The following is intended for informational purposes – always consult with your pediatrician before making any changes in your baby’s diet.
The minute new parents discover something they love that works for them, a bunch of naysayers publish blogs and Facebook posts that squash their enthusiasm and challenge their choice. It happens with baby monitors, it’s happened with the Snoo, and it persists with misleading information about European baby formula. And should the American Academy of Pediatrics (AAP) weigh in, which it did on the formula issue, parents listen and grow fearful, wondering if they are making a questionable choice.
The American debate over Euro formula started in 2018, when the AAP recommended against using non-FDA-registered formula, citing concerns about product safety and nutrition. That recommendation was disseminated to all American pediatricians, and not surprisingly, the issue picked up momentum. It snowballed when, in 2019, The New York Times published an article stating “European baby formula that is illegally sold in the United States carries risks.”
“It’s not FDA approved! It could be contaminated!” screamed the commenters, fueling the public maelstrom of anxiety. But these are the things you hear based on incomplete or biased news reporting. As cynical as this may sound, it’s important to recognize that sales of European formula cut into sales of American formula, especially as various Euro formulas gain popularity; they are viewed as unwelcome competition to the market. The best way for manufacturers to deter parents from purchasing foreign products is to scare them into believing they are dangerous or inferior.
So, let’s sift through these fears one by one in order to be more informed about your infant’s potential food source.
The three big things that worry parents and doctors about purchasing European formula are lack of FDA approval, nutritional differences, and safety in transport and storage. Differences in product marketing and formulations for special diets are concerns as well.
FDA Approval
When the commenters in online “mom groups” exclaim, “But it’s not approved by the FDA!” we may react toward the product with distrust. We expect our government to protect us from harm whether danger lurks in food, supplements, vaccines, or medication. However, just because something hasn’t been approved by the FDA does not mean it is somehow dangerous or inferior. Nearly half the FDA’s budget comes from user fees paid by the very corporations whose products the agency regulates. This sets up a huge conflict of interest, which does not exactly spur trust.
The European Union (Europe’s FDA equivalent) is considered more stringent about formula and contaminants than the FDA. For example, formula sold in Europe may contain neither corn syrup nor even “trace levels” of pesticide. Unfortunately, we cannot say the same for formula made here. Even certified organic American formula may contain trace amounts of pesticide resulting from inadvertent contamination from a neighboring farm, for example. Dr. Steven Abrams, chair of the Committee on Nutrition at the American Academy of Pediatrics said, “In many respects, food safety standards for products sold in the European Union are stricter than those imposed by the FDA.” That said, he added, “But there’s no scientific evidence that imported European formulas are better for babies, according to many pediatricians.”
Still, American parents are clamoring for the European thing.
Nutritional Differences
Infant formula is about as tightly regulated as any food can be. All brands manufactured here contain a balance of protein, fat, carbohydrates and other nutrients. European formulas contain the same ingredients as ours with differences in the levels of these ingredients. When the 2019 study referenced by The Times examined 16 European products, they noted an absence of linoleic acid, an essential fatty acid associated with DHA and ARA. (DHA and ARA are often advertised on formula labels as Human Milk Oligosaccharides or HMOs). However, that is old news. Effective 2020 all infant formula marketed in the EU (which is what Americans wind up buying) must have 20–50 mg omega-3 DHA per 100 kcal, the equivalent of 0.5–1% of fatty acids.
The study was critical of European formulas for other reasons. Ingredients were not listed on the outside of packaging, and directions on how to use German and Dutch formulas, which represent the majority of European formulas sold in the U.S., were not in English. These issues have since been addressed. Suppliers now provide a perfect translation of directions and ingredients on their websites and in their shipments to customers.
Organic
European formulas are made from the milk of free-range cows living on sustainable farms. No pesticides, synthetic fertilizers, or GMO technology is allowed. The cows graze on their natural food source, which is grass. This makes for healthy and happy cows that do not require antibiotics or anti-inflammatory medications. Grass-fed cows produce milk that may have additional benefits to infants compared to cows raised on corn (which make up most of the cattle the U.S.). Organic American formulas are still a good choice, but few are as pure as their European counterparts especially when it comes to pesticide residue.
Iron: Let’s agree to disagree. The AAP expressed concern about the relatively low iron content of European formulas, which contain 1.3 mg of iron per 100 calories at the most, compared to 3.3 mg of iron for some American formulas. But pediatric nutritionist Bridget Young, Ph.D., says, “The U.S. range is just much larger than the European range. U.S. formulas all seem to follow the classic ‘more is better’ approach and add iron closer to the upper end of the range.” Many parents find that high iron gives formula a metallic taste (and yes, you absolutely should taste your baby’s formula), and some parents report constipation in their babies as a result of high iron. Any woman who has taken iron supplements during pregnancy knows about this pesky side effect.
Recalls
“What if there is a recall with European formulas? You’ll never know” is an oft-stated concern. But according to one major California-based supplier of European formula with whom I spoke, “If there were ever to be a recall, we would be able to respond faster than any recall in the U.S. That’s because we have the ability to immediately identify who has purchased our formula and write to them directly. Any manufacturer issuing a recall in the U.S. would have to spread that message via news outlets and hope that consumers will see it. They have no idea who bought their product and from where. Whereas we know exactly who bought our product and when. I think this alone makes us a safer option for parents who have this concern.”
Transportation and Distribution
This is another issue that worries parents. “How long does it take for the formula to get here? Where is it being held? What about heat and humidity affecting nutrients? What about the formula’s expiring?”
I can’t speak for distributors in Kentucky, but in the New York area and in California, these Euro formula suppliers are on top of their game, and their products are in high demand, so the products move quickly in and out of storage. Find out before you order if the distributor receives its shipments via air or sea. Always choose one that uses air freight so that the formula arrives quickly and is kept cold during transit. Feel free to ask where suppliers’ storage units are and how the boxes are stored; keep in mind that every package is stamped with an expiration date in the European format: day, month, year.
Marketing
Unlike American formula, European formula is manufactured and marketed using “stages” based on the infant age’s. Stage 1 is for babies aged 0–6 months, and Stage 2 is for babies aged 6–10 months, when infants also get nutrients from solid food. It’s important to recognize this when ordering formula though many parents use Stage 1 their babies’ entire first year of life.
Special Diets
One more criticism that came up in the study was regarding hypoallergenic formula for babies with cow’s milk protein allergy. I can make this really easy by stating if your baby has a milk protein sensitivity or allergy, follow your doctor’s recommendation for what formula is appropriate. Most babies do well on fully hydrolyzed formula (Alimentum or a soy-based formula, for example), but it’s probably best not to use European formula should your baby be anemic or have dietary problems; European manufacturers’ specifications concerning allergies are different from ours.
The Upshot
Many of my clients who couldn’t breastfeed or didn’t want to breastfeed report feeling quite satisfied with their choice of European formula. With the pressure to breastfeed so prevalent in our culture, having a nutritious, quality alternative that smells and tastes more like human milk comes as a relief to most parents. Being educated on the differences can help you address your baby’s nutritional needs intelligently and objectively.
Always consult your pediatrician before making changes in your baby’s diet. For more detailed information on all infant formula, please visit Dr. Young’s website.
For more information on European formulas, please see https://babyformulaexpert.com/european-formula/.
Note: An earlier version of this article stated that “Stage 2” European formulas are marketed for babies aged six months to one year. They are in fact formulated for children aged six months to ten months, whereafter manufacturers market formula labeled “Stage 3.” Stage 3 formula may be used as long as desired.