If you look at the nutrition label on a loaf of bread, you may come across folic acid or folate. It’s a vitamin that, in pregnant women, has been shown to reduce debilitating and sometimes fatal birth defects. For decades, folic acid has been added to some foods, but not others. Now, a new FDA decision to expand those foods could bring the vitamin to more people in the San Joaquin Valley.
When Graciela Soto became pregnant 12 years ago, she didn’t know much about folic acid. She learned about it during her first ultrasound, when her unborn daughter was diagnosed with spina bifida—a condition that meant her spinal cord wouldn’t develop properly. Spina bifida is one of a family of conditions called neural tube defects, and studies have shown that taking folic acid can prevent most of these defects—if the mother starts early enough.
“She was my first child, so I didn't know any better that I was supposed to be taking folic acid before my pregnancy,” Soto says. “Maybe had I taken the folic acid prior, maybe she wouldn’t have had this diagnosis.”
Folic acid is added to grains like wheat and rice flour in breads, cereals and pasta. But Soto’s diet is based less on wheat and rice flour and more on corn masa flour—the main grain in corn tortillas, tamales and enchiladas.
Unfortunately, Soto’s not dealing with spina bifida alone. The Centers for Disease Control and Prevention say Hispanic Americans are at higher risk for neural tube defects than other ethnicities—and the risk is even higher for those born in Mexico. But earlier this year, the FDA approved fortifying corn masa with folic acid, and a prominent masa manufacturer has jumped on board. It’s a series of events that was many years in the making, and is poised to have an impact right here in the San Joaquin Valley.
Patricia Clerkin is a pediatric neurosurgeon at Valley Children’s Hospital in Madera. She says, with spina bifida, the spinal cord doesn’t close properly, and part of it may actually extend outside the body.
“You have kids without any problems to kids who are profoundly debilitated, paraplegic, to kids who do not survive beyond the first couple days of life,” she says.
Those who do survive require a lot of specialized care. Valley Children’s is one of the few medical centers in Central California with a dedicated spina bifida clinic. Clerkin says the clinic has over a thousand patients, some of whom drive in from as far as Sacramento and San Luis Obispo.
“It is a chronic problem, and it is a large part of this hospital and this practice,” she says.
The condition is rare. The CDC estimates about 1,500 people are born with it each year in the U.S. In the San Joaquin Valley, the rate is highest in Tulare County. Most of those cases are among Hispanics.
Still, the numbers are lower than they used to be. Products enriched with folic acid, mostly made from wheat flour, hit the shelves in 1996. Since then, the CDC estimates that spina bifida cases have dropped by over a third. Folic acid supplements are available, but some women don’t know to start taking them early.
“Unfortunately, it is important to be taking the folic acid before conception,” Clerkin says, “so food is critical.”
But women who don’t rely on wheat or rice flour have been left behind.
Sara Struwe saw the need for more fortified foods. She’s president of the national Spina Bifida Association. In 2012, the association teamed up with March of Dimes and other groups to petition the FDA to get folic acid in corn masa.
“It started with a series of phone calls that led to face-to-face meetings and getting individuals who were doing research at CDC involved,” Struwe says, “and it really gelled as a group. We were able to come together and make a big difference.”
Four years later, in April of this year, the FDA announced it would expand its recommended fortifications to include corn masa flour. It’s voluntary, but the world’s largest masa manufacturer, the Mexican company Gruma has already committed to it. Gruma produces brands like Mission and Guerrero tortillas and Maseca corn masa. Gruma promised its improved foods by the fall, and fortified Maseca, at least, has already rolled out.
For some families, it’s just in time for cooking home-made tamales for the holidays.