May 5, 2025 • 14 mins
In this eye-opening episode, Dr. Michael Richman— double board-certified general and cardiothoracic surgeon — tackles the latest medical misinformation head-on.
Responding to recent claims about genetic tests for the MTHFR gene, Dr. Richman dives deep into the science behind genetic polymorphisms, homocysteine levels, and cardiovascular risk. He breaks down major clinical studies, busts myths about methylated folic acid, and explains why you don't need expensive testing or supplements sold by non-doctors.
Learn the facts that insurance-covered tests already reveal, and why you should think twice before trusting social media health trends.
The truth matters when it comes to your health.
Tune in and empower yourself with real, evidence-based information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
Morning, everybody.
It's early here in SouthernCalifornia.
This is Dr.
Michael Richman, double boardcertified general surgeon and
cardiothoracic surgeon.
One half of Two Doctors Tell theTruth podcast with my friend and
colleague, Dr.
Fiorillo.
And I'm doing this short podcastthis morning because, like I
(00:20):
said in a prior podcast, I gettexts very early in the morning
from Dr.
Fiorillo, who is on the EastCoast.
And it's usually somethingaggravating.
So yes, he sent me somethingaggravating this morning.
So I just wanted to get thisout.
Apparently, I haven't seen it,but Gary Brekka, one of the most
(00:44):
infamous or famous, whatever youwant to call them, medical
influencers who's a biologistwith his company 10X, was on
Megyn Kelly or Joe Rogan thisweek or something and is
encouraging everybody to get agenetic test from his company,
10X, which is$599, to have genesmeasured, and one of them is
(01:10):
called the MTHFR, which standsfor methylhydrotetrafolate
reductase, because somehow it'sgoing to make your body, if you
have a gene, what's calledpolymorphism, an abnormality,
it's going to make the gene...
not be able to do its jobproperly and it's going to
(01:32):
result in various issues withyour body.
So I think it's important, firstof all, that I make a comment.
If you look on the bottom of 10xwebsite, it says everything on
this website is forinformational purposes and it
doesn't constitute medicaladvice.
So I submit to you, why wouldyou be selling a genetic test?
(01:56):
and telling people to do this ifyou're not giving medical
advice, especially if it's falsemedical advice.
So leave it at that.
Next thing is, if you wanttesting of any sort and you go
to a lab, a LabCorp, a Quest,your insurance covers it if it's
for, or Medicare covers it ifit's for real reasons, okay?
(02:18):
So as Dr.
Fiorello and I talk all the timeabout all we're selling is the
truth, we're not selling anyproducts, I'm like, these other
people and we're not selling anybooks.
I'm going to be a littletechnical in this, but I need
everybody to understand thetruth because if I don't tell
you the information, if we don'ttell you the information in the
(02:38):
literature and the accurateinformation, how are you going
to believe us?
If I just said to you right now,like Gary Breck and other
influencers are, that this isthe fact and trust me, I know,
what credibility do I have?
Yes.
Fine, I'm a cardiothoracicsurgeon, certainly more than a
(02:58):
biologist or a philosopher, butat the end of the day, you don't
really know me, so I have toestablish credibility.
Okay, so I want to just quicklygo through what the claims are.
And so there's a gene, as I toldyou, it's called MTHFR.
What MTHFR is, it's a gene thatattaches what's called a methyl
(03:23):
group to folic acid.
And this is a new thing on theinternet.
Obviously, this gene has beenaround since the dawn of time
because it's what does methylatefolic acid in our body.
And somehow, if the gene's notproperly functioning, you'll
have a folic acid deficiency.
(03:44):
And if you have a folic aciddeficiency, something in your
body called homocysteine iselevated.
And homocysteine does...
a variety of things.
And therefore, if you do thistesting, then you should buy
special folic acid from allthese guys, which is already
(04:05):
methylated folic acid, and yada,yada, yada.
