A Guide for People with Alpha-gal Syndrome
Determining Your Tolerance for Alpha-gal
Seek your healthcare provider’s advice about which foods you should and should not eliminate from your diet. If your physician approves, the following steps may help you:
Step #1: Remove the riskiest foods (meats, organs, etc.) and any other foods that you know you react to from your diet.
Step #2: Learn about the relative risks of other foods that contain alpha-gal (see below).
Step #3: With the advice of your doctor, cautiously work to determine your personal tolerance for different foods that contain alpha-gal. See Determining Your Tolerance for Alpha-gal for more information (coming soon).
The Spectrum of Risk
Many foods contain alpha-gal. Some need to be avoided by everyone with alpha-gal syndrome (AGS); others are tolerated by most of us (57). At one end of the spectrum are the internal organs of mammals, like intestines and pork kidneys. Organs can be so high in alpha-gal content that they can even trigger anaphylaxis in people who do not have reactions after eating mammalian meat (24,59). In other words, some people sensitized to alpha-gal never have a reaction until they eat an organ like a pork kidney. At the other end of the spectrum are hundreds of mammalian byproducts. The alpha-gal content of most of these byproducts is unknown (57), and most people with AGS tolerate most of them.
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.
(kidney, liver, lung, intestines, heart, etc.)
Mammalian sausage casings
(gut or collagen casings, even on poultry sausages)
Flounder roe (eggs)
(Not all fish roe contains alpha-gal).
(milk, cheese, yogurt, butter, etc.)
Gelatin in foods*
(Jello, gummy bears, marshmallows, gummy supplements, etc.)
(from splattering fat, grills, pans, food prep surfaces, etc.)
(skeletal muscle, such as beef, pork, lamb, etc.)
(in refried beans, vegetables, baked goods, tortillas, chips, foods fried in lard, etc.)
Mammalian broth and gravy
(often added to flavor dishes, injected into poultry, etc.)
(e.g. fumes from cooking meat)
Carrageenan in foods*
(in dairy products, dairy-free dairy substitutes, poultry products, and many other products)
Mammalian Byproducts in foods*
(whey, mono- and di- glycerides, lanolin, vitamin D3, etc.)
Highest risk: avoidance recommended for all people with AGS
→ → → → →
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.
Food-Related Risks by the Numbers
*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).
To learn more about the relative risks of foods that contain alpha-gal and how to figure out your own, personal tolerance for different foods, see Determining Your Tolerance to Alpha-gal (coming soon).
The Riskiest Foods: Mammalian Meat, Organs, Tissues, and Fluids
Don’t play Russian roulette!
Stop eating mammalian meat, organs, and other high risk foods!
Alpha-gal is found in the meat, organs, tissues, cells, and fluids of all mammals except for humans, great apes, and Old World monkeys (1). It is also found in products made from them. Some of the riskiest sources of alpha-gal in food include, but are not limited to:
- Mammalian meats (1), such as beef, pork, lamb, bison, venison, goat, horse, rabbit, squirrel, kangaroo, antelope, buffalo, camel, guinea pig, bats, whales, etc.
- If you are not sure which animals are mammals, there is a guide here.
- The internal organs of mammals, like liver (21), lung, heart, intestines (tripe), sweetbreads, and kidneys (6,57)
- Mammalian gut sausage casings
- Mammalian fat, like lard, tallow, and suet
- Mammalian fat is often in cooked foods, such as sauces, pastries, pie crusts, tortillas, tortilla chips, refried beans, baked beans, vegetable dishes, mashed potatoes, and desserts.
- Some baking mixes (like Jiffy Corn Muffin Mix) contain lard.
- Beef fat is often added to fry oil to enhance flavor (6,57).
- Bones and bone marrow
- Testicles (Rocky Mountain or prairie oysters)
- Mammalian collagen (e.g. beef collagen sausage casings) (6,57)
- Meat broth, bouillon, and stock (6,57)
- Gravy (6,57)
- Mammalian blood, found in soups, black pudding, blood sausage, blodplättar, and other foods
- Meat extracts, like Bonox and Bovril
- All other mammalian body parts, organs, tissues, cells, and fluids, such as tendons, brain, lungs, heart, nerves, skin, mammalian bile (Papait seasoning), and the products that contain them.
Most of the foods on this list should be avoided by everyone with alpha-gal syndrome. Many of us need to avoid all of them. Refer to the above figure and table for more information.
