Fifteen years after losing her first child to a rare and devastating birth defect, Andrea Lopez takes comfort in knowing that other Latina mothers can finally avoid the same pain.
In January, California became the first state to require food manufacturers to add folic acid, an important vitamin, to the corn masa flour used to make tortillas and other traditional foods widely used in its community.
It’s a long-delayed move aimed at reducing the disproportionately high rates of a serious condition called neural tube defects in Hispanic infants, which Lopez’s son, Gabriel Cuad, claimed to have when he was 10 days old.
“It’s a small effort to have such a tremendous impact,” said Lopez, 44, who lives in Bakersfield and is now an attorney with two young daughters. “There’s very little I wouldn’t do to save someone from this heartache.”
A similar law takes effect in Alabama in June, and legislation is pending or being considered in Florida, Georgia, Oklahoma and Oregon. Four more states – Texas, Delaware, New Jersey and Pennsylvania – have expressed “active interest” in the issue, according to the Food Fortification Initiative, an advocacy group focused on addressing micronutrient deficiencies.
“All women and children in the United States should have access to folic acid and have healthy babies,” said Scott Montgomery, the group’s director.
For nearly 30 years, the addition of folic acid, a key B vitamin, to enriched wheat and white breads, cereals and pasta in the US has been required.
Decades of research show rates of serious defects such as spina bifida and anencephaly were cut in 1998. up to about 30%Preventing approximately 1,300 cases per year. It is considered one of the top public health triumphs of the 20th century.
But corn masa flour, a staple used in the Latino diet, was left out of the original fortification requirement — and rates of conditions like spina bifida and anencephaly remain very high in that community.
In 2016, federal regulators allowed, but did not require, the addition of folic acid to corn masa products. By 2023, only about 1 in 7 corn masa flour products and no corn tortillas contained folic acid, found a review.
Nationwide, Hispanic women have the highest rates of these defects during pregnancy. In California, the rate of Hispanic mothers is twice as high As far as white or black women are concerned, the state data shows.
California’s new law — and the state’s vast purchasing power — could help drive its adoption nationwide, said state Assemblyman Joaquin Arambula, who is sponsoring legislation passed in 2024.
“You have to be the first one to turn the ball over a lot of times,” he said. “So, I am happy that other states have also taken up this responsibility.”
California’s action and pressure from advocates have already prompted changes.
Gruma Corp., parent company of Mission Foods and Azteca Milling, has been involved in the fortification issue for nearly two decades. Azteca began selling some — but not all — varieties of its largest brand of corn masa flour, Maseca, with folic acid in 2016.
As of this year, 97% of the company’s retail sales in the US include folic acid. The rest are expected to be strengthened before July, Gruma said in a statement.
Mission Foods to launch fortification in 2024. It now adds folic acid to all of its branded and private label corn tortillas in the US.
According to one, such actions taken by large producers have helped pave the way for smaller manufacturers to do the same recent reports by the Center for Science in the Public Interest, a consumer advocacy group that has pushed for strengthening.
Initially, the industry was concerned that folic acid could affect taste and the cost of changing labels, said Jim Cabbani, head of the Tortilla Industry Association. But now he hopes tortilla makers will start selling fortified products on a wider scale.
“I think overall the train has left the station and it will be in more and more states,” he said.
Public health experts applaud the growing momentum.
“The science is clear: Folic acid fortification works,” said Vijaya Kancherla, MD, an epidemiology professor at Emory University and director of the Spina Bifida Prevention Center. “It’s safe. It’s proven. And it’s cost-effective.”
This view is in sharp contrast to critics – including some at the highest levels of government – who regard fortification of the food supply as a form of government overreach.
Late last year, Health Secretary Robert F. Kennedy Jr. criticized California’s new law a post on x: “This is madness. California is waging a war against its own children – targeting the poor and communities of color,” he wrote.
A spokesman for 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 gene variation called MTHFR can’t process the vitamin properly.
According to advocates and medical experts, none of these claims are accurate.
“What’s really crazy is that our nation’s top health officials are spreading false claims and scaring people into avoiding a nutrient that’s proven to prevent birth defects and save babies’ lives,” said CSPI senior policy scientist Eva Greenthal.
Dr. Jeffrey Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who works to prevent neural tube defects in the U.S. and globally, said that at fortification doses, folic acid “has never been shown to harm individuals or populations.”
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 the guidelines recommend pregnant women eat folate-rich foods such as leafy green vegetables, beans, and lentils. But they also acknowledge that folic acid obtained from fortified foods or supplements is “important” for preventing neural tube defects before conception and during early pregnancy.
“Folic acid fortification of corn masa flour may help prevent neural tube defects,” the CDC website says.
Neural tube defects, which affect about 2,000 babies each year in the U.S., occur in the first weeks after conception, when the tube that makes up the spine and brain doesn’t develop properly.
This often happens when many women realize they are pregnant. More than 40% of pregnancies in the US are unintended. In those cases, many women may not be preparing for pregnancy, said Dr. Kimberly Bedell, medical director of the rehabilitation clinic that helps children with spina bifida at Miller Children’s Hospital in Long Beach, California.
“Even with women’s best efforts to go to an OB immediately and start prenatal vitamins, it’s often too late,” Bedell said.
Adding folic acid to corn masa, the same way it is added to other grains, is one way to ensure the nutrient reaches the broader population that needs it, she said.
At age 28, pregnant with her first child, Andrea Lopez didn’t know about the importance of folic acid or that missing the vitamin from her diet could cause harm.
Then, an ultrasound midway through her pregnancy revealed her baby had anencephaly, a fatal condition in which the skull fails to develop properly.
Lopez carried the pregnancy to term and Gabriel survived by 10 days. The pain of his loss would never go away, she said, had Gabriel been a high school freshman this year. She supports the California law requiring folic acid fortification of corn masa and finds it “mind boggling” that it took so long to implement the action.
“Trust me, you don’t want to go through this,” she said. “He is the love of my life. I have two little girls who are alive, but he is my first born. He is my only son.”
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. AP is solely responsible for all content.
