Adapting to AGS Part 3: Surprising Alpha-Gal Sources

Alpha-gal syndrome (AGS) aka "red meat allergy" is a potentially life-threatening food allergy that can be brought on by tick bites in anyone at any age.  Alpha-gal reactions result from exposure to a carbohydrate rather than a protein, are usually delayed by several hours, and have a variety of symptom presentations, all of which helped to keep the condition hidden from science until its discovery in 2009.  Unfortunately, this carbohydrate is produced by all mammals, with the exception of old-world primates like humans, making it more than a little difficult to avoid.  It is also found in some species of red algae (carrageenan).  Even worse, as a carbohydrate is it much tougher than a protein and doesn't easily break down or filter out and can even end up concentrated by some processing techniques. Learning ingredients to avoid is half the battle for someone with AGS, and while many will never need to worry about more than meat, a significant portion of patients find they react to a whole lot more.  There are a number of alphabetical resources available for checking the source of various processed ingredients (see our reviews here), but some risky ingredients get left off labels or are easy to miss.  Here we will go over some of the biggest pitfalls encountered by those still learning about their condition.  This article is for everyone with AGS including those who have become extremely sensitive, so if you have a higher tolerance, many of these items will never be a concern for you.

Mammal Meat

There have been a number of incidents of severe reactions in people shortly after diagnosis due to confusion about what qualifies as red meat when trying to avoid future reactions, so here is some clarification:

• The term red meat, in the case of a "red meat allergy", refers to any flesh of any mammal.
• Organs, nerves, fat, muscle, bones and skin are all forms of flesh.
• A mammal can be recognized as an animal with a backbone that produces milk and/or sweat from glands in its skin and has some kind of hair or fur.
• Whales, kangaroos, cows, sheep, pigs, dogs, deer, rabbits and bats are all examples of mammals, and they all contain alpha-gal in their flesh.
• Pork, despite being called "the other white meat" is still the flesh of a mammal (pigs). That means it contains alpha-gal and can NOT be safely eaten by someone with AGS.  Sadly, this means no pig based ham or bacon either.
• Meat from fish, amphibians, turtles, snakes/lizards, crocodiles, and birds are all free from alpha-gal and can be eaten safely.
• Meat from birds such as ostrich and emu that appear red and taste similar to mammal meat are safe to eat for those with a "red meat allergy" because they are not mammals. This is an important piece to remember!

Pure muscle meat has to be labeled in plain English in the USA, so if you see lamb, mutton, veal, beef, venison, pork or any other term that commonly means flesh of a mammal on a product label (pretty easy to spot when you get good at it!), avoid it, regardless of what is listed after (ie beef broth is just as bad as beef steak).

But what about...?

