Thursday, 14 August 2014

FAQ's: Is A2 milk suitable for those with a cow's milk allergy, or 'milk intolerance'?

When I had 'Baby' among all our other problems I struggled with breastfeeding - not least because huge cracks, which were incredibly painful, developed around the nipple area. What I wanted to find was a nipple cream. My problem was that the only one on the market that is recommended is made with Lanolin... and guess what?? I'm allergic to Lanolin. When I approached the matter with my (locum) GP. She wouldn't entertain any discussion as to what else I might use, because nothing else had been found to be safe and it 'wasn't ethical' to test things on babies.

How is it relevant to this post?

Because I am feeling a niggle of concern about the way that A2 milk is presenting itself to the allergic/intolerant. Recently on Twitter, someone who (as far as I'm aware) was unknown to A2 was questioning what I thought about it. A2's representative to this person's query by responding with, 'Why don't you try it?' (Or words to that effect!) 

'Scuse me? Apparently not knowing this person, or much about their health condition (or indeed anything else) they suggested trying it!! Well, that strikes me as being rather irresponsible at the very least and unethical at it's very worst!

For those who don't know, A2 is a milk that in it's modern incarnation hails from Australia, where a special breed of cows has been bred. These cows produce milk that doesn't contain A1 milk proteins, but instead produces milk containing A2 proteins. The idea is that some people might be better off drinking A2 milk, rather than milk containing A1. The way it's explained all sounds very beguiling - to those who are having problems with 'normal' cows' milk. After all, we're desperate aren't we??  To find a solution to our problems??

A2 Milk is still Cow's milk

Up to now, I have restrained myself from blogging about A2 milk. My main worry being that if I draw attention to this product, that people will inevitably (out of curiosity, which is a powerful thing) want to try it - to see if they are the 'lucky' ones for whom it might work - especially if 'helpful' friends or relatives suggest they should 'give it a go'. BUT because the subject of A2 milk keeps cropping up, I've come to decide that some words of caution might well be required.

Following a recent exchange with A2 on Twitter, I discovered that A2 say that their milk is NOT suitable for those with a cows' milk allergy*. Good! I'd agree with them about that! 

So what's my problem? You may well ask!

Well, the thing is, it appears that A2 like to use the term dairy/milk intolerance or cmpi - which, by the way, doesn't feature in up-to-date NHS terminology. They referred me to their Nutritionist*, who tried to point me to a line in the NICE document which refers to 'food intolerance'. However, the bit to which she referred was talking about food intolerance as a whole, in an overarching sense - NOT specifically milk allergy. 

According to the NHS see here (near the bottom of the article, under the heading 'Milk and Dairy Intolerance'): 

'There are three conditions that cause a reaction to milk.'

The article goes on to explain that 

there is lactose intolerance and there is milk allergy - of which there are two kinds - Ige and Non-Ige.***

That's it. 

What used to be called cow's milk protein intolerance or cmpi is now referred to as a Non-Ige Mediated Cow's Milk Allergy. 

Following this one through, it would seem either that A2 mean that their milk is suitable for a medical condition that doesn't exist, or they mean that they think their milk is suitable for those who once upon a time would have been described as cow's milk protein intolerant, but who are now described as having a Non-Ige Mediated Cow's Milk Allergy. But as A2 say their milk is NOT suitable for those with milk allergy, it can't be the latter, can it?

Part of my worry about the use of the term cmpi/cow's milk protein intolerance, is that, confusingly, it still seems to be in use, by some individuals. Perhaps some medical professionals (hopefully not allergy professionals) are still using out-dated terminology, because there are still people who seem refer to themselves, or their little ones, in this way

Or, it's quite possible that if you/your child were diagnosed around the time 'Baby' was diagnosed (she was originally diagnosed as cow's milk protein intolerant) or any earlier, you/your child may have been diagnosed as cow's milk protein intolerant. Unless your knowledge has since been updated you might still be referring to your diagnosis using the old terminology. If you describe your condition as cmpi/cow's milk protein intolerance, when it is in fact a milk allergy, you might wrongly assume that A2 milk might work for you. 

