January 16, 2025 • 29 mins
Take the Health Type Quiz
Ever wondered how a simple experiment could change your health forever? In today's episode, I reveal the transformative power of N of 1 trials—a method for crafting personalized health strategies that cater to your unique needs.
Discover how my own trials with salt, apple cider vinegar, creatine, and magnesium have led to significant health revelations, and how you too can harness this method to go beyond generalized study results. Whether you're a holistic health enthusiast, a methodical planner, or just looking to enhance your well-being, our tailored approach will equip you with the knowledge to make informed health decisions.
We'll embark on a journey to revolutionize personal health insights through N of 1 trials, highlighting when this method is most beneficial—like when current data doesn't tell the full story.
Understand the step-by-step process of conducting your own trial, from choosing the right intervention to measuring outcomes using everyday tools like blood pressure monitors or wearable technology.
I also want to celebrate a key milestone with you as we reach 100,000 downloads and that is all because of you so thank you for your listenership and I can't wait for more episodes to come!
Time Stamps:
(1:30) N Of 1 Trials
(2:43) My Health Type Quiz
(3:53) 100,000 Downloads
(5:32) My N of 1 Trial Example
(8:46) The Genesis of N of 1 Trials
(10:42) New England Journal of Medicine Study
(13:03) What Are N of 1 Trials?*
(15:31) N of 1 Trials in Non-Health Scenarios
(16:10) When To Use N of 1 Trials
(19:35) When N of 1 Isn’t An Option
(20:29) N of 1 Trial Steps
(25:25) What To Do About The Placebo Effect
(28:28) Let Me Know What You Think!
----------
Research Mentioned In This Episode:
1. History of N of 1
2. 1986 New England Study on Randomized Trials for Individual Patients
----------
Work with Dr. Bobby: https://drbobbylivelongandwell.com/mastermind-waitlist
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
We all want personalized medicine and
knowing what will work for us.
The N of 1 technique allows usto test whether a cool bedroom
improves our sleep, or magnesiumreduces muscle cramps, or
reducing salt lowers my bloodpressure.
Studies give us averages.
(00:21):
We want to know what will makea difference for us.
Hi, I'm Dr Bobby Du Bois andwelcome.
To Live Long and Well, apodcast where we will talk about
(00:42):
what you can do to live as longas possible and with as much
energy and vigor that you wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
(01:03):
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome everyone to Episode 27,27.
One person, one studyrevolutionizing your health
(01:27):
journey with N of 1 trials.
Now, in prior episodes we'vetalked about N of 1 studies or N
of 1 trials.
We talked about it in thenutrition episode, the sleep
episode and, most recently, whenwe talked about New Year's
resolutions.
(01:48):
N of 1 studies is a simple wayto test what works for you.
It is a scientific study of oneperson, and that one person is
you To answer questions likewill cooler bedrooms help me
sleep?
Or what about a hot showerbefore bed?
(02:10):
Will that help my sleep?
Or will reducing saturated fatshelp our cholesterol levels?
Is our blood pressure sensitiveto salt?
These and many more questionscan really really be tested with
our N of 1 studies.
So for today, I would like totake a bit of time and explore
(02:34):
with you the what, the when andthe how of N of 1 trials.
Now, we've talked a lot abouthealth types before, and if you
haven't taken the quiz, pleasedo so because, as you know, I
will refer to this a lot.
If you're a holistic healthhacker, somebody who's dialing
(02:56):
in the latest and greatest,trying the N of 1 approach is
perfect because they want tolearn the most about what to do
better for their health.
Well, if you're a purposefulpath planner, you often get lost
in the choices.
But here again, the N of oneapproach may allow you to test
(03:20):
and find out what's likely towork for you.
And find out what's likely towork for you.
Even the contentment creatorwho's happy with their life in
general and doesn't wanna giveup too much for their health
might consider a change if therewas a quick test, the end of
one approach that might convincethem that a small change really
(03:43):
really could be powerful.
So remind yourself which healthtype you are and join us for
the ride over the next half hour.
Well, before diving in anyfurther, I want to say a
heartfelt thank you.
Today, right before sitting downto record this episode, I got
(04:04):
an email that I've had my100,000th download.
Now, for major podcasters, thatnumber is pretty tiny.
They might get that many in aday or a couple of hours, but
for me this is a major milestone, and that's all because of you.
(04:25):
My goal is to help you and asmany people as I can.
As you know, the episodes arefree.
There's no advertising, there'sno subscriptions.
It's really just about theenjoyment of helping others, and
if you enjoy the show, pleaseshare it with a few members of
(04:46):
your family and some friends,and so maybe the number of
followers will grow and thenumber of downloads and people
helped will also grow.
Well, nothing new here.
I have to start with my end ofone personal story, or, in this
case, my four personal stories.
I've always been fascinated byend of one trials.
(05:09):
Going far back is my medicalschool years and my residency
years and my research phasesafter that.
But it really came to fruitionfor me when I tested things on
myself which really had a bigdifference.
So some years ago I wasdiagnosed with high blood
(05:32):
pressure not high high, butenough that it was worth asking
myself the question.
I wonder, if I cut out salt inmy diet, whether that might
lower blood pressure.
Because if you look at largestudies on balance, lower salt
does reduce blood pressure.