Broth, bouillon, stocks, pan drippings and gravy made from any mammal can cause massive reactions, even in those with high tolerance.  Many report their worst reactions ever occurring from these items, so treat them with as much caution as you would a fatty rack of ribs. Gelatin/gelatine causes reactions for some people but not others.  There are 3 major types of gelatin on the market.  Pure "beef gelatin" seems to cause reactions for more people with AGS than "pork gelatin", but the type of gelatin is usually only called out when needed for religious food law reasons.  Kosher gelatin will either be beef or fish based, but most of the time it is beef unless stated otherwise.  Undeclared generic "gelatin" is usually a mix of pork and/or beef gelatin.  "Fish gelatin" is something you can buy for use in your own cooking and is safe to use.  Anytime fish gelatin is used in a product, it is called out as such.  Gelatin is found in a lot of candies and other sweets, as well as the classic "Jello".  Those who start reacting to gelatin usually find they have to avoid cross contamination as well.  Be aware that even if eating gelatin does not bother you, injected or intravenous gelatin products could be life-threatening.  Make sure health care workers are aware of this concern anytime you need a jab. Kidneys, liver and other organs have the highest concentration of alpha-gal in most mammal species and that makes them especially dangerous.  Their use in producing the broths and products above may account for why those ingredients are so high risk.  Unlike other body parts, organ meat exposure can cause nearly instant reactions.  Although kidney pie and liver and onions are not eaten much in the USA, you may find organ meats under some other names like tripe, offal, bologna, liverwurst, olive loaf and patet (some of these will not always be mammal based but warrant a closer look). Lard and tallow are the fat from pigs and cows respectively.  Alpha-gal is found abundantly in mammal fat cells, so these products should be avoided as strictly as meat. They are frequently found in pie crusts, refried beans, tortillas and baked beans.  Candles and dryer sheets may also have large amounts of the mammal fats, enough to cause airborne problems.  Waxed paper cups and plates should also be used with caution. Natural beef or pork casing can be a real bother.  People usually react to the beef casing first, but both are problematic.  Make sure to check any sausage product's ingredient list closely.  Casein based casings are an option for those who do not react to dairy but are an issue for those that do, so be cautious with them as well.  It is not normally enough to simply pull the casing off of the sausage since the cross contamination will be quite heavy.  Remember, natural casings are made from intestines and as an organ (see above), they can have an especially high concentration of alpha-gal, even if they are reduced to just a membrane. Natural flavoring is one of those ambiguous terms that can mean almost anything.  While true muscle meat cannot be called "natural flavoring", other mammal body parts and dairy can be.  Meat that has been altered by chemical processes rather than heat or mechanical means can also be listed as "natural flavoring".   Savory foods with natural flavoring are known to sometimes cause notable reactions, even in those with a high tolerance, but reactions to sweets containing natural flavoring are less common.  Be especially cautious of soups and poultry that have been brined with "natural flavoring" and buttery flavored sweets.

Meat Cross-Contamination

Cross-contamination (also known as cross contact) occurs when a mammal flesh component touches a cooking tool or eating implement that then touches the food to be consumed.  Common sources of meat cross-contamination are as follows: Deep fryers have oil that is used for a long time between cleaning.  A lot of places mix some beef or pork products into the oil, but they don't need to have done this to cause a problem for someone who reacts to cross-contamination from AGS.  While proteins have a hard time surviving the oil bath, the tough alpha-gal carbohydrate does not.  If any mammal product has been fried since the last cleaning, a cross contamination reaction could result if a normally safe food is cooked in the same fryer. Griddles, grills, and pans should be well cleaned between uses if switching between mammal products and food for someone with AGS.  Fast food places are generally not able to prevent cross-contamination, but a few of them do have dedicated chicken and/or fish areas, so you can always ask.  Most restaurants will attempt to accommodate and minimise cross-contamination if asked, but some may simply say it isn't a good idea to risk it given their facility.  They know their kitchens best, so it's good to follow their advice in such cases, even if it means ordering a V8 for breakfast instead of the eggs that share a griddle with bacon. Lunch meat slicers at the deli do not need to be cleaned between meats because lunch meats are pre-cooked.  This makes reactions from lunch meats, even those without mammal ingredients, a common problem.  Lunch meats sliced at the factory are done so on slicers that are normally cleaned between products or dedicated to a single meat and are much safer choices.  You may also be able to ask a local deli to save you some specially-sliced meat that they do first thing after the next cleaning. Meat counters can be a potential issue.  If the person handling the meat doesn't change their gloves or puts the meat in the display next to each other, there can be cross-contamination.  Legally they must clean when switching between parting different meats, but in practice, small meat markets often aren't as careful as they should be and some have older countertops that can't be fully cleaned.  Talk to your meat counter about their practices and consider buying products that are processed and parted at a dedicated facility to reduce the chances of cross-contamination if you have had problems in the past.

Dairy and Algae Extracts?

