FRESNO, Calif. – Ramiro Ortuño has over 20 years of experience working with tortillas.
He learned to make them in Mexico. Making a tortilla does not require many ingredients; only corn flour and water are needed, which must be mixed together in a giant mixing bowl.
Afterward, the dough passes through a machine where it is rolled out, cut into circles, heated, and finally conveyed along a belt — emerging as soft, golden tortillas. This is the process at Ortuño’s business, Tortilleria Ortuño.
Ortuño says the perfect tortilla should puff up and be able to split easily.
Ortuño estimates his company makes about 2,400 tortillas in a single day.
For many years, the tortilla-making process was the same.
But that changed when, folic acid began being added to the corn masa flour he uses, which he has been importing from Mexico for over 15 years.
"All of my tortillas contain folic acid," Ortuño said.
A new state law now requires all corn masa-based products to contain folic acid.
This is to reduce the prevalence of neural tube defects in the U.S.
Corn masa products aren't the only ones to contain folic acid. In 1998, the U.S. Food and Drug Administration began fortifying certain products such as bread, flour, rice, pasta, and other standardized grain products.
But it was not required in corn masa products – which is a staple of many dishes in primarily Hispanic communities.
Assemblymember Dr. Joaquin Arambula, who wrote the California law to add folic acid to corn masa products, says there is no clear reason why the folic acid was not implemented in those products.
“In 2016 through much advocacy at the national level they [the FDA] included a voluntary inclusion of folic acid, but it was not insisted upon. Our law took the next incremental step to make sure that manufacturers were including it in their production,” Arambula said.
Arambula said the new law seeks to reduce so-called neural tube defects — including spina bifida and anencephaly — conditions in which the spinal cord, the brain, or the skull do not fully develop during the mother's pregnancy. These defects are primarily linked to insufficient folic acid intake before and during pregnancy.
Neural tube defects are among the most common defects in the U.S., along with congenital heart disease and Down syndrome.
Valley Children’s Hospital Pediatrician Dr. Sushma Chamarthi said these conditions are serious and sometimes even fatal.
"Spina bifida can lead to lifelong physical challenges while anencephaly is generally not compatible with life," Chamarthi said.
Adam Guerrero, a behavioral technician for special-needs kids in Sacramento, wishes more could be known about these birth defects.
"Spina bifida is just a condition that I've realized that they don't have a whole lot of research on. They're still trying to catch up," Guerrero, who also has spina bifida, said.
He doesn’t feel anything from his knees down. He can move his upper body, but he doesn’t have the strength to walk.
He says the condition does not define him. But he hopes that more awareness of these conditions can help prevent them in others.
Neural tube defects are not uncommon in the San Joaquin Valley. The California Department of Public Health estimates the defects are found in 6.8 percent of Latinos in the region, followed by lesser but still present rates among Black, Asian and White residents.
That prevalence motivated Arambula to become involved in the legislation.
"It's really the Latinas that we're focusing on. They need the folic acid oftentimes prior to them even knowing that they're pregnant," Arambula said.
The law requires 0.7 milligrams of folic acid per pound of corn masa flour and 0.4 milligrams of folic acid per pound of the final product. Based on these quantities, the change in flavor is almost undetectable.
The U.S. Centers for Disease Control and Prevention recommends women having a daily intake of folic acid of at least 400 micrograms.
For Arambula, the costs of adding folic acid to these products are not comparable to the benefits it will provide. Chamarthi agrees the initiative will change lives.
"The trajectory is generally positive. We have proven that the intervention works at a scale, but now we are excited for this new law," she said.
However, not all products made with corn masa are included under this law. Arambula said that certain snack foods, cottage food industries, and small grocery businesses were excluded from this law.
"We wanted to give some flexibilities. Our goal here wasn't to drive certain industries into the ground, but for those that have large manufacturing that could easily include this as an ingredient. We wanted to make sure that they were doing so," Arambula said.
Arambula wants to encourage other states to consider adopting a similar law. Some states have already begun moving in that direction, with Alabama scheduled to be the first to implement it in June.
Ortuño, the tortilla maker in Fresno, says the law doesn’t affect his business all that much. Instead, he views the effort as worthwhile.
“It must be a good option, as long as it helps to improve the health of mothers and children,” Ortuño said.