But not all of us are saltsensitive and I'm one of the 25%
(05:56):
or so when I reduce my salt orincrease my salt.
It had no impact on my bloodpressure.
So a simple test over a coupleof weeks of reduced salt diet
and I knew what was right for me.
More recently last year, therewas a headline which was apple
cider vinegar.
(06:17):
Two tablespoons a day led to 12pounds weight loss.
Well, the study seemed like itwas well done, but I just
thought, you know if it soundstoo good to be true, it probably
is.
But I figured well, what theheck?
It's only apple cider vinegar.
I'll give it a try and see ifit affects my weight in any way.
(06:39):
Bottom line this one didn'twork.
No impact for me and of course,after a few weeks I decided no
more apple cider vinegar everymorning.
I've been trying to increasemuscle strength, muscle mass,
and I've had a whole series ofend-of-one trials to figure out
(06:59):
what works and specifically askthe question what about creatine
as a supplement?
It's been shown in studies tohelp a bunch of people, but not
everybody.
So I did a DEXA scan whichmeasured my muscle mass and in
each of my limbs started thecreatine.
Of course I had been doingstrength training and definitely
(07:24):
was eating enough protein.
So the new factor that I wastesting was creatine.
Lo and behold, within sixmonths I had gained several
pounds of muscle and I havecontinued to take creatine.
But again, I wouldn't haveknown that without my N of 1
study.
And finally, magnesium.
Some people say everybodyshould be on magnesium.
(07:46):
Some people say, well, onlycertain people should be on
magnesium.
And the data frankly isn't allthat great to tell us who should
take magnesium or not.
Frankly isn't all that great totell us who should take
magnesium or not.
I live in Texas, very hot, Iwork on the ranch, I sweat a lot
during the summer and I getreally tough muscle cramps.
So I decided oh, I'll try an Nof 1 study with magnesium.
(08:10):
Well, took magnesium for awhile, cramping seemed to be
better.
Stopped the magnesium for awhile, cramping seemed to be
better.
Stopped the magnesium for awhile, cramping came back.
Started it up again, crampinggot better.
So for me the end-of-one trialshave really helped me to
personalize what I do and refinehow I approach my health.
(08:34):
Well, end-of-one trials werenot invented by me, certainly
and refine how I approach myhealth.
Well, n of 1 trials were notinvented by me, certainly.
Maybe I've popularized themquite a bit, but certainly I
didn't invent it.
In fact it goes back to the1600s where the first reported N
of 1 trial happened.
There was a surgeon who tookcare of King Charles II and this
(09:00):
surgeon had a patient.
He came in with leg edema,large swollen legs where fluid
was collecting.
It was so bad he was gettingskin ulceration.
He wasn't able to walk a lot,couldn't go out in the carriage
in the nice air in the 1600s andit was a real problem.
(09:24):
So he decided, the surgeon, toput some laced stockings that
would compress the leg.
Lo and behold, the patient gotbetter, was able to walk around,
go in his carriage, enjoy hislife so much more.
But then somebody said to himoh, wait a second, those
(09:45):
stockings could be harmful toyou.
And so he stopped the stockingsand you can probably guess what
happened next the swelling cameback, the edema came back, the
ulcers of his skin came back.
Well, they waited about sixweeks, got the ulcers and the
skin cured, put him back on thelace stockings and once again he
(10:08):
was much better.
So that's the first recorded Nof 1 trial.
Perhaps there were ones beforethat, but that's the first one
that was recorded.
Well, about 100 years ago,around 1930, there were a set of
principles that were developedby a scientific group and these
were about how to do N of 1studies properly.
(10:31):
Now this was largely ignoredand so nobody really did a lot
of N of 1 studies at all.
Then there was a reallyimportant article that came out
in the New England Journal ofMedicine in 1986 describing a
patient with asthma that wasreally poorly controlled.
(10:51):
Asthma had a hard time feelingcomfortable.
Poorly controlled asthma had ahard time feeling comfortable
and the patient was on atheophylline which at the time
was a very common way to treatasthma a beta agonist like the
inhalers that people often usetoday, and a steroid on
prednisone and they decided theywere going to do an N of 1
trial where they would eithergive the patient theophylline
(11:16):
along with their othermedications or a placebo, and
the patient didn't know whatthey were getting.
So they were on the firstapproach for a while.
Patient then determined theirsymptoms and they were on the
other approach, alternating backand forth between the placebo
and the theophylline, and thepatient was like oh, I
absolutely feel better when Itake pill A than I do when I
(11:42):
take pill B.
Of course everybody thought thepillA was going to be
theophylline.
Well, it turned out it wasactually the placebo.
He felt better on the placebo,not because the placebo was
benefiting him, but thetheophylline actually was making
his asthma worse.
So it was a win-win-win Patientfelt better on fewer meds,
(12:07):
spent less money on drugs, andthis article led to a lot of
excitement.
But N of 1 studies still didn'tcatch on and to this day most
people feel that the bestevidence is a randomized,
controlled trial of a largegroup of people and that the N
(12:29):
of 1 approach may not be aseasily performed or analyzable
in the ways that people mightwant.
Now, that may be true if you'relooking at trying to get a drug
approved or a certain newtreatment.
