Fifteen years after losing her first child to a rare and devastating birth defect, Andrea Lopez finds solace in the hope that other Latina mothers may be spared from experiencing similar heartbreak.
In January, California became the first state to mandate the addition of folic acid — a vital nutrient — to corn masa flour, the key ingredient for tortillas and other traditional foods prevalent in her community.
This much-needed action addresses the alarmingly high incidence of neural tube defects among Hispanic infants, which claimed Lopez’s son, Gabriel Cude, when he was just ten days old.
“It’s a minor effort that can lead to a monumental impact,” said Lopez, now 44, living in Bakersfield as a lawyer and mother to two young daughters. “I would do anything to prevent anyone from going through this heartache.”
Similar legislation is set to take effect in Alabama in June, while proposals are underway in states like Florida, Georgia, Oklahoma, and Oregon. Additionally, Texas, Delaware, New Jersey, and Pennsylvania have shown interest in this vital issue, as indicated by the Food Fortification Initiative, an advocacy group dedicated to eradicating micronutrient deficiencies.
“Every woman and child in the United States deserves access to folic acid to ensure the birth of healthy babies,” stated Scott Montgomery, the initiative’s director.
Corn masa was left out of nationwide regulations
For nearly three decades, the addition of folic acid — a crucial B vitamin — has been mandated in enriched wheat and white breads, cereals, and pastas in the U.S.
Research spanning decades reveals that this regulation, established in 1998, reduced the incidence of severe defects like spina bifida and anencephaly by approximately 30%, effectively preventing around 1,300 cases per year. This initiative is widely regarded as one of the foremost public health successes of the 20th century.
However, corn masa flour, a staple in Latino diets, was notably excluded from the original fortification mandate, contributing to persistently high rates of conditions such as spina bifida and anencephaly in this community.
In 2016, federal regulators permitted folic acid to be added to corn masa products but did not impose this as a requirement. As of 2023, only about 14% of corn masa flour products included folic acid, and no corn tortillas had the nutrient, according to a recent review.
Nationwide, Hispanic women experience the highest rates of neural tube defects during pregnancy. In California specifically, the incidence among Hispanic mothers is reported to be twice as high as that among white or Black women, according to state data.
California’s new law — coupled with the state’s significant purchasing power — is expected to promote broader adoption of this initiative across the country, as noted by state Assemblymember Joaquin Arambula, who sponsored the legislation passed in 2024.
“Being first often means you have to lead the way,” he remarked. “I am pleased to see other states picking up this crucial cause.”
California’s proactive approach, along with pressure from advocates, has already fostered change.
Gruma Corp., which encompasses Mission Foods and Azteca Milling, has long been engaged in the issue of fortification. Azteca began introducing folic acid into some, but not all, varieties of its Maseca corn masa flour in 2016.
By this year, 97% of the company’s retail products in the U.S. included folic acid, with the remaining products expected to be fortified by July, as stated by Gruma.
Mission Foods began its fortification process in 2024, adding folic acid to all its branded and private label corn tortillas sold in the U.S.
These initiatives by major producers have paved the way for smaller manufacturers to implement similar practices, according to a recent report by the Center for Science in the Public Interest, a consumer advocacy organization committed to fortification.
Initially, concerns within the industry revolved around the potential impact of folic acid on flavor and the expenses associated with relabeling, as explained by Jim Kabbani, head of the Tortilla Industry Association. However, he now foresees tortilla manufacturers broadening their offerings of fortified products.
“I believe the momentum is building, and more states will follow suit,” he asserted.
Public health experts laud this growing momentum.
“The evidence is unequivocal: folic acid fortification works,” stated Vijaya Kancherla, a professor of epidemiology at Emory University and director of the Center for Spina Bifida Prevention. “It is safe, effective, and cost-efficient.”
This perspective starkly contrasts with critiques from some high-ranking government officials, who view the fortification of the food supply as governmental overreach.
Late last year, Health Secretary Robert F. Kennedy Jr. condemned California’s new legislation in a social media post, describing it as “insanity” and claiming it targets impoverished communities and people of color.
A spokesperson for Kennedy declined to elaborate on those comments.
Social media platforms abound with assertions claiming that folic acid fortification is “toxic” or that individuals with a genetic mutation known as MTHFR cannot correctly metabolize the vitamin.
Such claims have been debunked by advocates and medical professionals alike.
“What’s truly outrageous is that our country’s leading health official is perpetuating falsehoods and frightening people away from a nutrient proven to prevent birth defects and save lives,” said Eva Greenthal, a senior policy scientist with CSPI.
At the levels found in fortification, folic acid “has never been shown to be harmful to individuals or populations,” stated Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham, who is dedicated to combating neural tube defects both domestically and internationally.
The Centers for Disease Control and Prevention affirm that “people with the MTHFR gene variant can metabolize all forms of folate, including folic acid.”
Even Kennedy’s recent federal dietary guidelines endorse fortification. The documents supporting these guidelines suggest that pregnant women consume foods rich in folate, such as leafy greens, beans, and lentils. They also emphasize the importance of obtaining folic acid from fortified foods or supplements before conception and during early pregnancy to prevent neural tube defects.
“Folic acid fortification of corn masa flour could help in the prevention of neural tube defects,” the CDC adds.
Neural tube defects, affecting approximately 2,000 infants in the U.S. annually, arise during the initial weeks post-conception when the spinal cord and brain development is impaired.
This often occurs before many women even realize they are pregnant. Notably, over 40% of pregnancies in the U.S. are unintended, meaning many women may not have taken necessary precautions, as highlighted by Dr. Kimberly BeDell, the medical director of a rehabilitation clinic for children with spina bifida at Miller Children’s Hospital in Long Beach, California.
“Even with the best intentions, by promptly visiting an OB and beginning prenatal vitamins, it may be too late,” BeDell commented.
Fortifying corn masa with folic acid, similar to the practice for other grains, can ensure that this essential nutrient reaches a broader segment of the population that needs it, she added.
At 28, while pregnant with her first child, Andrea Lopez was unaware of the significance of folic acid or that it might be inadequate in her diet.
Unfortunately, an ultrasound halfway through her pregnancy revealed that her baby had anencephaly, a severe condition where the skull does not develop correctly.
Lopez carried the pregnancy to term, but Gabriel lived only for ten days. The pain of his loss lingers, she reflected, noting that Gabriel would have been a freshman in high school this year. She wholeheartedly supports California’s law mandating folic acid fortification in corn masa, expressing disbelief that it took so long to implement.
“Trust me, you don’t want to go through this,” she urged. “He’s the love of my life. I have two little girls who survived, but he’s my first born and my only son.”
