Food: First Steps

Food-Related Risks

The Variability of Risk

One of the hallmarks of alpha-gal syndrome is the variability of alpha-gal allergic reactions (57). This variability needs to be taken into account when assessing the risks that different foods and other exposures to alpha-gal may pose.

Reactions vary from person to person (57)

• Some people tolerate all foods except for mammalian meat and organs.
• Other people react to milk and dairy products, gelatin, and/or carrageenan.
• A minority of people with AGS react to trace amounts of alpha-gal.

With each individual, reactions can vary dramatically from exposure to exposure (57)

• A distinctive feature of AGS is that for many people, reactions don’t occur after every exposure, but when they do occur, they are often severe.
• For example, some people with AGS can eat a hamburger every day for months without reacting; then one day, they eat one and have a life-threatening allergic reaction.
• This variability is due in part to co-factors, like alcohol consumption, exercise, the use of NSAIDs (like Advil), illness, infection, stress, lack of sleep, and menses (your period) (57).

Reactions change over time (57).

• Variability over the long-term can be influenced by your exposure to ticks (57).
  • If you avoid ticks, your alpha-gal IgE may decrease over time (91), and you may become less reactive (57).
  • If you are bitten by ticks again, your alpha-gal IgE will likely increase (20), and you may find you cannot eat foods you previously tolerated. In addition, your reactions may become more severe (57). Some people develop a sensitivity to airborne alpha-gal, like fumes from cooking meat, after new tick bites.

Reproduced from: Platts-Mills TA, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and management of patients with the α-Gal syndrome. The Journal of Allergy and Clinical Immunology: In Practice. 2020 Jan 1;8(1):15-23, with permission from Elsevier.

Figure 1. The risk and also severity of reactions in the α-Gal syndrome relate to the amount of the oligosaccharide that is present in food, drugs, or other therapeutics. The route of administration is relevant to the speed at which reactions occur; that is, intravenous administration is associated with rapid reactions, whereas oral ingestion has delayed onset. Cofactors such as NSAIDs, exercise, and alcohol can be additional risk modifiers. This schematic reflects clinical experience, as well as challenge studies and laboratory investigations. CroFab, Crotalidae polyvalent immune Fab; MMR, measles, mumps, and rubella; NSAID, Nonsteroidal anti-inflammatory drug.

Reproduced from: Platts-Mills TA, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and management of patients with the α-Gal syndrome. The Journal of Allergy and Clinical Immunology: In Practice. 2020 Jan 1;8(1):15-23, with permission from Elsevier.

Lower  risk: caution advised*

Highest risk foods trigger reactions in the most people and tend to trigger the most severe reactions. Lower risk foods trigger reactions in the fewest people and are less likely to trigger severe reactions. Keep in mind that some people who are highly reactive to alpha-gal have severe reactions even to the least risky foods.

*When used in medical products, risks may be significantly higher, especially in the case of parenterally administered gelatin. 

*Some people who are sensitized to alpha-gal but do not react after eating meat or organs may react after exposure to some medical products that contain alpha-gal.

**Many people who tolerate gelatin in foods without experiencing any reactions may have severe reactions after other types of exposure to gelatin, such as the intravenous administration of gelatin-based plasma volume expanders or gelatin-containing vaccines administered via intramuscular injections (6,57).

***There is a lack of data on the risks of medical products that contain carrageenan to people sensitized to alpha-gal. 

†There is a lack of data on the alpha-gal content of many mammalian byproducts and the risks of medical products that contain them (6,57).

Kidneys

Kidneys are one of the most dangerous foods for people with AGS!

Tripe (mondongo)

Tripe is made from the stomach of mammals.

Sweetbreads

Sweetbreads are the thymus and pancreas of mammals.

Examples of mammalian meats, organs, and tissues

Lamb

Lamb and mutton are from sheep.

Jerky

Beef jerky, buffalo jerky, biltong, and other kinds of dried mammalian meat

Mammalian bones and bone marrow

Other meat products

Meat extracts

Some unexpected sources of lard

Corn muffin mixes

Corn muffin mixes, like Jiffy, can contain lard.

Mashed potatoes

Mashed potatoes often have lard added to them, especially in the southern U.S.

