Fifteen years after losing her first baby to a rare and devastating birth defect, Andrea Lopez is relieved to know that other Latinx mothers may finally be able to avoid the same suffering.
In January, California became the first state to require food manufacturers to add folic acid, an important vitamin, to corn masa flour used to make tortillas and other traditional foods that are widely used in the region.
It’s a long-delayed measure aimed at reducing the disproportionately high rates of a serious disease among Hispanic infants, called neural tube defects, which caused López’s son, Gabriel Cudo, to die when he was 10 days old.
“It’s a really small effort to make such a big impact,” said Lopez, 44, a Bakersfield resident and now a lawyer with two young daughters. “There are few things I wouldn’t do to spare someone this kind of heartache.”
A similar law took effect in Alabama in June, and bills are pending or being considered in Florida, Georgia, Oklahoma and Oregon. Four other states have expressed “active interest” in the issue: Texas, Delaware, New Jersey and Pennsylvania, according to the Food Fortification Initiative, an advocacy group focused on addressing micronutrient deficiencies.
“Every woman and child in America should be able to take folic acid and have a healthy baby,” said Scott Montgomery, the organization’s director.
Corn masa was exempted from state mandates.
For nearly 30 years, the United States has required folic acid, an important B vitamin, to be added to fortified wheat, white bread, cereals, and pasta.
Decades of research show that the 1998 requirements reduced rates of serious defects such as spina bifida and anencephaly by about 30 percent, preventing about 1,300 cases annually. This is considered one of the greatest public health victories of the 20th century.
However, corn masa flour, a staple food in the Latin diet, is excluded from the original fortification requirements, and the incidence of diseases such as spina bifida and anencephaly in this community remains high.
In 2016, federal regulators allowed folic acid to be added to corn masa products, but it was not required. One review found that by 2023, only one in seven corn masa flour products will contain folic acid, and corn tortillas do not contain folic acid.
Hispanic mothers have higher rates of birth defects
Nationally, Hispanic women have the highest rates of these defects during pregnancy. In California, the rate of Hispanic mothers is twice that of white or black women, according to state data.
State Rep. Joaquin Arambula, the sponsor of the 2024 bill, said California’s new law and the state’s vast purchasing power could help expand coverage across the country.
“You always have to be first to get the ball rolling,” he said. “So I’m glad other states are taking over that role.”
California’s actions and pressure from advocates are already spurring change.
Gurma Corporation, the parent company of Mission Foods and Aztec Milling, has been involved in fortification issues for nearly 20 years. In 2016, Azteca began selling some (but not all) varieties of Maseca, the company’s largest corn masa flour brand, with folic acid.
As of this year, 97% of the company’s retail sales in the U.S. contain folic acid. The remaining portions will be strengthened by July, Gruma said in a statement.
Mission Foods began fortifying folic acid in 2024 and now adds folic acid to all branded and private label corn tortillas in the United States.
Such actions by large producers are helping 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 advocates for enforcement.
Jim Cavani, president of the Tortilla Industry Association, said the industry was initially concerned that folic acid would affect flavor and the cost of label changes. But he now expects tortilla makers to start selling fortified products on a larger scale.
“Overall, trains are leaving stations and will be heading to more and more states,” he said.
Public health experts welcome the growing momentum.
“The science is clear: Fortifying with folic acid does work,” said Vijaya Kanchera, professor of epidemiology at Emory University and director of the Spina Bifida Prevention Center. “It’s safe. It’s proven. And it’s cost-effective.”
RFK Jr. calls corn masa strengthening “insanity”
This view stands in sharp contrast to critics, including some at the highest levels of government, who see the tightening of food supplies as a form of government overreach.
Late last year, Secretary of Health Robert F. Kennedy Jr. criticized California’s new law in a post on
A spokeswoman for President Kennedy declined to explain the comments.
Social media feeds are filled with people claiming that folic acid fortification is “toxic” or that people with a certain genetic mutation known as MTHFR cannot process the vitamin properly.
None of these claims are accurate, according to advocates and medical experts.
“What’s truly insane is that our nation’s top health officials are spreading false claims and scaring people into avoiding nutrients that are proven to prevent birth defects and save babies’ lives,” said Eva Greenthal, senior policy scientist at CSPI.
Dr. Jeffrey Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who works to prevent neural tube defects in the United States and internationally, said that fortified doses of folic acid “have never been shown to harm individuals or populations.”
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The Centers for Disease Control and Prevention emphasizes that “people with the MTHFR gene mutation are able to process all types of folic acid, including folic acid.”
President Kennedy’s new federal dietary guidelines also support fortification. Documents supporting the guidelines advise pregnant women to eat foods rich in folic acid, such as leafy green vegetables, beans and lentils. But they also acknowledge that folic acid from fortified foods and supplements before and during early pregnancy is “important” to prevent neural tube defects.
The CDC’s website adds, “Fortifying corn masa flour with folic acid may help prevent neural tube defects.”
Without reinforcement, “it’s already too late”
Neural tube defects, which affect about 2,000 babies in the United States each year, occur during the first few weeks after pregnancy when the tubes that form the spine and brain do not develop properly.
It often occurs before many women even know they are pregnant. More than 40% of pregnancies in the United States are unwanted. In such cases, many women would not be preparing for pregnancy, says Dr. Kimberly Bedell, medical director of the rehabilitation clinic that helps children with spina bifida at Miller Children’s Hospital in Long Beach, California.
“Despite a woman’s best efforts to immediately go to her gynecologist and start prenatal vitamins, it’s too late,” Bedell says.
Adding folic acid to corn masa, like adding folic acid to other grains, is a way to ensure the nutrient reaches more people who need it, she added.
Andrea Lopez, 28 and pregnant with her first child, didn’t know about the importance of folic acid or that she might be lacking it in her diet.
Later, an ultrasound during the third trimester revealed that the baby had anencephaly, a fatal condition in which the skull does not develop properly.
Lopez carried the pregnancy to term, and Gabriel lived for 10 days. The loss will never go 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 corn masa, and finds it “daunting” that it took so long to implement.
“Trust me, you don’t want to go through this,” she said. “He is the love of my life. I have two surviving little girls, but he is my firstborn. He is my only son.”
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