Kidneys are one of the most dangerous foods for people with AGS!
Tripe is made from the stomach of mammals.
Sweetbreads are the thymus and pancreas of mammals.
Examples of mammalian meats, organs, and tissues
Chitterlings are made from pork intestines.
Even turkey and chicken sausages often have casings made from mammalian intestines.
Lamb and mutton are from sheep.
Beef, lamb, pork, and other mammalian burgers
Pork might be called “the other white meat,” but pigs are mammals.
Foods from many cuisines contain blood, such as this blood sausage from Portugal.
Beef jerky, buffalo jerky, biltong, and other kinds of dried mammalian meat
Pork rinds are made from pig skin.
Mammalian bones and bone marrow
Other meat products
Mammalian broths are added as a flavoring to many foods.
Mammalian bouillon is also used to flavor many dishes.
Soups are often made from mammalian meat and bones.
Some unexpected sources of lard
Gravy and sauces
Gravy and sauces are often made with lard, as are biscuits.
Refried beans are often made with pork lard, as are many other Mexican dishes.
Tortillas are often made with pork lard, and tortilla chips are often fried in it.
Pies and other pastries
Pies and pastries often have lard added to their doughs.
Corn muffin mixes
Corn muffin mixes, like Jiffy, can contain lard.
Vegetables may be flavored with lard, especially in the southern U.S.
Baked beans are often made with lard or pork belly.
Beef tallow or lard may be added to fry oil used to fry chicken and other foods.
As with chicken, beef tallow can be added to the fry oil used to make French fries.
Mashed potatoes often have lard added to them, especially in the southern U.S.
Tips for Adjusting to a Diet without Red Meat
- Don’t despair! There a great substitutes for almost all the foods you love.
- 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.
- 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!
- 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.
- 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.
- The Alpha Gal Support Non-Public Facebook group is another great place to ask for advice about food products.
- Find other AGS-related Facebook groups and information about our Support Team 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.
Try These Substitutions
⚠ Beef steak
←Instead of this
✅ Emu steak
Photo courtesy of TJ Bruce
←Instead of this
Ground ostrich or emu with duck fat added both make great burgers. Ground turkey and chicken are other options. Vegan options include the Impossible Burger and the Better Burger. If you order any of the above at a restaurant, make sure they are not cooked on a grill used to cook mammalian meats.
✅ Ostrich burger
⚠ Beef stew with vegetables
←Instead of this
There are many cuts of emu. Emu rump roast makes a great stew.
✅ Emu rump roast with vegetables
Photo courtesy of Heather Hibbs
⚠ Pork bacon
←Instead of this
Many people discover they like duck bacon more than pork bacon. The most popular brand of duck bacon is D’artagnan’s. Popular brands of turkey bacon include Wellshire Organic Turkey Bacon and the less expensive Sam’s Choice Uncured Turkey Bacon. Some people prefer chicken bacon, including Wellshire Fully-Cooked Chicken Bacon and Al Fresco Uncured Chicken Bacon.
You can also make your own duck bacon.
✅ Duck bacon
⚠ Pork breakfast sausage
←Instead of this
People rave about Applegate Chicken and Sage Breakfast Sausages. If you try a different poultry sausage, remember to make sure that it doesn’t have a mammalian gut or collagen casing.
✅ Chicken breakfast sausage
⚠ Pork breakfast sausage patties
←Instead of this
✅ Duck breakfast sausage patties
Photo courtesty of Tami McGraw
⚠ Pork chop
←Instead of this
Revivicor has developed an alpha-gal-free pig, called the GalSafe™ pig. GalSafe™ pork products aren’t available to the public yet, but the FDA process for approving them in underway, and Revivicor is already conducting taste-tests.
✅ GalSafe™ Pork Chop
⚠ Pork lard
←Instead of this
Duck fat makes a great substitute for lard. Other good substitutes include vegetable shortening and dairy-free butter. Remember to check labels and make sure the brand you buy doesn’t contain mammalian byproducts or carrageenan.
More advice below in Cooking Tips from People with Alpha-gal Syndrome.
✅ Duck fat
⚠ Beef Bouillon
←Instead of this
✅ Vegan Beef Better Than Bouillon
⚠ Pork Franks
←Instead of this
⚠ Spaghetti Bolognese Made with Ground Beef
←Instead of this
Italian duck sausage from Amaroo Hills farm is delicious in Italian dishes.