Okay, so none of that's true.
So first of all, a littlebackground.
Dr.
Fiorillo told me that he hasvarious patients who come in all
the time and say, hey, I wastold I have an MTHFR.
gene polymorphism?
(04:25):
And am I susceptible when I'mhaving surgery to having blood
clots?
And the answer is no.
Okay.
So I did in 2011 and 2013, atwo-year institutional review
board, which is called the IRBstudy.
And an institutional reviewboard is a university-based,
(04:48):
although the private ones thatwhen you do a study.
It has to be approved by them ifit's legit that you're following
ethics, you're followingstandards, they monitor you.
So you know that this study isbeing done right and somebody is
looking over your shoulder.
And this study was looking atgene polymorphisms, this MTHFR
(05:12):
gene polymorphisms, and seeingif because people were not able
to methylate folic acid, Didthey have a higher homocysteine
level?
Because homocysteine allegedlyled to increased clotting in
some papers.
They were mostly in Europe.
(05:34):
And it was a 200-person study.
It took two years.
And we didn't publish it becausethe data was...
No.
And I didn't think it was worthpublishing.
Let me tell you exactly what wefound.
We found, first of all, Very fewpeople had MTHFR gene
polymorphisms.
Of those people who had genepolymorphisms, none of them,
(06:00):
none had abnormal folic acidlevels.
This claim that there's threegene polymorphisms, that the TT
version of the gene polymorphismdoesn't allow you to methylate
folic acid, So your homocysteinelevel rises and then your
homocysteine level rises andsomehow that's associated with
(06:22):
deep venous thrombosis is false.
And I will actually give you theliterature right here because I
think it's important that thetruth, okay, basically the new
studies say that while themethylation of folic acid is
impaired in individuals withthis TT polymorphism, It is not
(06:44):
completely inhibited.
And just increasing the folicacid supplementation will
mitigate any effects of reducedenzyme activity.
So therefore, you do not need tobuy methylated folic acid.
And that is from a recentarticle in the New England
Journal of Medicine, okay?
Furthermore, the AmericanCollege of Medical Genetics and
(07:07):
Genomics has noted that wildgene polymorphisms can lead to
mild hypohomocystinemia, theclinical significance of this is
uncertain and routine testingfor the MTHFR polymorphism is
not recommended due toinconsistent evidence linking
(07:27):
these gene defects to anyadverse medical events.
Okay, and that's huge becausethese guys are out recommending
it and scaring people thatthey're gonna have altered
disease processes They couldhave clotting.
Their body won't functionproperly.
And, you know, that's basicallybullshit.
So the second thing is we usedto think, and I wrote an article
(07:50):
about this for WebMD, and then Irewrote it for my Substack page,
is elevated homocysteine acardiovascular risk factor?
Because there was a lot ofthought for a while that if you
had this, again, if you had thisMTHFR gene polymorphism, the TT
version, You cannot put a methylgroup on folic acid, and
(08:12):
therefore you have a folic aciddeficiency.
And folic acid is necessary toreduce homocysteine levels.
And high homocysteine levels aresomehow associated with
cardiovascular events.
This has been blown out of thewater, okay?
First of all, homocysteine is anamino acid that cannot be made
by the human body.
It's synthesized from the aminoacid called methionine in our
(08:36):
body.
And what an essential amino acidmeans is that it's
indispensable.
In other words, we can't make itourselves.
So methionine supplied by ourdiet from tuna, salmon, shrimp,
beef, lamb, and plant-based fromBrazil nuts, soybean, tofu, I
think has it, wheat germ, andlentils.
(08:58):
Okay.
First trial, 2005, the HOPEtrial, which was HOPE II.
The Heart Outcome PreventionEvaluation Study was a large
randomized placebo-controlledtrial started in 1999, and it
was designed whether todetermine long-term
supplementation with folic acid,vitamin B6, and vitamin B12.