Now, even supposing that A2 milk might work for you/your child, the first problem you face is how to test/challenge you/your child to see if they're okay with it - without the risk of causing a significant reaction - remember the unethical bit? So I imagine the sensible way to do it would not be with a drink of A2 milk, but to follow the so-called Milk Ladder. Of course, you could only safely take this approach with a Non-Ige  Mediated Cow's Milk Allergy. Milk challenges of children with an Ige Mediated Cow's milk Allergy are usually carried out within a hospital setting - just in case (Heaven forbid) the worst happens!

The Milk Ladder (in case you've never heard of it before) is a 'safe' way of reintroducing milk to those with a Non-Ige Mediated Cow's Milk Allergy, by exposing them first to the tiniest trace. It is meant to be followed under the guidance of a dietitian - who can advise on specific amounts (even of biscuit, as this can make a difference) and for how long to stay on each stage, before moving on to the next. This will vary from person to person - which is why there is the need for a dietitian to be involved.

The Milk Ladder begins with trialling milk in the form of margarine or butter - which has been baked in a biscuit that has been heated long enough, at a high enough temperature, in order to 'denature' the milk protein somewhat. It has been discovered that most children with a milk allergy can tolerate milk in this form (my little one couldn't, until quite recently, see here) so this is a fairly safe starting point to use.

Of course the first problem is that A2 milk is (currently anyway) a standalone product - there is no A2 margarine or butter to bake in a biscuit. There is no A2 cheese (much further up the Milk Ladder) to be baked in a dish like Lasagna. So how, therefore, can you introduce A2 milk in a controlled way?

Even supposing you discover that A2 milk is suitable for you (without the use of the Milk Ladder), you will still only have one stand-alone product - another expensive replacement for 'normal' milk. You will still have to use dairy free/vegan margarine, butter, cream and yoghurt etc. When you eat out, you will still have to check every packet, every item on the menu for cow's milk - 'cos no one else will be using A2 milk.

Now I suppose it could be possible that the the Doctors, Dietitian's etc. just haven't yet identified the condition for which A2 milk is suitable - after all medical science is constantly evolving and discovering new things. However, one thing is for certain, until the Allergy Specialists say otherwise, I won't be touching it with a barge pole! Neither will my little one, with her confirmed diagnosis of Non-Ige Mediated Cow's Milk Protein Allergy

Anyone with a milk allergy, who is interested in the merits of A2 (or any other kind of milk, for that matter), should first discuss any new course of action with their own HCP's - that's Health Care Professionals - Doctors and Dietitians, who are best placed to advise you appropriately. 


I was most interested to read an article shared by Dr George Du Toit (@GoAllergy on Twitter) regarding A2 Milk. See here:

* I was therefore most surprised to see that despite this, they have published a testimony about their milk (on their website) by someone who describes themselves as having a milk allergy, but who is OK, apparently, with their milk. 

** I feel the need to point out that although some nutritionists are qualified in some way, not all are - in fact anyone can call themselves a nutritionist. I could, if I so wished, without a qualification to my name (see here for more about this)! Melanie Bibby, according to her profile on the A2 website has an MSc in Food Science from the University of Reading, but even so, the advice of a nutritionist should not supersede that of your Allergy Doctor or Specialist Allergy Dietitian.

***  For a more detailed description of Ige and Non-Ige Mediated Cow's Milk Allergy, see here.

New Update: 18th May 2015 

Today, A2's  nutritionist told me (via Twitter) that the NHS Choices article is out of date. I like to make sure my sources are reliable, so I've just checked. It was reviewed just the other month, so, no it isn't out of date!! She tells me that the FSA and NICE back up her definition of 'milk intolerance', however, she has not responded to my request for links to these (strangely enough)

Having dug around on the A2 website (see here - please note, their definition of 'milk intolerance' looks remarkably like a description for Non-Ige Mediated Milk Allergy - they even use the term 'Non-Ige'), I found the links to the sources to which I suspect she was referring. The link to NICE appears to be permanently broken (I tried it several times) but I'm guessing that it would have taken me to the extract which I have already addressed (see above). The link to the FSA worked, but as far as I can see, it bears no relation to her definitions of 'milk intolerance'. 

