When a2 Milk™ launched in this country five years ago, I admit to being sceptical about its purported benefits. The thing that sticks most in my mind was that the evidence presented to us was incomprehensible. It was so perplexingly inaccessible I remember actually being offended by it.
This is what it’s like now, and I’m not sure it’s much clearer than it was then.
Here’s the concept, simplified.
Ordinary milk usually contains both a1 and a2 beta-casein protein. a1, it is claimed, is trickier to digest, because among its breakdown products is a peptide called BCM-7, which may cause inflammation and symptoms similar to those of lactose intolerance. No a1, no symptoms, goes the theory – even in those with lactose intolerance, as a1 may reduce the activity of the enzyme lactase in the body, which is needed to digest lactose. a2, claim a2 Milk™, is “less likely to cause digestive discomfort”, even though it isn’t lactose free.
You might like to start with the brand’s own “4 Decades of Supporting Evidence” timeline (see right / see footnote), featuring “some of the most important scientific research findings”. Perhaps tellingly, it includes the official endorsement in 2016 from those noted peer reviewers and meta-analysts – NetMums.
In support of that approval, The a2 Milk Company™ cite a 2009 EFSA review of evidence which concluded that a1 and a2 proteins digest differently and that BCM peptides can potentially effect gastrointestinal function. Fair enough, but omitted is that EFSA also concluded there was insufficient evidence to support a link between a1 milk and non-communicable diseases such as CVD, type 1 diabetes and autism – even though from time to time since, a2 Milk™ have alluded otherwise.
The ‘4 decades’ claim looks increasingly shaky when you consider the first human trial comparing a1 and a2 only took place in 2014 at Curtin University, Perth, with funding from a2 Milk™. Published in the ECJN, the preliminary study involved 41 participants, most of whom did not consider themselves sensitive to milk. Those participants experienced softer stools with a1 – not necessarily a bad thing, and they were still normal – but researchers also noted some increase in inflammatory markers and abdominal discomfort. The eight who did consider themselves milk intolerant experienced some intestinal relief. Not all were impressed, however, including a leading Australian nutritionist, who questioned the results, as well as declaring it ‘irresponsible’ that The a2 Milk Company™ published comments on their website linking a1 to CVD, T1D, autism and schizophrenia.
More interesting was a Chinese study published in Nutrition Journal in 2016. Also funded by the a2 Milk Company™, this too was small – n=45 – around half of whom were diagnosed as lactase deficient / lactose intolerant. Bloating, flatulence, tummy rumbles and abdominal pain were found to be worse in those drinking regular milk, and a2 Milk™ did not trigger symptoms in any participants, including those with lactose intolerance. Again, higher inflammatory markers were found in participants who drank regular milk. However, intervention periods were still short (two weeks) and researchers acknowledged more studies are needed.
It’s entirely plausible that there is something in this; I actually think the science is interesting. To my mind, though, there isn’t anywhere near enough of it. Much more is needed, with far greater numbers of participants, and once that is forthcoming, it may well satisfy enough independent experts. Intriguingly, some claims look as if they are going to be tested in courts this November, if this report from The Sydney Morning Herald still stands.
Press releases and bloggers …
Although the science is diverting, more interesting to me has been the marketing of the product.
I first began to receive press information around mid 2012. Figures quoted in the early press releases were suspect. There was a claim that less than one third of cases of milk intolerance were due to lactose intolerance – with the implication that the remaining two thirds were therefore due to a1 milk protein intolerance. The citation for this was this Finnish study from 1999, which shows 20.2% of participants reported abdominal discomfort with dairy intake, but only 6.4% (i.e. a third, just under) had medically diagnosed lactose intolerance. The logic behind this calculation seems flawed, because absence of a diagnosis does not mean absence of lactose intolerance. Levels in Finland are high, and the condition is so well understood most don’t bother to seek a diagnosis. And besides, other milk-related reactions may account for the non-lactose ones – i.e., CMPA / non-IgE allergies to the various milk proteins.
Later in 2012, Dannii Minogue was hired. A new press release repeated the ‘a1 milk protein intolerance is twice as common as lactose intolerance’ claim, adding “Five Million Brits Could Have Dannii Minogue’s Milk Complaint”. The calculation to arrive at that vast number assumed that the 20.2% figure from the Finnish study – which, incidentally, had made no mention of either a1 nor a2 – also applies to the British public. But it doesn’t.
