Flour Tortillas: Safe Pregnancy Eats?

Flour tortillas are generally safe to eat during pregnancy, but there are some important considerations. Firstly, raw flour should be avoided as it can contain harmful bacteria such as E. coli, which can cause foodborne illnesses. Therefore, it is crucial to cook flour tortillas thoroughly before consumption. Additionally, flour tortillas may not contain folic acid, which is essential for preventing neural tube defects in the developing fetus. To ensure adequate folic acid intake, pregnant women should include a variety of fortified foods in their diet, such as enriched breakfast cereals and grain products.

Flour tortillas and folic acid

Folic acid is a B vitamin that plays a critical role in preventing severe brain and spinal cord defects in babies during pregnancy. In 1998, the U.S. Food and Drug Administration (FDA) mandated that folic acid be added to breakfast cereals, breads, rice, pasta, and other grain products made with enriched flour. Since then, the number of babies born in the U.S. with neural tube defects has dropped by roughly 35%, or about 1,300 babies per year.

However, one notable exception to this success story is Hispanic women, who have higher rates of neural tube defects. Researchers believe that this could be due to their staple food—tortillas. Under current FDA rules, tortillas, corn chips, and other foods made with corn masa flour are not allowed to be fortified with folic acid.

The Benefits of Folic Acid in Flour Tortillas

Folic acid is crucial for preventing severe neural tube birth defects, such as spina bifida and anencephaly. When consumed by women before and during early pregnancy, folic acid can reduce the risk of these defects by up to 70%. As the brain and spine begin to form within the first four weeks of gestation, it is essential to have adequate folic acid levels before becoming pregnant.

The Push for Folic Acid in Tortillas

A coalition of groups, including the March of Dimes Foundation and the National Council of La Raza, has petitioned the FDA to allow corn masa flour to be fortified with folic acid. They argue that by adding folic acid to tortillas, the staple food of many Hispanic women, they can help reduce the rates of neural tube defects in this community. According to the March of Dimes, about 3,000 pregnancies in the U.S. are affected by neural tube defects each year, with Latina women being 20% more likely to have a baby with these defects compared to non-Hispanic white women.

The FDA's Concerns and Approval Process

The FDA had previously banned the addition of folic acid to corn masa flour due to concerns about the stability of the vitamin during the nixtamalization process, a traditional method of softening corn kernels with an alkaline solution. However, in 2016, the FDA approved a petition to voluntarily add folic acid to corn masa flour after reviewing the safety data and determining that it would be safe for the general population.

The Impact of Folic Acid Fortification in Corn Masa Flour

Studies suggest that fortifying corn masa with folic acid could prevent 40 to 120 cases of neural tube defects among babies born to Hispanic mothers each year. While the FDA's approval is a step forward, producers have been slow to act, and a 2018 study found that only 10% of corn masa flour contained folic acid, while none of the corn tortillas tested did. This highlights the need for continued advocacy and education to ensure that manufacturers are taking the necessary steps to improve pregnancy outcomes and reduce health disparities.

The dangers of raw flour

The Food and Drug Administration (FDA) strongly discourages people from consuming raw flour. While the risk is low, it is very real. The Centers for Disease Control and Prevention (CDC) lists "raw flour" as one of the seven main groups of foods that can cause food poisoning. The CDC also has a webpage dedicated to the dangers of raw dough, aptly titled "Say No to Raw Dough".

The reason flour is risky is that its powdery consistency makes it seem like it has been cooked, but it is actually as much of a raw food as lettuce or carrots. Flour is made from grains that are grown in fields and may be exposed to harmful bacteria like Salmonella and E. coli. The processing that the plants undergo to convert from grain to flour does not kill these bacteria, and unlike vegetables, flour cannot be washed to remove them.

Consuming raw flour can cause food poisoning, and there have been many E. coli outbreaks in the past decade linked to raw flour. Those most at risk of getting sick from raw flour include children under 5, older adults, and people with weakened immune systems. Common symptoms of E. coli are abdominal cramps and diarrhea, and while most people recover within a week, some illnesses can result in kidney failure.

To stay safe, the FDA and CDC recommend always washing your hands, tools, and countertops after handling raw flour or dough, and never letting children play with raw dough or eat it.

Tortilla chips and acrylamide

Tortilla chips are a popular snack, especially among children, second only to potato chips. However, concerns have been raised about the presence of acrylamide in these chips and its potential health risks. Acrylamide is a chemical that forms during the heating process when the starches in potatoes and corn react to high temperatures. While it adds to the taste and crunchiness of the chips, it may also increase the risk of cancer.

Sources of Acrylamide

According to the FDA and USDA, snack foods like potato and tortilla chips are significant sources of acrylamide in the average American diet, accounting for about 25% of total intake. Potato chips alone contribute around 11%. Other major sources include French fries, breads, bakery products, and cereals.