(09:19):
They're aimed at reducinghomocysteine reduction, reduces
the rates of fatal and non-fatalcardiovascular events in people
who had diabetes or establishedcardiovascular disease.
And the finding was thatsignificant reductions of
homocysteine was achieved.
However, there was no benefitwith folic acid.
(09:40):
Okay, huge.
Next was the NORVIT trial,N-O-R-V-I-T, which was published
in the New England Journal ofMedicine in 2006.
And the aim of this study was tosee if homocysteine lowering
with B vitamins, again, folicacid for secondary prevention,
in other words, you've alreadyhad your heart attack or stroke,
(10:01):
in 3,749 men and women who hadan acute heart attack within
seven days before they were putin the study, seeing if you gave
them all these vitamins, didthey have a reduced incidence of
heart attack or strokes?
And the study found thatalthough homocysteine level was
lowered by 27% by people givenfolic acid plus B12, it did not
(10:26):
lower the risk of recurrentheart attacks or strokes.
Finally, a study called theWomen's Antioxidant and Folic
Acid Study.
It was published in 2008.
And the goal of the trial was toevaluate the effects of
treatment with folic acid,regular folic acid, not
methylated folic acid, okay?
So you got to assume in thatthere were people who did have
(10:48):
this MTHFR gene polymorphism.
So it was done to evaluate theeffect of folic acid and vitamin
B compared with placebo amongwomen with increased risk for
cardiovascular disease.
And it was a humandouble-blinded, in other words,
nobody knew what they weregetting, randomized trial of
53,788 patients.
(11:11):
Ultimately, 5,442 patients wereenrolled in the trial, okay?
And these were women who were atincreased risk of cardiovascular
events.
And half of them were givenfolic acid B12, the other half
weren't.
Despite reductions inhomocysteine levels, there were
no reductions in clinicalevents, in other words, heart
(11:32):
attacks or strokes.
So what does all this mean?
Sorry that I gave you all thescientific information, but I
need to establish thecredibility.
First of all, an elevatedhomocysteine may be a minor risk
factor for cardiovasculardisease.
It's not a major risk factor forcardiovascular disease.
There is no evidence.
(11:54):
in huge trials, and there willnever be another huge trial,
it's settled, that lowering yourhomocysteine level with folic
acid reduces your number ofcardiovascular events or
cardiovascular death, okay?
So if somebody is suggesting toyou or Gary Brecker or any of
this that you need to have yourMTHFR gene measured, bullshit,
(12:15):
okay?
Because lowering homocysteineis...
not related to a reduction againin events.
And we don't know, becausehomocysteine can be elevated in
people with mild renal failure.
We don't know what's going on,but it has no relation.
Second thing, as I told you inthe beginning, people who have
(12:36):
an MTHFR gene polymorphism, theTT variant, which he's trying to
tell you that you need to havemeasured, do not have any
clinically significant adversemedical events because they're,
quote, not methylating folicacid, because they all do
methylate folic acid, even inthat group, maybe to a lesser
(12:56):
amount, and they just needhigher levels of folic acid.
So how do you determine that?
Measure a folic acid level,okay?
And if somebody's deficient infolic acid, really deficient in
folic acid, you get a certaintype of anemia called the
macrocytic anemia, but yourbodily functions are are normal,
so you don't need it.
(13:17):
And then the third thing is, asI also said, is an MTHFR gene
polymorphism is not associatedwith deep venous thrombosis and
blood clotting.
O'Connor published an amazingstudy in the New England Journal
of Medicine, I think it was2017, 2018, and their conclusion
in a large trial was it's noteven worth measuring MTHFR
(13:41):
because there is no realevidence to show that it's
associated with clotting.
So I know this is a complicatedtopic, but I'm trying to set the
record straight, avoid you fromwasting your money.
If there was a need, you can goto LabCorp or Quest or any lab
and have it measured and coveredby insurance.