But if you're trying to figureout whether a particular
treatment works for you,especially if it's not a
(12:53):
prescribed drug, like the thingsI've been talking about, the N
of 1 approach just like I sharedhas been helpful to me and I
think it can be really helpfulfor you.
Well, what are N of 1 trials?
It's a way of testing whatworks for you, a desire to
(13:15):
create a personalized medicineapproach.
Now, if you do a study in lotsof people, you'll get an average
.
Well, on average, when patientstake a certain blood pressure
medicine, their blood pressurefalls three to five points, but
that's an average.
Some people's blood pressurefalls a lot more and, frankly,
(13:39):
some people's blood pressurefalls very, very, very little.
But all we know in thepublished trials is the average.
That doesn't necessarily meanthe average will apply to you.
Similarly, we know that goingout in the morning and getting
some sunlight helps to set ourcircadian rhythms and may help
(14:02):
people sleep better, but again,this is on average.
We also know that for largestudies, plant-based diets might
lower cholesterol, but again,that's for some people, not for
everyone, and there are alsotimes where we frankly just
(14:24):
don't have any real evidence ofwhat works or not, or it hasn't
been studied in women.
Maybe it was studied in men,maybe it was studied in young
people, but not in old people.
So there's a lot ofopportunities to use it.
So an NF1 trial at its highestlevel.
You find a focus or a treatmentyou're interested in testing.
(14:46):
You measure a baseline when amI today?
You try that new intervention,maybe a new diet, maybe a colder
bedroom it could be any ofnumber of things.
Wait a period of time, measurewhat's happened.
If something good has happenedyou got better Stop the
(15:08):
intervention.
See if your symptoms go back tothe way they used to be.
If your symptoms go back to theway they used to be, restart
the intervention.
See if it gets better again.
And you can repeat this as manytimes as you feel you want to,
and then you'll get your answer.
So that's what it is at a highlevel.
(15:33):
Now, all the examples that I'vetalked about are related to
health issues, but it can alsobe used in non-health issues.
Perhaps your test will begetting up early and getting
into work early.
Are you more productive?
Are things better at work foryou than when you come in later?
Or you might find a newapproach to talking with your
spouse or your kids.
(15:54):
You could test it, try analternative approach, so on and
so forth.
So you may find that thetechniques we're going to talk
about may be applicable morebroadly.
Okay, so when might you thinkabout doing an N of 1 trial?
It can't solve all the world'sproblems.
(16:16):
It can't solve every questionknown to man, but there are some
characteristics of when itmight be very helpful.
First, when the data aren't soobvious.
For example, some people arguethat magnesium helps sleep and
the studies, frankly, are veryconfused on this topic.
(16:38):
But it may help certain people.
Why not do an N of 1 trial andsee if it helps you?
As I've talked about, loweringsalt in my diet didn't affect my
blood pressure and when I triedchanging my diet to reduce
cholesterol levels didn't domuch of anything for me.
(16:58):
So when the data aren't obviousabout what to do, might be a
good time to think about an N of1 study.
Secondly, really important, anN of 1 study really works great
when the outcome, the changeyou're looking for, can happen
in the near term.
So if I'm going to try a newtechnique for sleep and on my
(17:22):
episode on sleep.
I talk about 12 different thingsyou can do or not do to improve
your sleep.
Each one of these can be tested.
The beauty is that if you tried, for example, taking a hot
shower or a sauna before bed tosee if that helped, you're going
to know within days whether itworks.
(17:44):
Or maybe you're going to cutout alcohol and see if that
improves your sleep Again acouple of days you'll have an
answer.
For me, when I was testingcreatine, it took a couple of
months weeks to months.
So again, these are short-termchanges that you can measure Now
(18:04):
.
An N of 1 study will not work ifit's a lifelong intervention.
For example, some people wouldargue omega-3 fatty acids reduce
the risk of cardiovasculardisease or dementia or any of
the other things.
Large studies don't show thatit works.
But you would think, could I dosomething of an N of 1 nature
(18:29):
and test it in me?
Well, the problem is thatyou're not going to know the
answer for 20, 30, or 40 years.
It's not something you canstart, see a benefit, stop, see
that it goes away.
Similarly, you wouldn't want todo an end-of-one study on
should I treat my diabetes andwill it prevent heart disease,
(18:49):
because, again, it's a 30-yearproposition and you're not
stopping and starting Now.
The other characteristic of whento consider an N of 1 study is
that it's safe to start and stopthe intervention, like when
we're talking about sleep andyou're thinking about a cold
(19:12):
bedroom.
There's no harm in having anormal temperature and a low
temperature, going back andforth.
If your blood pressure isn'tsky high, just borderline high
again, no harm in trying alow-salt diet for a while and
seeing what happens, then goingback to a regular diet and back
and forth.
Now the final criteria is whenyou really can't do an N of 1
(19:39):
trial, and that's when you havea single chance to get it right.
You have a bad case of cancerand you need chemotherapy.
Well, you can't do an N of onetrial here.
You're going to go forth withthe chemotherapy regimen based
upon the clinical studies andhope for the best.
Not a real opportunity to dotesting in yourself If you have
(20:03):
a very serious infection and youneed antibiotics again, it's
not something you're going totest in the end of one way, but
there are many, many things youcan use this technique for and I
hope you will give it a try.
