Corn masa fortified with folic acid would save Latine lives

Folic acid is a vital vitamin the body uses to create new cells, such as brain, blood, skin, nails, and hair cells. It also plays a significant role in preventing severe congenital disabilities. That’s why access to foods fortified with folic acid can promote better health outcomes and prevent health inequalities. Today, products made with enriched wheat flour are always fortified, but products made with corn are not. Fortifying corn tortillas and other corn masa products could help narrow certain health inequalities facing Latine communities. Learn more about folic acid fortification of corn masa products, why it’s taking so long to implement, and why it’s so essential manufacturers adopt the policy.

Folic acid is a form of folate, vitamin B-9, that helps your body make new cells, from blood and brain cells to skin and hair cells. Every new cell needs folate to develop. 

Folate is especially important for a developing fetus. The CDC offers a folic acid toolkit, which includes graphics, videos, and sample messages, to help those who might become pregnant and to raise awareness about folic acid's benefits. The National Birth Defects Prevention Network offers Folic Acid Awareness Week activities and listening sessions to spread folic acid awareness and celebrate folic acid's success in preventing birth defects of the spine and brain. 

Why folic acid is so important

Folic acid is crucial during early pregnancy because it helps develop the neural tube, which becomes the brain and spine. Randomized controlled trials have demonstrated that folic acid supplementation lowers the risk of neural tube birth defects (NTDs), which cause significant defects of the brain or spine. Consuming enough folic acid before or during early pregnancy reduces the risk of spina bifida, which can cause walking disabilities, paralysis, pressure sores, incontinence, and other lifelong health problems, and anencephaly, which results in stillbirth or infant death. 

Folic acid is so crucial to a developing fetus that the CDC, the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and other health authorities recommend that anyone who could become pregnant should be taking it. It’s essential to take 400 to 800 to 800 micrograms (mcg) a day of folic acid if you could become pregnant, whether you are planning to or not, because roughly half of all pregnancies are unplanned; NTDs occur very early in pregnancy (3 to 4 weeks after conception), long before many people know that they are pregnant. For pregnant people with a history of NTDs or other high-risk factors, an even higher dosage may be recommended by your doctor.

And since new research shows lower than recommended intakes among US Latine adults and persistent disparities in rates of NTDs affecting the Latine community, folic acid awareness is as important as ever. 

What is folic acid fortification? 

Folic acid fortification is critical in helping US adults meet the estimated average folate requirement. In the early 1990s, randomized trials found that folic acid supplements drastically cut the risk of NTDs, which occur when the neural tube fails to close properly in the first few weeks of pregnancy. 

Enter folic acid fortification, one of the greatest public health achievements of our time. Because consuming sufficient folic acid before or during early pregnancy reduces the risk of having a baby with an NTD, the FDA used staple foods like wheat flour, bread, and pasta to boost folic acid intakes. In 1996, the FDA added folic acid to the list of B vitamins (and iron) that companies must add to “enriched” bread, pasta, rice, grits, flour, and more. And it turns out that fortifying grains with folic acid works: Since 1996, NTDs in the U.S. have dropped by 28 percent, preventing an estimated 1,326 births with neural tube defects each year.

Corn masa fortification is crucial for closing gaps in health inequities

Though the FDA began requiring manufacturers to add folic acid to staple foods like enriched wheat flour, bread, and pasta in the 1990s, the FDA’s rule didn’t include corn masa flour, the main ingredient in corn tortillas and tamales, two dietary staples consumed by many Latine people in the US. That’s because the agency had no “standard of identity” for “enriched” corn masa. (A “standard of identity” is essentially a list of required ingredients, but most foods don’t have one.)

It wasn’t until 2016 that the FDA approved a petition to allow (but not require) manufacturers to fortify corn masa flour. This approval resulted from a 2012 multi-stakeholder coalition of health advocates and food companies, including Walmart and Gruma (which owns brands like Maseca and Mission tortillas), petitioning the FDA to allow food manufacturers and ingredient suppliers to add folic acid to corn masa flour voluntarily. 

Since rates of NTDs are still higher among the Latine community than in other ethnic or racial communities, further corn masa fortification could help save lives. 

The Latine community in the US are the primary consumers of corn masa flour (a main ingredient in corn tortillas, tamales, sopes, pupusas, etc.). Compared to other racial and ethnic groups, Latine people in the US face about 1.4 times higher rates of NTDs compared with other racial/ethnic groups. Corn masa fortification was proposed in 2012 and approved in 2016 as a simple and healthy way to help lower the rates of NTDs in the Latine population.

