereals, and milks.

Final Thoughts

There are a lot of parts on a label to weed through when looking for a safe product, but by learning easy to recognize symbols and streamlining the process, it's possible to avoid needing to read through the entire ingredient list on every product before eliminating it, and that can save a lot of time.  One you have things narrowed down, don't forget to try using one of the detailed ingredient origin resources we reviewed here for the final check.  Do you have any additional tips and tricks for speed reading labels?  Tell us about them in the comments!