Moreover the FSA article does not seek to define these terms, but rather examine how milk or dairy free foods are labelled and how that labelling is understood by individuals suffering from various forms of 'milk sensitivity' - this term being used as an overarching term for all medical conditions linked to an inability to tolerate milk.  

To me, it seems like they're re-shaping facts to fit their marketing claims for their milk - which could be interpreted as misleading. This is nothing new - pseudo-scientific terms have long been used by promoters of quack cures/therapies as a way of convincing the unsuspecting!

What I would much prefer to see offered by A2, by way of evidence, is a paper, quote or statement by a recognized specialised allergy professional, clearly and convincingly endorsing A2 and it's suitability for those with a so-called 'milk intolerance'. Someone such as Dr George Du Toit, or Dr Adam Fox would convince me - not someone like Dr Mark Porter (GP and TV Doctor) who has previously been used as a figurehead to endorse their product (or even the most recent addition to their arsenal: Rick Miller - a Clinical and Sports Dietitian - apparently renowned in his field, but NOT an allergy specialist)!

However, the kind of evidence (remember it needs to be independent, peer-reviewed etc. etc.) that would convince me of (A2 milk's suitability) is unfortunately lacking!!

New update: 4th June 2015

Hallelujah for 'Sense About Science'. Assisted by various experts in the field, they've just published a new booklet, 'Making Sense of Allergies' which has been created specifically to debunk myths about allergies. It confirms all I've been saying about A2! See the bottom of P.22 here for the full story but to quote: 

'... the best scientific evidence suggests that A1 protein intolerance does not exist. The position of the Dietitians Association of Australia is that "there is no solid scientific evidence demonstrating that A2 milk is better for you than regular milk." This company is marketing a product that the best scientific evidence suggests does not exist.' 

I rest my case!!

New update: 21st August 2015

Unfortunately A2 milk are still not playing ball, even though top allergy professionals continue to work behind the scenes on this one! Rick Miller (their RD) was trying to undermine this blog post today - casting aspersions, by saying it was a year old! Watch out for a future post, hopefully coming soon! 

Please note, despite A2's claims about new more recent research, it is still not recognised by current top UK allergy professionals and their 'research' and 'evidence' is only funded by their organisation - which is, of course, not going to release any information from their research unless it fits their version of the 'facts'. 

Always check the credentials of anyone who offers you advice about new products  - especially in relation to allergies/intolerances. Rick Miller's qualifications and expertise, for example, are mostly related to sports nutrition, NOT food allergies. Any responsible person should suggest you check with YOUR allergy HCP's first!

Related Posts: 

Further Reading:

A2 milk is Allergenic - The Medical Journal of Australia (subscription required)

A2 milk: What you need to know - Medical News Today

Cow's Milk (Dairy) Allergy - Australasian Society of Clinical Immunology and Allergy

More A2 Milk Nonsense - Planet Lactose (NZ blog)

Warning: A2 Milk - Allergy UK


  1. I actually have no problem with milk myself, but I found this story particularly interesting. It's becoming all too common for companies to market themselves as being a 'safe' or a 'healthy' option for people with certain dietary requirements, and yet falling far short of those requirements at the same time. If they are unable to identify clearly what intolerance/allergy their milk is allegedly safe for, they really shouldn't be marketing it at anyone except the general milk-consuming public.

  2. This milk terrifies me. A2 milk have been in touch with me to blog about their milk and I've declined - I have a milk allergy so I can't drink it. To their credit that accepted this and left it at that but what is this milk for? If it's for an intolerance to lactose in milk the person would be better off with lactose free milk, of which there are some on the market. I worry how long it will before someone has a bad reaction to this. Mostly if relatives of friends buy it to make something with, a cake or whatever for an allergic person and assume it's OK. It's frightening. I would steer well clear and not go near it with a barge pole if you have ige or non ige allergies and I'm not sure it would be that great for anyone with an intolerance either. What does it cost out of interest?