Manufacturers have been slow to adopt voluntary fortification

The FDA predicted that corn masa fortification would increase folic acid intake among Mexican American women of reproductive age from 164 mcg per day to 206 mcg per day and help close the gap in rates of NTDs. Unfortunately, recent data shows that the predicted impact has yet to be realized, since food companies are neglecting to take this simple step. Until very recently, it was impossible to find a corn tortilla product with folic acid in US stores. And studies suggest that at current fortification levels, people who get folic acid only from enriched grain products and corn masa flour typically get only about 135mcg a day of folic acid.

Since the FDA’s corn masa fortification policy is voluntary, it is only successful if companies choose to implement it. Studies published in 2018 and 2019 showed that few companies were implementing the policy.

CSPI’s ongoing work for fortified corn masa products

By 2022, six years after the FDA gave companies the green light to add folic acid, only 14 percent of corn masa flour products and not a single corn tortilla product contained folic acid. In February 2023, CSPI examined corn masa flour and corn tortilla products. We found that only eight of 59 corn masa flour products (14 percent) from 17 companies sampled, and none of the corn tortilla products (0 percent) of 476 products from 134 companies sampled, contained folic acid. (Our factsheet is available in Spanish.) By comparison, 401 of the 505 wheat flour products sampled (79 percent) and 731 of the 865 wheat tortilla products sampled (85 percent) contained folic acid. 

These findings were consistent with earlier studies, including one from 2018 that found two of 20 corn masa flours in Atlanta grocery stores (10 percent) contained folic acid and two studies that could not identify a single fortified corn tortilla product in US grocery stores. 

There’s been progress, which highlights the power of data to affect change: Since CSPI’s 2023 report, Walmart’s Great Value brand and Gruma’s Guerrero brand have started fortifying their corn tortillas. 

Gruma responded to CSPI’s report and outreach by making two critical commitments: 1) to fortify its remaining corn masa flour products by 2024 and 2) to fortify its core corn tortilla brands (such as Mission tortillas) by 2024. Let’s hope Gruma fulfills its commitments and other manufacturers follow suit.

The FDA and the U.S. Department of Health and Human Services (HHS) have also been listening. They’ve taken recent steps to improve supplier and consumer folic acid fortification awareness and encourage folic acid fortification. At a March 2024 HHS-hosted roundtable, government officials and representatives of corn masa flour manufacturers and distributors discussed strategies to increase the commercial availability of folic acid-fortified products. 

WIC has made some great changes. Recent revisions in WIC packages expanded the eligibility of whole-grain options to include corn tortillas made with folic acid-fortified corn masa flour.

California has proposed legislation requiring manufacturers to add 0.7 milligrams of folic acid to every pound of corn masa flour. CSPI supports this bill! 

CSPI plans to reassess the status of U.S. corn masa fortification in the coming years and is advocating for widespread fortification of corn masa flour and corn tortillas to increase folic acid intake and help close the gap in NTD rates. Read our full report, “Failure to Fortify: How companies are neglecting to take a simple step that could save Latino/a/e lives,” to learn more. (This report is also available in Spanish.)

How to get adequate folic acid from supplements and corn masa products

Supplements: Make sure you’re getting enough folic acid. Health authorities recommend supplements with “folic acid,” not “folate” or “5-MTHF.” Folic acid is better absorbed than folate, which occurs naturally in some foods. Also, don’t rely on the “% DV” (daily value) or “mcg DFE” (Dietary Folate Equivalent) of folate because the DFE includes forms of folate other than folic acid. (The amount of “DFE” accounts for the differences between the body’s ability to absorb folic acid from supplements versus naturally occurring folate in foods). And don’t rely on supplements that contain “100% DV” for folate. That’s less than 400 mcg of folic acid. Tip: Gummy vitamins are especially likely to contain low levels of folic acid. Look for “400 mcg folic acid” on the label. 

Corn masa products: Look for the words “folic acid” when buying corn masa flour and corn masa products. You can always check if a product contains folic acid by looking at the ingredients list, but some products make it even easier by declaring folic acid on the front of the package.

You can find additional resources and information in Healthy, safe pregnancy: CSPI’s research-based guide 

How you can support our work and folic acid awareness

Spread the message. Learn more and spread the word by participating in one or all of NDBPN’s National Folic Acid Awareness Week activities and listening sessions. 

Share resources. Share the CDC’s Folic Acid Toolkit and this great informational video on folic acid fortification with anyone who might benefit from the helpful data, tips, and tools.