California Just Required a Vitamin in Tortillas, and the Reason Why Is Heartbreaking

Andrea Lopez was 28 and pregnant with her first child when a mid-pregnancy ultrasound revealed her son had anencephaly, a fatal condition in which the skull does not develop properly. Gabriel Cude lived 10 days. Fifteen years later, California passed a law that Lopez believes could spare other families the same loss by requiring a single vitamin to be added to corn tortillas.

The Vitamin Has Been in Wheat Bread for Nearly 30 Years, Just Not in Tortillas

Since 1998, federal law has required folic acid, a B vitamin, to be added to enriched wheat breads, cereals, and pastas. Decades of research credit that mandate cutting rates of spina bifida and anencephaly by roughly 30%, preventing an estimated 1,300 cases annually, a result widely considered one of the most significant public health achievements of the 20th century. Corn masa flour never made it into that mandate.

Neural Tube Defects Strike Before Many Women Know They’re Pregnant

Neural tube defects affect roughly 2,000 babies in the U.S. each year, forming in the first weeks after conception, when the tube that develops into the spine and brain fails to close correctly. More than 40% of U.S. pregnancies are unintended, meaning many women have no chance to prepare. “Even women’s best efforts in going to an OB right away and starting prenatal vitamins, it’s just too late,” said Dr. Kimberly BeDell, medical director of a spina bifida rehabilitation clinic at Miller Children’s Hospital in Long Beach, California.

Hispanic Women Face the Highest Rates of These Defects in the Country

Corn masa flour is a dietary staple across Latino communities, and its exclusion from federal fortification rules has had measurable consequences. Nationwide, Hispanic women have the highest rates of neural tube defect pregnancies of any group. In California, the rate among Hispanic mothers is twice that of white or Black women, according to state data, a gap that has persisted for decades.

By 2023, Almost No Corn Tortillas on Shelves Contained Folic Acid

Federal regulators permitted folic acid to be added to corn masa products in 2016, but made it optional, not mandatory. The voluntary approach yielded limited results: a review found that by 2023, only about 1 in 7 corn masa flour products contained folic acid, and no corn tortillas did. The gap between what was allowed and what actually reached consumers remained wide for years.

California’s Law Is Already Pushing Major Producers to Act

California’s January mandate, sponsored by state Assemblymember Joaquin Arambula, applies to corn masa flour used in tortillas and other traditional foods. Gruma Corp., parent company of Mission Foods and Azteca Milling, reports that 97% of its U.S. retail sales now include folic acid, with the remainder expected to be fortified before July. Mission Foods began adding folic acid to all its branded and private-label corn tortillas in 2024.

The Industry Was Skeptical at First, but Now More States Are Following

Early resistance from tortilla manufacturers centered on potential flavor changes and the cost of updating labels, according to Jim Kabbani, head of the Tortilla Industry Association. That resistance has largely eased. Alabama’s similar law takes effect in June. Legislation is pending or under consideration in Florida, Georgia, Oklahoma, and Oregon. Texas, Delaware, New Jersey, and Pennsylvania have all expressed active interest, according to the Food Fortification Initiative. “I think overall the train has left the station and it will be more and more states,” Kabbani said.

Health Officials Say the Science Is Settled, but Critics Disagree

Public health experts are largely unified on the question. “The science is clear: Folic acid fortification works. It’s safe. It’s proven. And it’s cost-effective,” said Vijaya Kancherla, an epidemiology professor at Emory University and director of the Center for Spina Bifida Prevention. Health Secretary Robert F. Kennedy Jr. called the California law “insanity” in a post on X late last year, describing it as targeting “the poor and communities of color.”

Medical Experts Push Back on Claims That Folic Acid Is Harmful

Some social media accounts have claimed folic acid is toxic or that people with a gene variant called MTHFR cannot process it properly. Health professionals and advocates say none of those claims hold up. The CDC states that people with the MTHFR variant can process all types of folate, including folic acid. At fortification doses, the vitamin “has never been shown to harm individuals or populations,” said Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham.

Lopez Says Gabriel Would Have Been a High School Freshman This Year

Lopez, now 44 and a lawyer in Bakersfield with two daughters, still carries the weight of Gabriel’s 10 days. She finds it “mind-boggling” that California’s law took this long. “It’s such a small effort for such a tremendous impact,” she said. “There is very little that I wouldn’t do to spare anybody this heartache.” For her, the law isn’t just a policy achievement. It’s also personal.