Some people with AGS are sensitive enough to react to all dairy, others don't react to any dairy.  It is easy to confuse the symptoms of lactose intolerance with AGS, but they tend to run counter to each other, which is to say products with the most lactose usually have the least amount of alpha-gal and vice versa. Butter is pure concentrated mammal fat, so it should come as no surprise that it can induce a pretty potent reaction.  Even in those who normally only react to beef, sporadic reactions to eating large amounts of butter (ie cookies, cakes and frosting) have been reported.  Thankfully there are a plethora of butter substitutes to choose from on the market, so finding one that is carrageenan free isn't too difficult.  If plant-based butter substitutes aren't cutting it for you, smaltz (clarified chicken or duck fat) is a surprisingly excellent replacement, especially if blended with refined coconut oil.  In sensitive individuals, butter can be a real bother.  Watch out for it in seafood and baked goods especially. Carrageenan is an extract from a few species of red algae that contains alpha-gal.  It is frequently added to low-fat versions of dairy products to "improve mouth feel" and some people find that they are actually reacting to this additive long before reacting to true diary.  Keep an eye out for it in anything labeled vegan or low fat.  It isn't clear if people are cross reacting to it, or if it has actual alpha-gal but in a recent survey in a support group roughly 25% of people definitely reacted, 25% definitely did not react and 50% of people were unsure, but avoided it to be on the safe side. Casein is a concentrated protein from milk used to make things like sausage casings and supplements.  It is also the main component of cheese.  The amount of alpha-gal that gets into casein products is fairly low, so unlike the natural casing discussed above some people are able to get away with just removing the casing from sausages if they are less sensitive.  Casein is usually only an issue for those that are dairy sensitive. Cheese can be an issue for a couple of reasons. Rennet, an enzyme usually extracted from the stomach of baby mammals is used to make some kinds of cheese.  This and the high fat concentration of cheese usually makes it one of the first dairy products people react to.  It is possible to get lower fat versions of cheese, as well as cheese that is not made using mammal rennet for those who may be on the edge of tolerance. Eggs are not produced by mammals and are not an issue, even though they are found in the dairy section.  The only exception to this rule is a possibility that the washing processes in the USA may force fecal matter into the egg.  If the hens were fed mammal meats, this could potentially be a problem for those who are especially sensitive.  Buying vegetarian fed eggs usually resolves the problem when someone starts reacting to eggs unless they have developed an independent egg allergy. Ghee is butter that has been clarified to make it even more concentrated than butter.  Knowing this, as you might expect, this means it has been reported for causing even worse reactions than butter by some who have tried it. Ice Cream can cause a reaction by itself, or due to the addition of carrageenan and other additives.  Ice cream is high in fat and that makes it a bit more likely to cause a reaction than plain milk.  Unfortunately, low-fat ice creams are usually the ones that contain carrageenan.  A few companies offer vegan ice cream, so all hope is not lost, provided you watch for carrageenan.  Carrageenan tends to be used on a per flavor basis, so if one flavor by a given company has it, a different one from the same company may not. Milk is usually the last dairy product people react to.  Unless processed and concentrated, milk doesn't have enough alpha-gal for current testing equipment to detect.  This is not the same as having no alpha-gal, and it is still perfectly capable of causing a reaction in those that are especially sensitive.  Cream alone is concentrated enough to start being detected, so milk is just beneath current equipment abilities.  Any mammal milk can cause a reaction, this includes cow's milk and goat's milk.  Many alternative kinds of milk made from plants are on the market, but they need to be checked for lanolin derived vitamin d3 and carrageenan since usually by the time cow's milk bothers someone, these other 2 ingredients have also become issues. Whey protein powder is one way in which milk is concentrated.  Reactions are variable, but not uncommon to this additive even in those that handle other dairy.  Whey protein powder is often found in supplements, meal shakes and protein bars. Yogurt can be an issue if it is made from mammal milk.  Recently, a lot of plant-based yogurts have come on the market.  However, gelatin and carrageenan can be behind issues with these.  Watch out for premature yogurt reactions from additives in cow's milk yogurt as well.

