Back in January, California became the first state to pass legislation requiring manufacturers of corn masa flour to add folic acid to their formulations, as reported by CNN, in a move to reduce the risk of neural tube defects (NTD) among Hispanic infants, which remains disproportionately high.
Similar legislation will take effect in Alabama this June, and several laws are either pending or still being solidified in Florida, Georgia, Oregon, and Oklahoma.
In addition, four other states have expressed “active interest” in passing legislation in the near future to resolve the issue, including Texas, Delaware, New Jersey, and Pennsylvania, according to the Food Fortification Initiative, an advocacy group that works to address micronutrient deficiencies.
A national mandate was passed in 1988 requiring that folic acid, a key B vitamin, be added to all enriched wheat and white breads, cereals, and pastas.
Decades of research have revealed the measure has reduced rates of serious birth defects like spina bifida and anencephaly by about 30%, or about 1,300 cases annually.
This is why it’s now viewed as one of the biggest public health wins in the 20th century among experts.
“Fortification and enrichment of refined grains have made significant, long-lasting contributions to improve the health of Americans. The fortification of folic acid in certain grain foods has contributed to the significant reduction of neural tube defects,” said Stephanie Hodges, a public health dietitian who works in food policy.
However, corn masa flour, a staple of Latin-American cuisine, was excluded from the initial list, which is why rates of these birth defects have remained persistently high within this demographic.
“Hispanic mothers continue to be at the highest risk for having a baby with an NTD. Only 13% of Hispanic women consume folic acid, compared to 31% of non-Hispanic white women,” Hodges told FI.
So, why was corn masa flour left out of the original mandate?
Corn Masa Flour: A Forgotten Staple
Emma Zheng, a certified nutritionist and the co-founder of SummitBreezeTea.com, believes that the exclusion of corn masa flour from the 1988 mandate primarily revolved around manufacturing constraints.
“Back in the days when the addition of folic acid was first required by law, the focus was on products like wheat bread and cereals, since they could be produced by large manufacturing enterprises with strict quality standards,” Zheng told FI.
“However, tortillas are homemade goods prepared in numerous small kitchens and bakeries and consumed in multiple ways. At the time, it seemed impossible to introduce the mandatory presence of the vitamin in all tortillas.”
Kezia Joy, a registered dietitian nutritionist and medical advisor at Welzo, added that incorporating folic acid into all parts of corn products was historically challenging from a technical perspective; however, advances in food manufacturing processes and regulatory approaches have addressed these challenges.
Joy also pointed out that early fortification policies primarily revolved around the staple foods that were eaten by most Americans back then, such as wheat-based products like cereals and breads.
“There was little information available regarding variations in dietary practices among various ethnic groups; therefore, when the evidence began to emerge showing that the exclusion of corn masa resulted in some segments of the U.S. population having lower levels of folate exposure than others, this was an unintended consequence,” Joy told FI.
Despite its many benefits, not everyone is on board with corn masa fortification, which is another reason that a mandate has been delayed.
Opposition to Corn Masa Fortification
“This is insanity. California is waging war against her children – targeting the poor and communities of color,” Health Secretary Robert F. Kennedy Jr. posted on X following the passage of California’s new law.
Other members of the Make America Healthy Again (MAHA) movement have contended that folic acid fortification is “toxic” and that the vitamin cannot be processed properly by folks with a gene variation dubbed MTHFR; however, an overwhelming majority of medical experts disagree with these claims.
Even the CDC has emphasized that “people with the MTHFR gene variant can process all types of folate, including folic acid,” and Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham, told CNN that folic acid “has never been shown to harm individuals or populations” at fortification doses.
“The regulatory agencies that have established these guidelines have done so to ensure the maximum amount of benefit possible from each vitamin while minimizing the risk of adverse effects associated with excessive consumption,” Joy told FI.
However, pregnant individuals who remain wary of fortification can get their folic acid from other sources.
Natural Sources of Folic Acid
Zheng recommends for pregnant individuals to up their intake of folate-rich products like dark leafy greens, black beans, oranges, and avocados, as well as taking prenatal vitamins.
“Such small but important steps have the power to impact one’s pregnancy as positively as drinking morning coffee helps to set its tone,” the nutritionist told FI.
Joy agreed with these recommendations and also emphasized the importance of an adequate folate intake among individuals who may eventually become pregnant as well, as neural tubes are developed in the early weeks of a pregnancy.
The Food Institute Podcast
This episode features Julie Chapon, CEO and co-founder of Yuka, the fast-growing app that helps consumers better understand the health impact of food and cosmetic products. Chapon shares the origin story of Yuka, which began as a personal mission to decode confusing food labels and has since expanded into a global platform with over 80 million users.