Okay, let's get down to breadand butter or brass tacks or
whatever words you want to use.
(20:25):
How can we do one?
Well, you can't even thinkabout doing one until you figure
out.
What am I trying to test?
What is it that I think mightmake a difference in my life and
what would I accomplish?
What is the improvement thatI'm hoping I can measure?
(20:47):
Okay, with that as the preamble, there are a series of steps.
Step one figure out what thatintervention is going to be.
I've given you a number ofdifferent examples intervention
is going to be.
I've given you a number ofdifferent examples and then
determine what your outcome.
What are you going to measure?
And think also about theduration.
(21:08):
Is this something that's goingto take a week to figure out?
A month or longer?
So, if you're thinking of dietand blood pressure or diet and
cholesterol, now you'veidentified the intervention,
you've identified what theoutcome is and you'll have to
figure out how long you want totest it for.
Or maybe it's going to be oneof the 12 approaches to sleep.
(21:32):
That's step one.
Step two measure your baseline.
Ideally, the end-of-one approachis going to be based on
something quantitative that youcan measure and remeasure.
So, if you're thinking aboutblood pressure and diet.
Get a home blood pressuremonitor, go to your local
(21:54):
pharmacy costs about $100, andnow you can take your blood
pressure at home as often as youwant.
Or maybe you're going to testyour diet and its impact on your
cholesterol levels.
Yes, you can go to your doctor,work with your doctor on all of
this, but you might also beable to get a blood test for
your cholesterol at your localpharmacy and make it convenient
(22:18):
when you're going to thedrugstore for other reasons or
the market down the street.
Or if you want to focus onsleep, if you have an Oura ring
or a Fitbit or even many of thesmartwatches, you can use that.
But again, it's quantitative.
If you're going to be doing anintervention and you're hoping
(22:39):
it will maybe reduce youranxiety level or reduce the
amount of sadness that you haveover the course of a day, maybe
you're going to test exercise tosee if it helps those.
Yes, you could ask yourselfeach day on a scale of one to
five you know how's my anxietylevel?
Five, you know how's my anxietylevel.
(23:05):
But there are so manyquestionnaires on the web for
almost any symptom you mightwant to know and you could take
these five, question eight,question 10, question
questionnaires and get a numberand then you can compare that
number over time.
I'm very big on havingsomething quantitative.
Step three, the obvious one trythe new thing, whether it's the
(23:25):
diet, the sleep aid, whatever itmight be.
Next, measure the response.
Do that same baselinemeasurement again, whether it's
your blood pressure, it's yourweight, it's your sleep scores
or the questionnaire that you'redoing.
So you'll then measure again Ifit's successful.
(23:49):
We want to make sure that it'sreal.
Maybe it was a placebo effect.
Oh, by the way, placebo effectwill be my next podcast that
will be coming out.
So you want to stop theintervention and see if the
problem recurs.
The blood pressure goes back up, the sleep gets worse, the
(24:10):
anxiety level is no longer undercontrol and then, if you wish,
restart the intervention,remeasure, and you can start and
stop as many times as you wantto convince yourself that what
you're doing truly haspersonalized your approach to
(24:34):
health and wellness.
Here's a tricky one, and we'lltalk about this a lot more on
the episode related to placebo.
But let's say I was thinkingmagnesium might help my sleep.
Well, the placebo effect meansthat, as I take the magnesium,
(24:55):
even if the magnesium isn'tactually technically
biochemically helping me,actually technically
biochemically helping me.
If I believe it's going to helpmy sleep, it might actually
help my sleep.
Now I have nothing againstplacebos and we're going to talk
and learn about that.
But ideally, if you're going totest something like magnesium
(25:15):
in your sleep, create your ownplacebo meaning perhaps have
your spouse go to the market andbuy magnesium in a pill or
capsule and buy something elseMaybe it's calcium or something
(25:36):
that looks like a pill and thenhave your spouse give you the
pills and say, okay, for thenext week you're going to use
this round pill and then theweek after we're going to give
you the red pill.
Now you're not going to knowwhich one was actually the
(25:57):
magnesium and which wassomething else that wasn't going
to help your sleep, buteventually you will ask your
spouse which was which, justlike the theophylline story I
told you about in the NewEngland Journal of Medicine
article and you'll break thecode and know whether the
magnesium in fact helped yoursleep.
(26:18):
This is a more kind of an addedstep, but if you are able to
build into it the placebo, wow,that could be really, really
powerful.
Or if you're thinking, you know, maybe the blue light glasses
that people say might help yoursleep.
You know, you can't really tellthe difference.
(26:40):
Maybe somebody buys you twosets of glasses One is blue
light, one's not and again youcan get rid of the placebo
effect.
Time to wrap up, the end of onestudy or trial or approach.
The concept is quitestraightforward Test and figure
(27:01):
out what works for you.
The technique as I've talkedabout isn't difficult and I will
have a blog article about this.
So by all means, go to mywebsite,
drbobbylivelongandwellcom, andyou can see the various steps
written out.
If you need help on doing N of1 studies and making it apply to
(27:24):
you, go to my website.
Again, look at the blog and onmy website there'll be ways you
could request to work with medirectly.
I mentioned at the outset thatyou could try the N of 1
approach for non-health issues.