Explore Substitutes

• Don’t despair! There a great substitutes for almost all the foods you love.
• Steak:
  • Many people can’t tell emu from beef.
  • Some people think ostrich is even better, although it’s more expensive.
  • Amaroo Hills Farm, which is owned by a person with AGS, is a great source for both.
  • You can order directly from the Amaroo Hills Farm website or look for a store near you that sells their products.
  • Amaroo Hills Farms also sells other cuts of emu that are good substitutes for other cuts of beef.
• Burgers:
  • Ground emu with added duck fat makes a great burger, as does ground ostrich.
  • Turkey and chicken burgers can be made to taste more like beef. See tips below.
• Sausages:
  • Amaroo Hills Farm also sells delicious breakfast, Italian, and other sausage made from duck.
  • Turkey hotdogs are hard to tell apart from pork and beef ones.
  • There are good chicken and turkey sausages.
  • Do not make the mistake of eating poultry sausages with mammalian gut or collagen casings!
• Bacon:
  • You may discover you like duck bacon better than pork bacon. D’artagnan Uncured Smoked Duck Bacon is a favorite.
  • There are also good brands of turkey and chicken bacon, and they are more readily available and cheaper.

• See our substitution suggestions below.

Read Labels

• Now that you have AGS, you need to become a label detective.  On the bright side, once you start checking labels, you will become more aware of what you eat and can adopt a healthier diet.

Learn How to Eat Out Safely

• Create a restaurant card explaining your allergy or print one of the existing ones. There are printable restaurant cards in the Additional Resources section below.
• Learn how to talk to restaurant staff about AGS.
• Beware of lard! It is hidden in many foods.

Watch Your Nutrients

• Make sure your diet contains enough protein, calcium, vitamin D, vitamin B12, and iron, especially if you have to give up dairy and don’t like fish or poultry.
  • Keep in mind that most vitamin D3 is produced from mammals, so if you take vitamin D supplements look for vegan products.
• Consider asking your healthcare provider for a referral to a dietician if you can’t figure out what foods you can eat or have concerns about nutrition.

Use Available Resources

• Join the AlphaGal Kitchen Facebook group for more advice and information about food products, recipes, and more.
• Find other AGS-related Facebook groups here.
• See Additional Resources for more ideas.

Try New Foods, Recipes, and Cuisines

Exploring new foods and ethnic cuisines can be fun.

• Try guinea hens, pheasant, or quail in addition to emu and ostrich. They are delicious!
• You can buy alligator from Fossil Farms.
• How many kinds of beans have you tried? Check out all the varieties available from Camellia.
• Buy an Indian Cookbook like Fresh India, which has a lot of vegetarian recipes
• Middle Eastern cuisine also has a lot of great vegetarian dishes. Feasts has great recipes and meal ideas.
• Cook more eggs. The Good Egg cookbook has a lot of ideas and won a James Beard award.
• Sign-up for the New York Times Cooking site and learn how to cook lots of delicious fish, seafood, and bean dishes.

Consider a Plant-Based Diet

•  In addition to avoiding alpha-gal, other advantages of this diet include zero cholesterol and high fiber. Plant-based diets are associated with many positive health benefits including decreased risk of heart disease, stroke, high blood pressure, obesity, high cholesterol, type 2 diabetes, and many cancers.
• Forks over Knives is a great source of information about plant-based diets.
• Even if you have no interest in becoming a vegan, the Forks over Knives cookbook has great ideas for substitutions for baking, etc.
• Take the Forks over Knives cooking course and become a plant-based home chef in 90 days.
• Even if you adopt a strictly vegan diet, you may need to avoid carrageenan.

✅ Emu steak

Photo courtesy of TJ Bruce

✅ Ostrich burger

✅ Emu rump roast with vegetables

Photo courtesy of Heather Hibbs

✅ Duck bacon

✅ Chicken breakfast sausage

✅ Duck breakfast sausage patties

Photo courtesty of Tami McGraw

✅ GalSafe™ Pork Chop

✅ Duck fat

✅ Vegetarian Beef Better Than Bouillon

✅ Jennie-O Turkey Franks

✅ Spaghetti Bolognese Made with Eggplant and Italian Duck Sausage

Photo courtesy of Kim Nellis Bivins

✅ Turkey Ham

Photo courtesy of Jennifer Burton

✅ Eckrich Turkey Skinless Smoked Sausage Rope

✅ Amaroo Hills Farm Emu Pastrami

✅ Foster Farms Chicken Corn Dogs

How to Make a Turkey Burger Taste More Like a Hamburger

Rebecca:

I finely chop up some mushrooms and cook them with the ground turkey and it tastes really good. All of my little kids eat it up too. The mushrooms give the meat moisture and a beefy flavor. I also discovered that the cheaper turkey is more tender since it has dark and white meat. If I use ground turkey made from only white meat, it is pretty tough. 