(14:01):
And my challenge, have Dr.
Fiorillo and me, we'd love to goon Megyn Kelly or Joe Rogan and
any of these other people anddebate Gary Brecker, any of
these other influencers who arenot doctors, and set the record
straight.
Because when it comes to yourhealth, the truth matters.
All right, I hope everybody hasa good day.
Thanks a lot.
Morning, everybody.
It's early here in SouthernCalifornia.
This is Dr.
Michael Richman, double boardcertified general surgeon and
cardiothoracic surgeon.
One half of Two Doctors Tell theTruth podcast with my friend and
colleague, Dr.
Fiorillo.
And I'm doing this short podcastthis morning because, like I
(00:20):
said in a prior podcast, I gettexts very early in the morning
from Dr.
Fiorillo, who is on the EastCoast.
And it's usually somethingaggravating.
So yes, he sent me somethingaggravating this morning.
So I just wanted to get thisout.
Apparently, I haven't seen it,but Gary Brekka, one of the most
(00:44):
infamous or famous, whatever youwant to call them, medical
influencers who's a biologistwith his company 10X, was on
Megyn Kelly or Joe Rogan thisweek or something and is
encouraging everybody to get agenetic test from his company,
10X, which is$599, to have genesmeasured, and one of them is
(01:10):
called the MTHFR, which standsfor methylhydrotetrafolate
reductase, because somehow it'sgoing to make your body, if you
have a gene, what's calledpolymorphism, an abnormality,
it's going to make the gene...
not be able to do its jobproperly and it's going to
(01:32):
result in various issues withyour body.
So I think it's important, firstof all, that I make a comment.
If you look on the bottom of 10xwebsite, it says everything on
this website is forinformational purposes and it
doesn't constitute medicaladvice.
So I submit to you, why wouldyou be selling a genetic test?
(01:56):
and telling people to do this ifyou're not giving medical
advice, especially if it's falsemedical advice.
So leave it at that.
Next thing is, if you wanttesting of any sort and you go
to a lab, a LabCorp, a Quest,your insurance covers it if it's
for, or Medicare covers it ifit's for real reasons, okay?
(02:18):
So as Dr.
Fiorello and I talk all the timeabout all we're selling is the
truth, we're not selling anyproducts, I'm like, these other
people and we're not selling anybooks.
I'm going to be a littletechnical in this, but I need
everybody to understand thetruth because if I don't tell
you the information, if we don'ttell you the information in the
(02:38):
literature and the accurateinformation, how are you going
to believe us?
If I just said to you right now,like Gary Breck and other
influencers are, that this isthe fact and trust me, I know,
what credibility do I have?
Yes.
Fine, I'm a cardiothoracicsurgeon, certainly more than a
(02:58):
biologist or a philosopher, butat the end of the day, you don't
really know me, so I have toestablish credibility.
Okay, so I want to just quicklygo through what the claims are.
And so there's a gene, as I toldyou, it's called MTHFR.
What MTHFR is, it's a gene thatattaches what's called a methyl
(03:23):
group to folic acid.
And this is a new thing on theinternet.
Obviously, this gene has beenaround since the dawn of time
because it's what does methylatefolic acid in our body.
And somehow, if the gene's notproperly functioning, you'll
have a folic acid deficiency.
(03:44):
And if you have a folic aciddeficiency, something in your
body called homocysteine iselevated.
And homocysteine does...
a variety of things.
And therefore, if you do thistesting, then you should buy
special folic acid from allthese guys, which is already
(04:05):
methylated folic acid, and yada,yada, yada.
Okay, so none of that's true.
So first of all, a littlebackground.
Dr.
Fiorillo told me that he hasvarious patients who come in all
the time and say, hey, I wastold I have an MTHFR.
gene polymorphism?
(04:25):
And am I susceptible when I'mhaving surgery to having blood
clots?
And the answer is no.
Okay.
