A new California law has been proposed, and it’s all about tortillas.
This law is proposed as a way to close the gap in folic acid consumption between Hispanic women and non-Hispanic women in the United States, since most of the most common grains eaten in the U.S. are already fortified with folic acid.
As a Latina dietitian who encourages corn tortillas as a healthy choice for my clients, I support this bill. Here’s why.
Takeaway: Folic acid fortification in common grain foods has helped decrease neural tube defects by almost 30% in the United States. But Latina women haven’t seen these benefits since corn tortillas typically aren’t fortified with folic acid. A new California law is proposing mandatory fortification of corn tortillas and corn masa to help close the gap.
Grain Fortification in the United States
Fortifying common food products has been a part of U.S. public health efforts since the 1920’s, when iodized salt first took off (1).
While grain fortification isn’t required, a large portion of grain products in the United States are enriched with added B vitamins and iron.
The most common fortified grains are breakfast cereals made from wheat, corn, and rice. Besides that, other common fortified grains are wheat flour, corn meal, and rice (2).
Traditional heritage grains like corn masa, amaranth, and quinoa are typically not fortified.
It was in the 1990’s that the U.S. began to require manufacturers to add folic acid to their enriched grain products. (Note that this doesn’t mean all grain products have added folic acid, just that enriched grain products must also be enriched with folic acid.)
This initiative began as a way to prevent neural tube defects in newborn babies, since folic acid helps form DNA (3).
One of the reasons why fortifying grain products with folic acid is so important and effective, is that folic acid is most important in the first few weeks of pregnancy because of its role in DNA formation.
This means folic acid is most needed at a time when some women may not even realize they’re pregnant or think to take a prenatal vitamin. Fortifying commonly eaten foods can help close this gap.
Since requiring the addition of folic acid to enriched grain products, neural tube defects have decreased by almost 30% (4). This is a major public health success story!
Are Corn Tortillas Already Fortified?
But these benefits may not be affecting everyone equally, based on which grains are required to be fortified with folic acid.
Most corn tortillas and masa harina are not already fortified with folic acid or other vitamins and minerals.
In 2016, the FDA approved the possible addition of folic acid to masa harina. This approval came after 4 years of petitioning by the American Academy of Pediatrics, March of Dimes, and more.
This means before 2016 there wasn’t even the possibility that corn tortillas could be fortified with folic acid.
The FDA approving the ability to add folic acid to corn tortillas was a major win!
But at the same time, tortilla producers have largely failed to implement folic acid fortification.
A study from 2023 showed no significant decline in neural tube defects in the Latino population since the approval passed.
This is a stark difference from how effective fortifying wheat and rice products was at reducing neural tube defects among the general population.
The most likely reason is that not enough tortilla producers have voluntarily started adding folic acid to their products to make a significant difference at the population level.
Several studies have looked at the availability of fortified corn tortillas and corn masa in local grocery stores. They have found that the vast majority of corn tortillas and corn masa on grocery shelves are not fortified with folic acid (5, 6).
Latinas Don’t Get Enough Folic Acid
Knowing what we know about the failure of tortilla producers to add folic acid to corn masa, it’s not surprising to hear that Latinas have not seen the same decrease in neural tube defects as the general population.
In addition to the gap in fortified foods, Latinas are also less likely to take a prenatal vitamin.
As a result, Hispanic women are more likely to experience neural tube defects in pregnancy than non-Hispanic White and non-Hispanic Black women, according to the CDC.
What This New Law Could Mean for Latinas
While folate is naturally found in leafy green foods, most people struggle to meet their daily folate requirements. This is even more difficult for women who are pregnant or trying to conceive.
For the general population, folic acid supplementation has had a tremendous effect in decreasing neural tube defects. But Latinas have not seen this same benefit.
Requiring the fortification of a cultural staple like tortillas could go a very long way in reducing health disparities for the Latino community.
As a Latina dietitian who has dedicated her career to centering and celebrating Latino heritage foods, I also think this law and the publicity around it can go a long way to helping the healthcare system realize that Latino foods are a valuable and nutritious resource.
I’ve seen so many Latino clients of mine report that they were told to stop eating corn tortillas in favor of substitutes like whole wheat tortillas or even grain-free tortillas.
Hopefully this change will help drive conversations around the nutrition value of corn tortillas and help practitioners and Latinos embrace corn tortillas (and corn masa) in their nutrition goals.
This is huge! I knew about the voluntary fortification of corn masa, but didn’t realize it was not mandatory, or that we weren’t seeing great implementation. I’m hopeful that the CA bill will push national fortification of corn masa and tortillas forward.