Are European Baby Formulas Really Better Than Ones Made in the US?

I live my life by the Reddit Click Theory (something I just now invented on the spot), which states: the number of clicks it takes to get to a piece of information on Reddit is directly correlated with its status as a conspiracy theory. One click? You're probably safe. Five clicks? You're in anti-vaxxer territory. Anyway, as I Googled "best baby formula" to feed my twin boys, Reddit threads professing the life-altering magic of HiPP, Holle, Kendamil, and other European baby formulas kept rising to the top. Upon further research, it became clear that there is a fairly sizable faction of parents who prefer the standards of European Union baby formulas to American recipes.

"We dug into this trend in 2019, prior to the infant formula shortage," says Dina DiMaggio, MD, FAAP, medical research director at Bobbie Labs, an offshoot of the organic formula brand that supports research on infant feeding. "Our research, which focused on New York City-based parents, found that 20 percent of families were using illegally imported European infant formulas [bought through unregulated third-party websites]."

Parents who utilize EU formulas regularly cite that the EU has stricter standards for baby formulas than in the United States, with non-GMO, grass-fed dairy, and organic ingredients being frequently thrown around. If you look at third-party sites, this is echoed in the reviews, which bemoan the use of corn syrup, pesticides, and sugar levels in American formulas.

"The rise in this trend came while consumers were beginning to understand the difference between EU and US regulations in other product categories," says Dr. DiMaggio. "Just as people were taking a closer look at what was in the products they were purchasing for themselves, it's natural that they started to do the same for their babies."

In scrutinizing labels, I found that both EU and US formulas contain the same key ingredients: a milk source (usually from cows; though sometimes sensitive formulas are made from goat's milk), lactose, vegetable oils, and whey protein. As with labels for personal care products, ingredients for baby formulas are listed with the ingredient that's in the largest quantity in the formula at the front of the label.

Largely, the differences between formulas can be attributed to requirements that the Food and Drug Administration — which regulates baby formula in the United States — sets for brands to meet versus what the EU requires its formulas to meet. "Both the FDA and European Union have specific and strict standards for infant formula with nutrient requirements and labeling laws," says Anthony Porto, MD, FAAP, MPH, chief medical advisor at Bobbie Labs.

Let's take a closer look at where the regulating bodies' standards differ, shall we?

The EU requires DHA — an omega-3 fatty acid that plays an important structural role for brain, skin, and eye development — to be between 20 to 50 milligrams per 100 calories; however, the FDA and US formulas have no DHA requirement. Though, importantly, many formula companies in the U.S. still enhance their formulas with DHA.

There are also differences in sugar in the varying formulas. "The EU also has a limit on how much of the carb source can come from an alternative sugar source other than lactose, which is the sugar found in breastmilk," says Dr. Porto.

Most US formulas include more iron than formulas made in Europe.This is because the FDA requires US formulas to meet certain requirements for the level of 30 nutrients, one of them being iron. Formulas in the US are fortified with iron at 12 mg/dL.

Which formula to buy for your babe is a deeply personal decision. "It's important to remember that both US and European formulas provide safe and healthy nutrition for infants and the nutritional makeup of carbs, fats, proteins, nutrients and minerals that a baby needs to grow in year one of life," reminds Dr. Porto.

And according to Lyndsey Garbi, MD, chief medical officer at Blueberry, a digital pediatric care provider, "No long-term developmental outcomes have proven European formulas superior to American."

Technically EU formulas aren't authorized to be sold in the US because the FDA doesn't regulate them, but there are third-party websites that sell them. Experts are quick to remind that this can pose some risks. "There are factors outside of just what is in a bottle or powder of a formula to consider, such as shipping, temperatures, safety measures, factories, storage, FDA approvals, and potential contamination," says Dr. Garbi. "These things can have huge repercussions and can be complete unknowns for consumers in the US of EU formulas. . . . The risk of using a formula that is not regulated by the Food and Drug Administration in the US is real and needs to be considered."

What's more, often, the mixing and proportions needed to make formulas are different. While many US formulas require one scoop per two milliliters of water, European formulas require one scoop to one milliliter of water. Unfortunately, you might not know this is the case if you don't speak German: many of the best European formulas, like HiPP and Holle, are made in Germany, and English instructions aren't provided. This means you often have to use Google Translate to ensure you're properly understanding the instructions.

There can also be recalls on formulas (like anything else). If you buy formulas in the United States, those recalls are big news. The infant formula shortage of 2022, for example, occurred when a contaminated product in an Abbott Lab caused a factory shutdown resulting in too little formula being produced — and it was front-page news. That's not necessarily the case for European formulas.

Perhaps, most importantly, there are now formulas in the US that meet European standards. Bobbie, for one, does.

Suffice it to say that there are pros and cons to all available formula options. The best thing you can do is equip yourself with knowledge, understanding, and tools to make a right decision for your family.