So I did in 2011 and 2013, atwo-year institutional review
board, which is called the IRBstudy.
And an institutional reviewboard is a university-based,
(04:48):
although the private ones thatwhen you do a study.
It has to be approved by them ifit's legit that you're following
ethics, you're followingstandards, they monitor you.
So you know that this study isbeing done right and somebody is
looking over your shoulder.
And this study was looking atgene polymorphisms, this MTHFR
(05:12):
gene polymorphisms, and seeingif because people were not able
to methylate folic acid, Didthey have a higher homocysteine
level?
Because homocysteine allegedlyled to increased clotting in
some papers.
They were mostly in Europe.
(05:34):
And it was a 200-person study.
It took two years.
And we didn't publish it becausethe data was...
No.
And I didn't think it was worthpublishing.
Let me tell you exactly what wefound.
We found, first of all, Very fewpeople had MTHFR gene
polymorphisms.
Of those people who had genepolymorphisms, none of them,
(06:00):
none had abnormal folic acidlevels.
This claim that there's threegene polymorphisms, that the TT
version of the gene polymorphismdoesn't allow you to methylate
folic acid, So your homocysteinelevel rises and then your
homocysteine level rises andsomehow that's associated with
(06:22):
deep venous thrombosis is false.
And I will actually give you theliterature right here because I
think it's important that thetruth, okay, basically the new
studies say that while themethylation of folic acid is
impaired in individuals withthis TT polymorphism, It is not
(06:44):
completely inhibited.
And just increasing the folicacid supplementation will
mitigate any effects of reducedenzyme activity.
So therefore, you do not need tobuy methylated folic acid.
And that is from a recentarticle in the New England
Journal of Medicine, okay?
Furthermore, the AmericanCollege of Medical Genetics and
(07:07):
Genomics has noted that wildgene polymorphisms can lead to
mild hypohomocystinemia, theclinical significance of this is
uncertain and routine testingfor the MTHFR polymorphism is
not recommended due toinconsistent evidence linking
(07:27):
these gene defects to anyadverse medical events.
Okay, and that's huge becausethese guys are out recommending
it and scaring people thatthey're gonna have altered
disease processes They couldhave clotting.
Their body won't functionproperly.
And, you know, that's basicallybullshit.
So the second thing is we usedto think, and I wrote an article
(07:50):
about this for WebMD, and then Irewrote it for my Substack page,
is elevated homocysteine acardiovascular risk factor?
Because there was a lot ofthought for a while that if you
had this, again, if you had thisMTHFR gene polymorphism, the TT
version, You cannot put a methylgroup on folic acid, and
(08:12):
therefore you have a folic aciddeficiency.
And folic acid is necessary toreduce homocysteine levels.
And high homocysteine levels aresomehow associated with
cardiovascular events.
This has been blown out of thewater, okay?
First of all, homocysteine is anamino acid that cannot be made
by the human body.
It's synthesized from the aminoacid called methionine in our
(08:36):
body.
And what an essential amino acidmeans is that it's
indispensable.
In other words, we can't make itourselves.
So methionine supplied by ourdiet from tuna, salmon, shrimp,
beef, lamb, and plant-based fromBrazil nuts, soybean, tofu, I
think has it, wheat germ, andlentils.
(08:58):
Okay.
First trial, 2005, the HOPEtrial, which was HOPE II.
The Heart Outcome PreventionEvaluation Study was a large
randomized placebo-controlledtrial started in 1999, and it
was designed whether todetermine long-term
supplementation with folic acid,vitamin B6, and vitamin B12.
(09:19):
They're aimed at reducinghomocysteine reduction, reduces
the rates of fatal and non-fatalcardiovascular events in people
who had diabetes or establishedcardiovascular disease.
And the finding was thatsignificant reductions of
homocysteine was achieved.
However, there was no benefitwith folic acid.
(09:40):
Okay, huge.