Astrid Smith:

Add mushroom powder and soy sauce… but we just use ground emu

Julie Lyn:

Add Worcestershire sauce, a tablespoon of duck fat, and powdered mushrooms, a teaspoon garlic powder, a teaspoon onion powder. You can’t hardly tell the difference

Crystal J. Norton:

Add Worcestershire sauce and McCormick hamburger seasoning.

Crystal Payne:

Mix half ground chicken and half ground turkey then add a cap of liquid smoke for each lbs. Boom, tastes like burgers!

Annie Katarina:

Dehydrated mushroom powder adds great flavour.

Kim Nellis Bivins:

I like Mushroom & Company Umami from Trader Joe’s.

Liz Palmer: 

I find that adding onions and mushrooms sautéed in margarine or plant-based “butter” to my ground turkey gives it a heartier taste. I also sometimes add a few drops of liquid smoke.

Debbie Jones: 

Blend up onions, carrots and celery and brown it with the ground meat. Helps with the texture and taste.

April McQuate: 

Grinding your own chicken or turkey helps with texture! I buy chicken breasts or boneless chicken thighs usually. Cut them down into strips that will fit into your grinder. Package in freezer quart bags FLAT. They thaw better that way.

Butter Substitutes

Substitute Duck Fat for Pork Lard

Montie Webb Vogt:

Duck fat is the best substitute for pork lard. I render my own from duck skins/fat available at Amaroo Hills website. It can also be purchased from D’Artagnan already rendered.

Jennifer Burton:

Best sub for pork lard – duck fat

How to Cook an Emu Steak

From Amaroo Hills Farm:

COOKING TIPS

The USDA recommends emu and ostrich be treated like beef in terms of internal cooking temperatures.  Emu and ostrich are both true red meats and are categorized as such by the USDA. Since emu and ostrich both have little fat, overcooking the meats may cause them to become dry and a bit tough.  You do not need specific emu or ostrich recipes to cook them.  Emu and ostrich are not gamey and do not require any special preparation. You can simply substitute emu and ostrich in place of beef, but just keep in mind that these meats cook quicker than beef.

GRILLED STEAKS/FILETS

 Chefs in culinary schools learn that grilled emu and ostrich steaks are best cooked no more than medium rare for optimal taste.  For optimal flavor and consistency, grill (or pan fry) steaks to an internal temperature of 125-130F degrees.   Then wrap in foil and let the steak rest for 5 to 10 mins to allow it to continue to cook and marinate in its own juices.  You can also cook the steaks to medium (130-140 degrees) if you prefer a more cooked steak.  For seasoning you can go simple (olive oil, salt, pepper), use a dry rub, or use a marinade—whatever you prefer.

Bacon Ideas

Stephanie Smith:

I cook turkey bacon on a sheet pan with olive oil, garlic and onion powder to get a nice crisp and savory flavor.
Using a sprinkle of brown sugar/pumpkin pie spice or drizzle maple syrup would work too for those who like sweet bacon.

Julie Lyn:

I fry turkey bacon in duck fat. It’s so delicious!

Use Smoked Turkey Instead of Ham

Meatballs

When avoiding the riskiest foods isn’t enough to stop your reactions, you may need to eliminate other sources of alpha-gal from your diet. Use the links below to learn more about these sources. 

Alpha-gal syndrome is not just a food allergy. People with AGS can also have life-threatening, and sometimes fatal, reactions to medications and other medical products. Some react to airborne alpha-gal, especially fumes from cooking meat. Personal care and household products can also cause reactions. For more information, see What is Alpha-gal Syndrome.

Non-Food-Related Risks By the Numbers

More Information

Cookbook Suggestions 

Warning: some recipes in some of these cookbooks include mammalian ingredients. 

Online sources of red meat substitutes

Online sources of seafood

Other online food sources

Recipes and cooking tips

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