In subsequent years, there seemed to be a more concerted effort to target allergy bloggers. Categorically unsuitable for milk allergy, this understandably frustrated some people, especially milk allergic folk. Ruth, blogger at What Allergy, was approached to blog about a2. Ruth is anaphylactic to milk.
Rugby player Danny Cipriani was hired. He forgot his shirt and spilt his milk and like Minogue was a photogenic self-diagnosed a1 intolerant. Bloggers – exclusively female, it appeared – received an invite to an a2 event with Mr Dairy Spilliani. They seemed really happy about it, and some declared they could now drink milk again. Blogger Nathalie, The Intolerant Gourmand, who has a child with severe milk allergy, experienced personal success with the product herself, and has since become an ambassador for the brand, working with them for a couple of years, writing glowing reports of both product and science – here and here, for instance – while always taking great care to remind readers that the product is not suitable for milk allergies / CMPA – arguably greater care than the brand itself.
Marketing and advertising …
Given the quantity of sponsored content presently doing the rounds, it’s clear The a2 Milk Company™ still has money to spend, and many are prepared to take it. The reach is broad – for example taking in The Telegraph (last month), Pulse (aimed at GPs), and online allergy / intolerance lifestyle magazine FreeFrom Inspired.
I have grave concerns with claims that a2 Milk™ is “just like nature intended” and “the way milk’s meant to be”. Nature has no ‘intent’, and if the a1 genetic mutation that appeared in cows around 6,000 years ago isn’t what nature ‘intended’, then the mutation which occurred in humans 12,000 years ago that first enabled us to digest cows’ milk ought to be considered unnatural as well. (For the record, neither should: mutations are vital in ensuring diversity of life.) For something to be ‘meant’ requires a conscience to do the meaning. We’re talking science here, not fate, not God, not the will of the universe, and if The a2 Milk Company™ wish to bring ‘meaning’ into the discussion, they might like to consider that their milk – as any other – is ‘meant’ for calves not humans.
So, an attempt to seize the ‘natural’ dairy ground, paying generously for the repetition of their message, seeking personal testimonies from bloggers, placing disproportionate value on anecdotal reports of success … What other cards have a2 Milk™ played? Well, they have arguably encouraged self-diagnosis, not only addressing those who suspect themselves milk sensitive, but looking to sow doubt into the minds of those with self-diagnosed gluten sensitivities too, as this ad demonstrates. I find it perverse that they question people’s lactose intolerance – even going so far as occasionally asking whether the concept of lactose intolerance is a myth – when we have tests for it and yet none for a1 milk protein intolerance.
What are the consequences? To my mind – the risk of public confusion. But perhaps this style of marketing is merely indicative of the confidence of the brand, now that some measure of popular acceptance seems to have been achieved. To some degree, maybe it doesn’t matter if people are scratching their heads, and if there are sceptics such as dietitians, or allergists, or the non-a2 dairy industry, when you can afford to buy appearances in influential journals, celebrities to endorse you, bloggers to say nice things about you, and a prominent presence at excellent events such as the Allergy & FreeFrom Show.
Is it Free From?
But the real point I can’t get past with a2 Milk™ is this: to me, it just isn’t a free from product.
I guess we could argue over definitions, but a free from food is a food which is free from one of the allergens which would ordinarily be present in the ‘everyday’ equivalent.
It doesn’t need stating that a2 Milk™ contains milk, one of the 14 allergens. Arguing that, because it is free from one milk protein, it is a free from food, is very much like arguing that liquidised egg whites – free from egg yolks – are a free from food. No, they still contain egg, another of the 14 allergens. Yet this was no obstacle to the product winning the World Dairy Innovation Awards’ Best Dairy Product which is ‘Free From’ category – and no, I don’t understand what’s innovative about a product which nature apparently offered up so freely, either.
Anyway. Free from or not, what I want to hear now are independent voices commenting fairly, objectively and authoritatively on a1 / a2 science. Experts to analyse the data – both pros and cons. I would like organisations such as allergy charities and the British Dietetic Association to issue position statements. I want to hear from doctors and allergists on whether or not there is confusion in their surgeries and clinics, and whether they have seen reactions because of this, which is a fear for many – or whether they welcome the product. And more bloggers too – bloggers who’ve tried the product both without success, and with success (but without payment).
To put it another way, I want to hear more voices speaking about a2 Milk™ other than those belonging to a2 Milk™ or those being courted or funded by a2 Milk™.
Footnote, 2nd August 2017. Between the publication of this post and today, the a2 Milk Company™ have removed the Mumsnet endorsement from their 4 Decades of Supporting Evidence timeline.