For years, California health officials have been frustrated by the disproportionately high rates of birth defects among Latino children. Tortillas, they say, may help.
On Jan. 1, the state became the first to require that corn masa, the flour used to make tortillas, contain folic acid, a key vitamin that decades of research has found reduce certain birth defects, including spina bifida.
The law is a “powerful act of prevention and care that honors our traditions while protecting our babies before a pregnancy even begins,” California Surgeon General Diana Ramos, the first Latina to hold the role, said in a statement. “This is one way we can care for Latino communities in California.”
California, where nearly half of babies born are Hispanic, according to the March of Dimes, has one of the country’s largest Latino populations.
The new requirement is part of national effort to add folic acid, already required in other types of flour, to corn masa. Alabama’s version of the law takes effect in June, and lawmakers in Florida, Georgiaand Oklahomaare considering similar legislation.
While public health officials have lauded these efforts, some conservatives say folic acid fortification is another form of government overreach and potentially dangerous, despite the lack of scientific evidence to support their claim. Health Secretary Robert F. Kennedy Jr. has called these efforts “insanity” and said “California is waging war against her children — targeting the poor and communities of color.” Make America Healthy Againinfluencers have claimed that folic acid is a “toxin,” which health experts say has no basis in science.
When asked about Kennedy’s opposition to the law, Health and Human Services Spokesman Andrew Nixon pointed to the department’s new dietary guidelines, which prioritize eating folate-rich foods, including dark leafy greens and beans, as a way to increase a person’s folic acid intake.
But the Centers for Disease Control and Prevention’s website also encourages Latina women to take folic acid supplements. “For Hispanic women, taking 400 mcg of folic acid each day is especially important to reduce the risk of some serious birth defects,” says a flier created by the CDC to spread awareness about the vitamin.
The Public Health Service, a division of the Department of Health and Human Services, has mandated folic acid in enriched grain products since 1998. But that didn’t include corn masa.
Since the start of those efforts, the rates of neural tube birth defects for White women and other groups dropped 40 percent, but remained high for Latinas, studies have found.
Hispanic women have the highest rate of children born with spina bifida, 3.8 per 10,000 live births, compared with non-Hispanic White women, at 3.09 per 10,000 live births, according to the CDC.
“A lot of the cultural food patterns of Hispanic populations tend to be more focused on using corn as their grain source,” said Jamie Stang, a professor in public health nutrition at the University of Minnesota. “As a result of that, they don’t receive the same benefits from fortification.”
Manufacturers add folic acid supplements to about 10 percent of corn masa products, which are used in common staples of Hispanic pantries like tamales and tortillas, according to a 2018 study by Emory University.
The supplement is also found in prenatal vitamins, but many people don’t begin taking them until after learning they’re pregnant, said Stang. That may not give their bodies sufficient time to absorb enough to prevent a neural tube birth defect, she said.
Public health officials have long advocated for folic acid fortification in tortillas but met pushback from manufacturers concerned about the cost. However, Jim Kabbani, chief executive of the Tortilla Industry Association, said that the industry’s attitude toward adding folic acid supplements to their products has changed in recent years as more information became available about the potential health benefits.
“Anything that’s good for moms and babies has to be a good thing,” Kabbani said.
Sana Jaffery, legislative director for California Assemblymember Joaquin Arambula, who introduced the bill, said it costs manufacturers about 4 cents to add the supplement to one ton of corn masa flour. “That’s how cheap folic acid is,” Jaffery said.
The California law does not apply to snack foods or foods prepared in home kitchens that make less than $75,000 in gross annual sales.
The law is likely to be replicated across the country, Jaffery said. “We’ve seen a shift, nationally,” he said. “Where California goes, the rest of the nation follows.”
In Alabama, which passed its own version of the law requiring corn masa products have specific amounts of folic acid last year, research from physicians at the University of Alabama at Birmingham helped persuade state Rep. Danny Crawford to sponsor the bill along with 9 other Republicans.
Crawford said he’s only heard “good things” about its passage and the research supporting its benefits, which include preventing 30 to 120 cases of spina bifida annually in the Hispanic community in Alabama.
“This is not a partisan issue in any way, it’s a public health issue,” said Edward Bray, senior director of state affairs at March of Dimes.
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