You might say well, I wonder ifvolunteering at a local
(27:46):
organization might make mehappier and you could again
measure a happinessquestionnaire.
Volunteer a couple of weeks ina row, remeasure your happiness.
Then do something else forthose same hours, see if your
happiness level is lower.
Or maybe you'll call yourmother more often and you'll
(28:10):
test how connected you feel toher and how connected you think
she is with you.
Or, as I said earlier, youmight get to the office 30
minutes earlier and see ifyou're more productive.
So that's it.
I hope you try the end of oneapproach.
I really would like you to giveme some feedback both on the
(28:33):
episode and my podcast ingeneral, and if you try the end
of one approach, you can replywithin your podcast app and send
me a note, or you can go to thewebsite
drbobbylivelongandwellcom.
Until next time, may you tryand succeed with N of 1
(28:54):
approaches to live long and well.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
(29:17):
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobblivelongandwellcom.
That's, doctor, as in D-R Bobbylive long and wellcom.
We all want personalized medicine and
knowing what will work for us.
The N of 1 technique allows usto test whether a cool bedroom
improves our sleep, or magnesiumreduces muscle cramps, or
reducing salt lowers my bloodpressure.
Studies give us averages.
(00:21):
We want to know what will makea difference for us.
Hi, I'm Dr Bobby Du Bois andwelcome.
To Live Long and Well, apodcast where we will talk about
(00:42):
what you can do to live as longas possible and with as much
energy and vigor that you wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
(01:03):
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome everyone to Episode 27,27.
One person, one studyrevolutionizing your health
(01:27):
journey with N of 1 trials.
Now, in prior episodes we'vetalked about N of 1 studies or N
of 1 trials.
We talked about it in thenutrition episode, the sleep
episode and, most recently, whenwe talked about New Year's
resolutions.
(01:48):
N of 1 studies is a simple wayto test what works for you.
It is a scientific study of oneperson, and that one person is
you To answer questions likewill cooler bedrooms help me
sleep?
Or what about a hot showerbefore bed?
(02:10):
Will that help my sleep?
Or will reducing saturated fatshelp our cholesterol levels?
Is our blood pressure sensitiveto salt?
These and many more questionscan really really be tested with
our N of 1 studies.
So for today, I would like totake a bit of time and explore
(02:34):
with you the what, the when andthe how of N of 1 trials.
Now, we've talked a lot abouthealth types before, and if you
haven't taken the quiz, pleasedo so because, as you know, I
will refer to this a lot.
If you're a holistic healthhacker, somebody who's dialing
(02:56):
in the latest and greatest,trying the N of 1 approach is
perfect because they want tolearn the most about what to do
better for their health.
Well, if you're a purposefulpath planner, you often get lost
in the choices.
But here again, the N of oneapproach may allow you to test
(03:20):
and find out what's likely towork for you.
And find out what's likely towork for you.
Even the contentment creatorwho's happy with their life in
general and doesn't wanna giveup too much for their health
might consider a change if therewas a quick test, the end of
one approach that might convincethem that a small change really
(03:43):
really could be powerful.
So remind yourself which healthtype you are and join us for
the ride over the next half hour.
Well, before diving in anyfurther, I want to say a
heartfelt thank you.
Today, right before sitting downto record this episode, I got
(04:04):
an email that I've had my100,000th download.
Now, for major podcasters, thatnumber is pretty tiny.
They might get that many in aday or a couple of hours, but
for me this is a major milestone, and that's all because of you.
(04:25):
My goal is to help you and asmany people as I can.
As you know, the episodes arefree.
There's no advertising, there'sno subscriptions.
It's really just about theenjoyment of helping others, and
if you enjoy the show, pleaseshare it with a few members of
(04:46):
your family and some friends,and so maybe the number of
followers will grow and thenumber of downloads and people
helped will also grow.
Well, nothing new here.
I have to start with my end ofone personal story, or, in this
case, my four personal stories.
I've always been fascinated byend of one trials.
(05:09):
Going far back is my medicalschool years and my residency
years and my research phasesafter that.
But it really came to fruitionfor me when I tested things on
myself which really had a bigdifference.
So some years ago I wasdiagnosed with high blood
(05:32):
pressure not high high, butenough that it was worth asking
myself the question.
I wonder, if I cut out salt inmy diet, whether that might
lower blood pressure.
Because if you look at largestudies on balance, lower salt
does reduce blood pressure.
But not all of us are saltsensitive and I'm one of the 25%
(05:56):
or so when I reduce my salt orincrease my salt.
It had no impact on my bloodpressure.
So a simple test over a coupleof weeks of reduced salt diet
and I knew what was right for me.
More recently last year, therewas a headline which was apple
cider vinegar.
(06:17):
Two tablespoons a day led to 12pounds weight loss.
Well, the study seemed like itwas well done, but I just
thought, you know if it soundstoo good to be true, it probably
is.
But I figured well, what theheck?
It's only apple cider vinegar.
I'll give it a try and see ifit affects my weight in any way.
(06:39):
Bottom line this one didn'twork.
No impact for me and of course,after a few weeks I decided no
more apple cider vinegar everymorning.
I've been trying to increasemuscle strength, muscle mass,
and I've had a whole series ofend-of-one trials to figure out
(06:59):
what works and specifically askthe question what about creatine
as a supplement?