Trace Sources

Only the most sensitive have trouble with trace sources, but if you are among the unlucky or looking to minimise your alpha-gal exposure it is good to watch out for all of these sources.  We only cover a few here, but you can find a collection of more comprehensive lists we reviewed here. Disodium inosinate is a flavoring component that can be made from mammal meat, fish and/or mushrooms.  It is often added to frozen and canned vegetables and will appear on the ingredient list when it is. (Thank you Jennifer Burton for pointing this one out) Honey in the raw is not a problem, but be cautious about filtered and/or pasteurized conglomerate honey brands, and those that have an ingredient list.  This industry is notorious for unlisted contaminants.  Raw unfiltered honey from local producers is unlikely to cause a problem. Lactic acid sounds like it should come from milk, but usually, it is a product of microbes and not an issue.  It's a good thing too because this stuff is in everything. Lactose is a sugar in milk and can be concentrated and used as a filler or ingredient.  Being concentrated and made up of sugars that are happy to bring alpha-gal along with them makes this ingredient an issue for those sensitive to dairy.  Lactose is commonly found in tablet pills. Lanolin is the skin oil extracted from sheep's wool and is not something that one normally associates with food.  Unfortunately, it is used rather a lot for producing flavorings and for making cheap vitamin D3.  For those that start reacting to vitamin D3, it must be carefully watched for in food.  Milk (including plant milk), orange juice and breakfast cereals are all frequent offenders that contain vitamin D3 as cholecalciferol.  A fungal-derived version of vitamin D3 is available, but it is only found in vegan certified products right now.  Any nonspecific vitamin D3 is the lanolin kind.  Some patients find lanolin in shampoo makes their hair fall out, others have no issue.  Lotions and chapstick are other products that frequently contain lanolin. Maple Syrup is sometimes defoamed with mammal products and commercial jugs are mixtures of dozens or even hundreds of different producers' products.  There is no tracking of defoamers currently, so buying syrup from a conglomerate is risky.  Instead, try finding a specific producer that you can confirm the defoamer as vegetable based with. Stearic Acid can be mammal based or vegetable based.  Unfortunately, the only way to know is to contact the company.  When it isn't made from cattle, it usually comes from soy so if you see it on a product that claims to be soy free, watch out.  This ingredient is found in highly processed foods, butter flavoring and as a binder in tablet pills. Sugar, when listed in the generic form, is frequently processed through bone char (70% carbonated cattle bone), to bleach it.  One wouldn't think this would be an issue, but enough people with AGS seem to react to it, albeit mildly, that we wanted to mention it.  Switching to unbleached cane sugar or beet sugar can help, but any regular sweetener can potentially be defoamed with mammal products during processing so caution is advised.  Organic sugars, however, can not be filtered through bone char, so looking for organic or vegan certified sugar will avoid reactions.  It's very impractical to avoid sugar and any contamination would be extraordinarily minute, so unless you are sure it is behind reactions there is no need to bend over backward trying to avoid it. Transglutaminase aka meat glue is an enzyme that can be used to stick together scraps of meat into a single chunk.  It is often made by growing a microbe in the blood of freshly slaughtered cattle and swine.  Watch out for it in things like chicken nuggets and of all things, tofu.  That's right, they put mammal byproducts in tofu.  Transglutaminase will appear in the ingredients list and is used to increase yield, so try checking for a different brand or type of tofu and you'll usually find one that doesn't use it.

Additional Sources

While this list just introduces some of the bigger and more unexpected players found in foods, there are many more to watch out for when someone becomes highly sensitive.  We reviewed a number of resources dedicated to describing where ingredients come from that can help with recognizing the remaining problem ingredients here.  For those feeling overwhelmed, our article on speed reading labels may prove of use as well.  When in doubt, there are a variety of support groups on social media which can help answer questions about specific ingredients, products and adapting to alpha-gal syndrome. Have you encountered any particularly annoying or surprising ingredients or products with alpha-gal in them that cause reactions?  Tell us about it in the comments section and we'll add it!