California now requires corn tortillas and other foods made from corn masa flour to contain folic acid, aiming to close a long-running gap in U.S. food fortification and to reduce neural tube defects that occur very early in pregnancy.
The requirement took effect after California became the first state to order food makers to add folic acid to corn masa flour used to make tortillas and other traditional foods. Supporters say the change is intended to address disproportionately high rates of serious neural tube conditions among Hispanic families. Andrea Lopez, who lost her first baby to a rare neural tube defect, said the law could spare other families “this heartache” and called it “such a small effort for such a tremendous impact.”
Lopez lives in Bakersfield and said her son, Gabriel Cude, died at 10 days old after the condition known as anencephaly. She now works as a lawyer and has two young daughters. She described how early pregnancy can be “just too late” to rely only on vitamins started after pregnancy is recognized, arguing that broader fortification helps nutrients reach people who may not yet know they are pregnant.
The state’s policy builds on decades of research and earlier national fortification rules that covered enriched wheat and white breads, cereals, and pastas. Those rules, according to the AP report, were viewed as a major public health achievement, cutting rates of defects such as spina bifida and anencephaly by about 30% after a 1998 federal requirement. But corn masa flour was not included in that original mandate, and advocates have said rates in Latino communities remained “stubbornly high.”
California lawmakers said the measure reflects both the science of folic acid and the role that state buying power can play in accelerating adoption nationwide. Assemblymember Joaquin Arambula, who sponsored the legislation passed in 2024, said “You have to be the first oftentimes to get the ball rolling,” adding, “So, I’m glad other states have taken up that mantle.” The Food Fortification Initiative, an advocacy group focused on micronutrient deficiencies, said Alabama’s similar law takes effect in June and that legislation is pending or being considered in Florida, Georgia, Oklahoma and Oregon. It also said Texas, Delaware, New Jersey and Pennsylvania have expressed “active interest” in the issue.
Companies involved in corn masa production have also moved in recent years. Gruma Corp., the parent company of Mission Foods and Azteca Milling, began fortifying some products in 2016; the report said that by this year 97% of the company’s retail sales in the U.S. include folic acid, with the remainder expected to be fortified before July. Mission Foods, which started fortification in 2024, said it now adds folic acid to all of its branded and private label corn tortillas in the U.S. The Center for Science in the Public Interest’s policy scientists and other supporters have pointed to such actions by major producers as paving the way for smaller manufacturers.
Public health experts and advocates said the fortification approach works. Vijaya Kancherla, an Emory University epidemiology professor and director of the Center for Spina Bifida Prevention, said, “The science is clear: Folic acid fortification works,” describing it as “safe,” “proven,” and “cost-effective.” The Center for Science in the Public Interest also said critics’ claims are inaccurate, including claims circulating online that folic acid is “toxic” or that the MTHFR gene variant prevents people from properly processing the vitamin.
The report also described pushback from the federal government and social media. Late last year, Health Secretary Robert F. Kennedy Jr. criticized the California law in a post on X, writing, “This is insanity. California is waging war against her children — targeting the poor and communities of color,” and his spokesman declined to explain the comments. Eva Greenthal, CSPI’s senior policy scientist, said, “What’s truly insane is that our nation’s top health official is spreading false claims and frightening people into avoiding a nutrient that’s proven to prevent birth defects and save babies’ lives.” Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham, said folic acid at fortification doses “has never been shown to harm individuals or populations,” and the U.S. Centers for Disease Control and Prevention said people with the MTHFR gene variant can process all types of folate, including folic acid.
Backers of fortification point out that neural tube defects develop in the first weeks after conception, often before many women realize they are pregnant. The report said about 2,000 babies are affected each year in the U.S. and that more than 40% of pregnancies are unintended. Dr. Kimberly BeDell, medical director at a rehabilitation clinic that helps children with spina bifida at Miller Children’s Hospital in Long Beach, said, “Even women’s best efforts in going to an OB right away and starting prenatal vitamins, it’s just too late,” and added that fortification is one way to ensure folic acid reaches people who may need it most.
In her advocacy following Gabriel Cude’s death, Lopez said she supports California’s requirement and described her experience as lasting. “Trust me, you don’t want to go through this,” she said, describing him as “the love of my life” and the only son among her children.