Acrylamide in Tortilla Chips

Tortilla chips are made by cutting corn tortillas into wedges and then frying or baking those wedges. During the heating process, tortilla chips form acrylamide, similar to potato chips. Interestingly, the levels of acrylamide in tortilla chips tend to be lower than in most potato chips. In tested samples, none of the tortilla chip lots exceeded 200 ppb, while values over 200 ppb were common for potato chips.

Strategies for Reducing Acrylamide

Several strategies have been proposed to mitigate the formation of acrylamide in heat-processed foods, including:

• Using aspartic acid or Ca2+ to block the formation of the Schiff base of asparagine.
• Employing antioxidants, hydrocolloids, phospholipids, lecithin, and amino acids as effective mitigation agents.
• Adding chemical compounds such as mono, di, and trivalent cations (Na+, K+, Fe2+, Mg2+, Zn2+, Ba2+, V2+, Fe3+, and Al3+).
• Utilising the nixtamalization process, which involves cooking corn in an alkali solution, can help reduce acrylamide levels.

While tortilla chips are a popular snack food, it is important to be aware of the presence of acrylamide, which may pose potential health risks. Strategies such as the nixtamalization process and the use of specific chemical compounds can help reduce acrylamide levels in tortilla chips, making them safer for consumption. However, it is always advisable to consume these snacks in moderation and ensure a balanced diet that includes fresh fruits and vegetables.

Corn intake and spina bifida

In 1998, the US Food and Drug Administration mandated that enriched grain products be fortified with folic acid. Folic acid is a B vitamin that plays a vital role in preventing severe brain and spinal cord defects during pregnancy. Spina bifida is a birth defect that occurs when the bones in a baby's spinal column do not properly close. The baby's spinal cord extends through the bones and attaches to the skin, which may cause spinal cord damage. Folate has been shown to decrease the incidence of spina bifida in several population studies.

The US Centers for Disease Control and Prevention (CDC) found that Hispanic women represent the highest percentage of US women giving birth to children with neural tube defects (NTDs). NTDs are birth defects of the brain, spine, and spinal cord, such as anencephaly and spina bifida. This disparity was linked to the staple food of tortillas in the Hispanic diet, which did not naturally contain folic acid.

In 2016, the FDA approved the addition of folic acid to corn masa flour, which is used to make tortillas, tacos, tortilla chips, and tamales. This was in response to a petition from organisations such as the March of Dimes Foundation and the National Council of La Raza. Manufacturers can now voluntarily add folic acid to corn masa flour, with the potential to prevent 40 to 120 cases of neural tube defects among Hispanic babies each year.

Research has shown that folic acid is only protective if consumed during the early weeks of pregnancy, specifically before and around the time of conception. This is because the nervous system closes within the first few weeks of development. Therefore, folic acid intake prior to pregnancy is crucial to reducing the risk of spina bifida.

In a study by Ahrens et al., data was collected from the Slone Birth Defects Study from 1998 to 2008. The study found that folic acid supplementation did not appear to offer further benefit for reducing the risk of spina bifida. Instead, the benefit was associated with increasing amounts of dietary folic acid consumed, regardless of folic acid supplementation. The study suggested that folic acid supplementation during the months immediately preceding neural tube closure may not offer additional benefits in reducing the risk of spina bifida. However, dietary folic acid intake does appear to decrease the risk, regardless of whether folic acid supplements were taken.

Fortifying corn masa flour

Corn masa flour is a staple food for many Latin Americans, including those of Mexican and Central American descent living in the United States. It is made from corn cooked in alkali and then ground into a dough. This process, called nixtamalization, has been used in Mesoamerica for thousands of years. Nixtamalization gives corn masa its distinctive aroma and flavour, and its alkaline treatment softens the corn, making it pliable for grinding. The ground product is called masa nixtamalera, and it can be dried and powdered into a flour called masa harina.

Corn masa flour is used to make tortillas, tortilla chips, tamales, taco shells, and corn chips. However, under previous FDA rules, corn masa flour could not be fortified with folic acid, a B vitamin that helps prevent severe neural tube birth defects. This rule posed a problem, as Hispanic women are more likely to have babies with neural tube defects, and corn masa flour is a staple in their diet.

In 2012, a coalition of groups, including the March of Dimes Foundation and the National Council of La Raza, petitioned the FDA to allow corn masa flour to be fortified with folic acid. In 2016, the FDA approved the voluntary addition of folic acid to corn masa flour. Manufacturers can now add up to 0.7 milligrams of folic acid per pound of corn masa flour, which is consistent with the levels in other enriched cereal grains.

The approval of folic acid fortification in corn masa flour is expected to increase folic acid consumption among Latina women, thereby reducing the risk of neural tube defects in their infants. However, a recent CDC analysis found that there has not been a significant improvement in blood folate levels among Hispanic women of reproductive age since the approval. This finding highlights the importance of consumer and supplier education to ensure that those who can benefit from fortified corn masa flour are aware of its health benefits and availability.

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