It's been shown in studies tohelp a bunch of people, but not
everybody.
So I did a DEXA scan whichmeasured my muscle mass and in
each of my limbs started thecreatine.
Of course I had been doingstrength training and definitely
(07:24):
was eating enough protein.
So the new factor that I wastesting was creatine.
Lo and behold, within sixmonths I had gained several
pounds of muscle and I havecontinued to take creatine.
But again, I wouldn't haveknown that without my N of 1
study.
And finally, magnesium.
Some people say everybodyshould be on magnesium.
(07:46):
Some people say, well, onlycertain people should be on
magnesium.
And the data frankly isn't allthat great to tell us who should
take magnesium or not.
Frankly isn't all that great totell us who should take
magnesium or not.
I live in Texas, very hot, Iwork on the ranch, I sweat a lot
during the summer and I getreally tough muscle cramps.
So I decided oh, I'll try an Nof 1 study with magnesium.
(08:10):
Well, took magnesium for awhile, cramping seemed to be
better.
Stopped the magnesium for awhile, cramping seemed to be
better.
Stopped the magnesium for awhile, cramping came back.
Started it up again, crampinggot better.
So for me the end-of-one trialshave really helped me to
personalize what I do and refinehow I approach my health.
(08:34):
Well, end-of-one trials werenot invented by me, certainly
and refine how I approach myhealth.
Well, n of 1 trials were notinvented by me, certainly.
Maybe I've popularized themquite a bit, but certainly I
didn't invent it.
In fact it goes back to the1600s where the first reported N
of 1 trial happened.
There was a surgeon who tookcare of King Charles II and this
(09:00):
surgeon had a patient.
He came in with leg edema,large swollen legs where fluid
was collecting.
It was so bad he was gettingskin ulceration.
He wasn't able to walk a lot,couldn't go out in the carriage
in the nice air in the 1600s andit was a real problem.
(09:24):
So he decided, the surgeon, toput some laced stockings that
would compress the leg.
Lo and behold, the patient gotbetter, was able to walk around,
go in his carriage, enjoy hislife so much more.
But then somebody said to himoh, wait a second, those
(09:45):
stockings could be harmful toyou.
And so he stopped the stockingsand you can probably guess what
happened next the swelling cameback, the edema came back, the
ulcers of his skin came back.
Well, they waited about sixweeks, got the ulcers and the
skin cured, put him back on thelace stockings and once again he
(10:08):
was much better.
So that's the first recorded Nof 1 trial.
Perhaps there were ones beforethat, but that's the first one
that was recorded.
Well, about 100 years ago,around 1930, there were a set of
principles that were developedby a scientific group and these
were about how to do N of 1studies properly.
(10:31):
Now this was largely ignoredand so nobody really did a lot
of N of 1 studies at all.
Then there was a reallyimportant article that came out
in the New England Journal ofMedicine in 1986 describing a
patient with asthma that wasreally poorly controlled.
(10:51):
Asthma had a hard time feelingcomfortable.
Poorly controlled asthma had ahard time feeling comfortable
and the patient was on atheophylline which at the time
was a very common way to treatasthma a beta agonist like the
inhalers that people often usetoday, and a steroid on
prednisone and they decided theywere going to do an N of 1
trial where they would eithergive the patient theophylline
(11:16):
along with their othermedications or a placebo, and
the patient didn't know whatthey were getting.
So they were on the firstapproach for a while.
Patient then determined theirsymptoms and they were on the
other approach, alternating backand forth between the placebo
and the theophylline, and thepatient was like oh, I
absolutely feel better when Itake pill A than I do when I
(11:42):
take pill B.
Of course everybody thought thepillA was going to be
theophylline.
Well, it turned out it wasactually the placebo.
He felt better on the placebo,not because the placebo was
benefiting him, but thetheophylline actually was making
his asthma worse.
So it was a win-win-win Patientfelt better on fewer meds,
(12:07):
spent less money on drugs, andthis article led to a lot of
excitement.
But N of 1 studies still didn'tcatch on and to this day most
people feel that the bestevidence is a randomized,
controlled trial of a largegroup of people and that the N
(12:29):
of 1 approach may not be aseasily performed or analyzable
in the ways that people mightwant.
Now, that may be true if you'relooking at trying to get a drug
approved or a certain newtreatment.
But if you're trying to figureout whether a particular
treatment works for you,especially if it's not a
(12:53):
prescribed drug, like the thingsI've been talking about, the N
of 1 approach just like I sharedhas been helpful to me and I
think it can be really helpfulfor you.
Well, what are N of 1 trials?
It's a way of testing whatworks for you, a desire to
(13:15):
create a personalized medicineapproach.
Now, if you do a study in lotsof people, you'll get an average
.
Well, on average, when patientstake a certain blood pressure
medicine, their blood pressurefalls three to five points, but
that's an average.
Some people's blood pressurefalls a lot more and, frankly,
(13:39):
some people's blood pressurefalls very, very, very little.
But all we know in thepublished trials is the average.
That doesn't necessarily meanthe average will apply to you.
Similarly, we know that goingout in the morning and getting
some sunlight helps to set ourcircadian rhythms and may help
(14:02):
people sleep better, but again,this is on average.