Next was the NORVIT trial,N-O-R-V-I-T, which was published
in the New England Journal ofMedicine in 2006.
And the aim of this study was tosee if homocysteine lowering
with B vitamins, again, folicacid for secondary prevention,
in other words, you've alreadyhad your heart attack or stroke,
(10:01):
in 3,749 men and women who hadan acute heart attack within
seven days before they were putin the study, seeing if you gave
them all these vitamins, didthey have a reduced incidence of
heart attack or strokes?
And the study found thatalthough homocysteine level was
lowered by 27% by people givenfolic acid plus B12, it did not
(10:26):
lower the risk of recurrentheart attacks or strokes.
Finally, a study called theWomen's Antioxidant and Folic
Acid Study.
It was published in 2008.
And the goal of the trial was toevaluate the effects of
treatment with folic acid,regular folic acid, not
methylated folic acid, okay?
So you got to assume in thatthere were people who did have
(10:48):
this MTHFR gene polymorphism.
So it was done to evaluate theeffect of folic acid and vitamin
B compared with placebo amongwomen with increased risk for
cardiovascular disease.
And it was a humandouble-blinded, in other words,
nobody knew what they weregetting, randomized trial of
53,788 patients.
(11:11):
Ultimately, 5,442 patients wereenrolled in the trial, okay?
And these were women who were atincreased risk of cardiovascular
events.
And half of them were givenfolic acid B12, the other half
weren't.
Despite reductions inhomocysteine levels, there were
no reductions in clinicalevents, in other words, heart
(11:32):
attacks or strokes.
So what does all this mean?
Sorry that I gave you all thescientific information, but I
need to establish thecredibility.
First of all, an elevatedhomocysteine may be a minor risk
factor for cardiovasculardisease.
It's not a major risk factor forcardiovascular disease.
There is no evidence.
(11:54):
in huge trials, and there willnever be another huge trial,
it's settled, that lowering yourhomocysteine level with folic
acid reduces your number ofcardiovascular events or
cardiovascular death, okay?
So if somebody is suggesting toyou or Gary Brecker or any of
this that you need to have yourMTHFR gene measured, bullshit,
(12:15):
okay?
Because lowering homocysteineis...
not related to a reduction againin events.
And we don't know, becausehomocysteine can be elevated in
people with mild renal failure.
We don't know what's going on,but it has no relation.
Second thing, as I told you inthe beginning, people who have
(12:36):
an MTHFR gene polymorphism, theTT variant, which he's trying to
tell you that you need to havemeasured, do not have any
clinically significant adversemedical events because they're,
quote, not methylating folicacid, because they all do
methylate folic acid, even inthat group, maybe to a lesser
(12:56):
amount, and they just needhigher levels of folic acid.
So how do you determine that?
Measure a folic acid level,okay?
And if somebody's deficient infolic acid, really deficient in
folic acid, you get a certaintype of anemia called the
macrocytic anemia, but yourbodily functions are are normal,
so you don't need it.
(13:17):
And then the third thing is, asI also said, is an MTHFR gene
polymorphism is not associatedwith deep venous thrombosis and
blood clotting.
O'Connor published an amazingstudy in the New England Journal
of Medicine, I think it was2017, 2018, and their conclusion
in a large trial was it's noteven worth measuring MTHFR
(13:41):
because there is no realevidence to show that it's
associated with clotting.
So I know this is a complicatedtopic, but I'm trying to set the
record straight, avoid you fromwasting your money.
If there was a need, you can goto LabCorp or Quest or any lab
and have it measured and coveredby insurance.
(14:01):
And my challenge, have Dr.
Fiorillo and me, we'd love to goon Megyn Kelly or Joe Rogan and
any of these other people anddebate Gary Brecker, any of
these other influencers who arenot doctors, and set the record
straight.
Because when it comes to yourhealth, the truth matters.
All right, I hope everybody hasa good day.
Thanks a lot.
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