Corn tortillas in California now must contain folic acid. More states are looking at it

Fifteen years after losing her first baby to a rare and devastating birth defect, Andrea Lopez takes comfort in knowing that other Latina mothers could finally avoid the same pain.

In January, California became the first state to require food manufacturers to add folic acid, an essential vitamin, to corn masa flour used to make tortillas and other traditional foods widely used in its community.

It’s a long-delayed measure aimed at reducing the disproportionately high rates of serious conditions called neural tube defects in Hispanic infants, which took the life of Lopez’s son, Gabriel Cude, when he was 10 days old.

“It’s such a small effort for such a huge impact,” said Lopez, 44, who lives in Bakersfield and is now an attorney and father of two young daughters. “There are very few things I wouldn’t do to spare anyone this heartache. »

A similar law takes effect in Alabama in June, and legislation is pending or under consideration in Florida, Georgia, Oklahoma and Oregon. Four other states – Texas, Delaware, New Jersey and Pennsylvania – have expressed “active interest” in the issue, according to the Food Fortification Initiative, an advocacy group that focuses on combating micronutrient deficiencies.

“All women and children in the United States should have access to folic acid and have healthy babies,” said Scott Montgomery, director of the group.

For nearly 30 years, folic acid, a key B vitamin, has been required to be added to fortified wheat and white breads, cereals and pastas in the United States.

Decades of research show that the 1998 requirements reduced rates of serious abnormalities such as spina bifida and anencephaly by about 30 percent, preventing about 1,300 cases a year. It is considered one of the greatest public health triumphs of the 20th century.

But masa corn flour, a staple used in Latin American diets, was excluded from the initial fortification requirements – and rates of diseases such as spina bifida and anencephaly in that community have remained stubbornly high.

In 2016, federal regulators allowed, but did not require, the addition of folic acid to masa corn products. By 2023, only about 1 in 7 masa corn flour products and no corn tortillas contained folic acid, according to one study.

Nationally, Hispanic women have the highest rates of these abnormalities during pregnancy. In California, the rate among Hispanic mothers is twice as high as among white or black women, according to state data.

California’s new law — and the state’s enormous purchasing power — could help expand its adoption nationwide, said state Assembly member Joaquin Arambula, who sponsored the legislation passed in 2024.

“You often have to be the first to get the ball rolling,” he said. “So I’m happy that other states have taken up this role.”

California’s action and pressure from its advocates have already sparked change.

Gruma Corp., the parent company of Mission Foods and Azteca Milling, has been involved in the fortification issue for nearly two decades. Azteca began selling some varieties – but not all – of Maseca, its largest masa corn flour brand, with folic acid in 2016.

As of this year, 97% of the company’s U.S. retail sales include folic acid. The rest should be fortified before July, Gruma said in a statement.

Mission Foods began fortification in 2024. It now adds folic acid to all of its branded and private label corn tortillas in the United States.

Such actions by large producers have helped pave the way for smaller manufacturers to follow suit, according to a recent report from the Center for Science in the Public Interest, a consumer advocacy group that has lobbied for fortification.

Initially, the industry was concerned that folic acid might affect flavor and the cost of the label change, said Jim Kabbani, director of the Tortilla Industry Association. But he now expects tortilla makers to start selling fortified products on a larger scale.

“I think overall the train has left the station and there will be more and more states,” he said.

Public health experts welcome this growing dynamic.

“The science is clear: Folic acid fortification works,” said Vijaya Kancherla, professor of epidemiology at Emory University and director of the Spina Bifida Prevention Center. “It’s safe. It’s proven. And it’s profitable.”

This view stands in stark contrast to critics – including some at the highest levels of government – ​​who view enriching the food supply as a form of government overreach.

Late last year, Health Secretary Robert F. Kennedy Jr. criticized California’s new law in an article on X: “This is madness. California is waging a war on its children, targeting the poor and communities of color,” he wrote.

A Kennedy spokesperson declined to explain the comments.

Social media is full of people claiming that folic acid fortification is “toxic” or that people with a certain genetic variation known as MTHFR cannot process the vitamin properly.

None of these claims are accurate, according to advocates and medical experts.

“What is truly insane is that our nation’s top health official is spreading false claims and urging people to avoid a nutrient that is proven to prevent birth defects and save babies’ lives,” said Eva Greenthal, CSPI senior policy scientist.

At fortification doses, folic acid has never been shown to “harm individuals or populations,” said Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who works to prevent neural tube defects in the United States and around the world.

The US Centers for Disease Control and Prevention emphasizes that “people with the MTHFR gene variant can process all types of folate, including folic acid.”

Even Kennedy’s new federal dietary guidelines support fortification. Documents supporting these guidelines advise pregnant women to eat foods rich in folate, such as leafy green vegetables, beans, and lentils. But they also recognize that folic acid from fortified foods or supplements is “essential” before conception and early in pregnancy to prevent neural tube defects.

“Enriching masa corn flour with folic acid may help prevent” neural tube defects, the CDC website adds.

Neural tube defects, which affect about 2,000 babies each year in the United States, occur in the first weeks after conception, when the tube that forms the spine and brain does not develop properly.

This is often before many women realize they are pregnant. In the United States, more than 40% of pregnancies are unintended. In these cases, many women have not prepared for pregnancy, noted Dr. Kimberly BeDell, medical director of a rehabilitation clinic that helps children with spina bifida at Miller Children’s Hospital in Long Beach, California.

“Even women’s best efforts to immediately go to an obstetrician and start taking prenatal vitamins, it’s simply too late,” BeDell said.

Adding folic acid to masa corn, in the same way it is added to other grains, is one way to ensure the nutrient reaches the broader population that needs it, she added.

At 28 years old, pregnant with her first child, Andrea Lopez did not know the importance of folic acid or that this vitamin could be lacking in her diet.

Then an ultrasound mid-pregnancy showed that her baby had anencephaly, a life-threatening condition in which the skull doesn’t develop properly.

Lopez carried her pregnancy to term and Gabriel lived 10 days. The pain of his loss never goes away, she said, adding that Gabriel would have been a freshman in high school this year. She supports California’s law requiring folic acid fortification of masa corn and finds it “staggering” that the action took so long to be implemented.

“Believe me, you don’t want to go through this,” she said. “He’s the love of my life. I have two little girls who survived, but he’s my firstborn. He’s my only son.”

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