We also know that for largestudies, plant-based diets might
lower cholesterol, but again,that's for some people, not for
everyone, and there are alsotimes where we frankly just
(14:24):
don't have any real evidence ofwhat works or not, or it hasn't
been studied in women.
Maybe it was studied in men,maybe it was studied in young
people, but not in old people.
So there's a lot ofopportunities to use it.
So an NF1 trial at its highestlevel.
You find a focus or a treatmentyou're interested in testing.
(14:46):
You measure a baseline when amI today?
You try that new intervention,maybe a new diet, maybe a colder
bedroom it could be any ofnumber of things.
Wait a period of time, measurewhat's happened.
If something good has happenedyou got better Stop the
(15:08):
intervention.
See if your symptoms go back tothe way they used to be.
If your symptoms go back to theway they used to be, restart
the intervention.
See if it gets better again.
And you can repeat this as manytimes as you feel you want to,
and then you'll get your answer.
So that's what it is at a highlevel.
(15:33):
Now, all the examples that I'vetalked about are related to
health issues, but it can alsobe used in non-health issues.
Perhaps your test will begetting up early and getting
into work early.
Are you more productive?
Are things better at work foryou than when you come in later?
Or you might find a newapproach to talking with your
spouse or your kids.
(15:54):
You could test it, try analternative approach, so on and
so forth.
So you may find that thetechniques we're going to talk
about may be applicable morebroadly.
Okay, so when might you thinkabout doing an N of 1 trial?
It can't solve all the world'sproblems.
(16:16):
It can't solve every questionknown to man, but there are some
characteristics of when itmight be very helpful.
First, when the data aren't soobvious.
For example, some people arguethat magnesium helps sleep and
the studies, frankly, are veryconfused on this topic.
(16:38):
But it may help certain people.
Why not do an N of 1 trial andsee if it helps you?
As I've talked about, loweringsalt in my diet didn't affect my
blood pressure and when I triedchanging my diet to reduce
cholesterol levels didn't domuch of anything for me.
(16:58):
So when the data aren't obviousabout what to do, might be a
good time to think about an N of1 study.
Secondly, really important, anN of 1 study really works great
when the outcome, the changeyou're looking for, can happen
in the near term.
So if I'm going to try a newtechnique for sleep and on my
(17:22):
episode on sleep.
I talk about 12 different thingsyou can do or not do to improve
your sleep.
Each one of these can be tested.
The beauty is that if you tried, for example, taking a hot
shower or a sauna before bed tosee if that helped, you're going
to know within days whether itworks.
(17:44):
Or maybe you're going to cutout alcohol and see if that
improves your sleep Again acouple of days you'll have an
answer.
For me, when I was testingcreatine, it took a couple of
months weeks to months.
So again, these are short-termchanges that you can measure Now
(18:04):
.
An N of 1 study will not work ifit's a lifelong intervention.
For example, some people wouldargue omega-3 fatty acids reduce
the risk of cardiovasculardisease or dementia or any of
the other things.
Large studies don't show thatit works.
But you would think, could I dosomething of an N of 1 nature
(18:29):
and test it in me?
Well, the problem is thatyou're not going to know the
answer for 20, 30, or 40 years.
It's not something you canstart, see a benefit, stop, see
that it goes away.
Similarly, you wouldn't want todo an end-of-one study on
should I treat my diabetes andwill it prevent heart disease,
(18:49):
because, again, it's a 30-yearproposition and you're not
stopping and starting Now.
The other characteristic of whento consider an N of 1 study is
that it's safe to start and stopthe intervention, like when
we're talking about sleep andyou're thinking about a cold
(19:12):
bedroom.
There's no harm in having anormal temperature and a low
temperature, going back andforth.
If your blood pressure isn'tsky high, just borderline high
again, no harm in trying alow-salt diet for a while and
seeing what happens, then goingback to a regular diet and back
and forth.
Now the final criteria is whenyou really can't do an N of 1
(19:39):
trial, and that's when you havea single chance to get it right.
You have a bad case of cancerand you need chemotherapy.
Well, you can't do an N of onetrial here.
You're going to go forth withthe chemotherapy regimen based
upon the clinical studies andhope for the best.
Not a real opportunity to dotesting in yourself If you have
(20:03):
a very serious infection and youneed antibiotics again, it's
not something you're going totest in the end of one way, but
there are many, many things youcan use this technique for and I
hope you will give it a try.
Okay, let's get down to breadand butter or brass tacks or
whatever words you want to use.
(20:25):
How can we do one?
Well, you can't even thinkabout doing one until you figure
out.
What am I trying to test?
What is it that I think mightmake a difference in my life and
what would I accomplish?
What is the improvement thatI'm hoping I can measure?
(20:47):
Okay, with that as the preamble, there are a series of steps.
Step one figure out what thatintervention is going to be.
I've given you a number ofdifferent examples intervention
is going to be.
I've given you a number ofdifferent examples and then
determine what your outcome.
What are you going to measure?
And think also about theduration.
(21:08):
Is this something that's goingto take a week to figure out?
A month or longer?
So, if you're thinking of dietand blood pressure or diet and
cholesterol, now you'veidentified the intervention,
you've identified what theoutcome is and you'll have to
figure out how long you want totest it for.
Or maybe it's going to be oneof the 12 approaches to sleep.
(21:32):
That's step one.