✅ Spaghetti Bolognese Made with Eggplant and Italian Duck Sausage
Photo courtesy of Kim Nellis Bivins
⚠ Pork Ham
←Instead of this
Yes, turkey ham. It’s a thing! Wellshire Seasoned Honey Turkey Ham Nugget comes highly recommended. Smoked turkey legs can also be used in place of ham. Watch out for carrageenan in some other brands.
✅ Turkey Ham
Photo courtesy of Jennifer Burton
Cooking Tips from People with Alpha-gal Syndrome
How to Make a Turkey Burger Taste More Like a Hamburger
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.
Add mushroom powder and soy sauce… but we just use ground emu
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.
Mix half ground chicken and half ground turkey then add a cap of liquid smoke for each lbs. Boom, tastes like burgers!
Dehydrated mushroom powder adds great flavour.
Kim Nellis Bivins:
I like Mushroom & Company Umami from Trader Joe’s.
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.
Blend up onions, carrots and celery and brown it with the ground meat. Helps with the texture and taste.
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.
Becky Godwin Ball:
I use plant butter, mainly Miyoko’s Organic Cultured Vegan Butter, for frostings and things of that nature. For cookies that call for butter I use butter flavored vegetable shortening. I also use a product called Nutiva Organic Coconut Oil Butter Flavor to cook my eggs in every morning and to spread on my toast.
Nutiva Organic Coconut Oil Butter Flavor
Miyoko's Organic Cultured Vegan Butter
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.
Best sub for pork lard – duck fat
How to Cook an Emu Steak
From Amaroo Hills Farm:
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.
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.
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.
I fry turkey bacon in duck fat. It’s so delicious!
Use Smoked Turkey Instead of Ham
To season dishes such as beans use smoked turkey legs or wings. Also you can put legs in slow cooker till the meat falls off the bone and make bbq.
The best turkey ham is Wellshire Farms 1.75 lb Seasoned Honey Turky Ham Nugget. The next best thing to Wellshire Farms is Frick’s Smoked Turkey Drum or wings. They make great ‘ham & beans’ or pulled pork sammies.
Anna Lee Lightsey Jordan:
Use smoked turkey necks to season vegetables. Use smoked turkey wings to make gumbo.
Avoidance Beyond Mammalian Meat, Organs, and Tissues
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.
Milk and Other Dairy Products→
Natural Flavors and Flavorings→
Not Just Food
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, Coming Soon
Medications and Other Medical Products→
Personal Care and Household Products→
The AlphaGal Kitchen
Check out the AlphaGal Kitchen for more tips on how to adjust to an alpha-gal-free diet, including recipes, emu and ostrich suppliers, restaurant tips, alpha-gal related food blogs, product recommendations and more. There is an AlphaGal Kitchen website, Facebook group, and Youtube channel.
Copeland Casati’s Shopping Tips
Copeland Casati has compiled shopping tips for people with alpha-gal syndrome here.
Bring a card describing you allergy to restaurants and ask the wait staff to share it with the manager and chef preparing your meal. You can make your own or use one created by someone else.
Jennifer Burton’s restaurant cards:
Tick-Borne Conditions United Co-founders Dr. Jennifer Platt and Beth Carrison team with TBCU Board Chair Dr. Tina Merritt to provide guidance to those with Alpha-gal Syndrome on what ingredients to avoid in food, medicines, and other personal care products. The webinar provides an overview of Alpha Gal Syndrome (AGS) – the tick-borne condition that renders patients allergic to mammalian meats and the myriad by-products that contain mammalian-derived ingredients (e.g. pharmaceuticals and vaccines).
Warning: some recipes in some of these cookbooks include mammalian ingredients.
Vegan for Everybody
Warning: language may not be appropriate for children.
Forks Over Knives
The Good Egg
Amaroo Hills Farm
Amaroo Hills Farm is owned by a farmer with alpha-gal syndrome and is a popular source of emu, ostrich, guinea fowl, and a variety of duck sausages for the alpha-gal community.
Fossil farms sells ostrich, emu, guinea fowl, pheasants, quail, and squab, in addition to more common poultry species. They also sell alligator.
Many people with alpha-gal syndrome like D’Artagnan duck bacon. Sometimes it is available in supermarkets, but it can also be ordered online.
Thrive Market is a popular source of vegan foods and other vegan products.
Camellia is a great source of beans and other legumes.
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