Step two measure your baseline.
Ideally, the end-of-one approachis going to be based on
something quantitative that youcan measure and remeasure.
So, if you're thinking aboutblood pressure and diet.
Get a home blood pressuremonitor, go to your local
(21:54):
pharmacy costs about $100, andnow you can take your blood
pressure at home as often as youwant.
Or maybe you're going to testyour diet and its impact on your
cholesterol levels.
Yes, you can go to your doctor,work with your doctor on all of
this, but you might also beable to get a blood test for
your cholesterol at your localpharmacy and make it convenient
(22:18):
when you're going to thedrugstore for other reasons or
the market down the street.
Or if you want to focus onsleep, if you have an Oura ring
or a Fitbit or even many of thesmartwatches, you can use that.
But again, it's quantitative.
If you're going to be doing anintervention and you're hoping
(22:39):
it will maybe reduce youranxiety level or reduce the
amount of sadness that you haveover the course of a day, maybe
you're going to test exercise tosee if it helps those.
Yes, you could ask yourselfeach day on a scale of one to
five you know how's my anxietylevel?
Five, you know how's my anxietylevel.
(23:05):
But there are so manyquestionnaires on the web for
almost any symptom you mightwant to know and you could take
these five, question eight,question 10, question
questionnaires and get a numberand then you can compare that
number over time.
I'm very big on havingsomething quantitative.
Step three, the obvious one trythe new thing, whether it's the
(23:25):
diet, the sleep aid, whatever itmight be.
Next, measure the response.
Do that same baselinemeasurement again, whether it's
your blood pressure, it's yourweight, it's your sleep scores
or the questionnaire that you'redoing.
So you'll then measure again Ifit's successful.
(23:49):
We want to make sure that it'sreal.
Maybe it was a placebo effect.
Oh, by the way, placebo effectwill be my next podcast that
will be coming out.
So you want to stop theintervention and see if the
problem recurs.
The blood pressure goes back up, the sleep gets worse, the
(24:10):
anxiety level is no longer undercontrol and then, if you wish,
restart the intervention,remeasure, and you can start and
stop as many times as you wantto convince yourself that what
you're doing truly haspersonalized your approach to
(24:34):
health and wellness.
Here's a tricky one, and we'lltalk about this a lot more on
the episode related to placebo.
But let's say I was thinkingmagnesium might help my sleep.
Well, the placebo effect meansthat, as I take the magnesium,
(24:55):
even if the magnesium isn'tactually technically
biochemically helping me,actually technically
biochemically helping me.
If I believe it's going to helpmy sleep, it might actually
help my sleep.
Now I have nothing againstplacebos and we're going to talk
and learn about that.
But ideally, if you're going totest something like magnesium
(25:15):
in your sleep, create your ownplacebo meaning perhaps have
your spouse go to the market andbuy magnesium in a pill or
capsule and buy something elseMaybe it's calcium or something
(25:36):
that looks like a pill and thenhave your spouse give you the
pills and say, okay, for thenext week you're going to use
this round pill and then theweek after we're going to give
you the red pill.
Now you're not going to knowwhich one was actually the
(25:57):
magnesium and which wassomething else that wasn't going
to help your sleep, buteventually you will ask your
spouse which was which, justlike the theophylline story I
told you about in the NewEngland Journal of Medicine
article and you'll break thecode and know whether the
magnesium in fact helped yoursleep.
(26:18):
This is a more kind of an addedstep, but if you are able to
build into it the placebo, wow,that could be really, really
powerful.
Or if you're thinking, you know, maybe the blue light glasses
that people say might help yoursleep.
You know, you can't really tellthe difference.
(26:40):
Maybe somebody buys you twosets of glasses One is blue
light, one's not and again youcan get rid of the placebo
effect.
Time to wrap up, the end of onestudy or trial or approach.
The concept is quitestraightforward Test and figure
(27:01):
out what works for you.
The technique as I've talkedabout isn't difficult and I will
have a blog article about this.
So by all means, go to mywebsite,
drbobbylivelongandwellcom, andyou can see the various steps
written out.
If you need help on doing N of1 studies and making it apply to
(27:24):
you, go to my website.
Again, look at the blog and onmy website there'll be ways you
could request to work with medirectly.
I mentioned at the outset thatyou could try the N of 1
approach for non-health issues.
You might say well, I wonder ifvolunteering at a local
(27:46):
organization might make mehappier and you could again
measure a happinessquestionnaire.
Volunteer a couple of weeks ina row, remeasure your happiness.
Then do something else forthose same hours, see if your
happiness level is lower.
Or maybe you'll call yourmother more often and you'll
(28:10):
test how connected you feel toher and how connected you think
she is with you.
Or, as I said earlier, youmight get to the office 30
minutes earlier and see ifyou're more productive.
So that's it.
I hope you try the end of oneapproach.
I really would like you to giveme some feedback both on the
(28:33):
episode and my podcast ingeneral, and if you try the end
of one approach, you can replywithin your podcast app and send
me a note, or you can go to thewebsite
drbobbylivelongandwellcom.
Until next time, may you tryand succeed with N of 1
(28:54):
approaches to live long and well.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
(29:17):
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobblivelongandwellcom.
That's, doctor, as in D-R Bobbylive long and wellcom.
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