Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#27: One Person, One Study: Revolutionizing Your Health Journey With N of 1 Trials
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!
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Research Mentioned In This Episode:
1. History of N of 1
2. 1986 New England Study on Randomized Trials for Individual Patients
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Work with Dr. Bobby: https://drbobbylivelongandwell.com/mastermind-waitlist
We all want personalized medicine and knowing what will work for us. The N of 1 technique allows us to test whether a cool bedroom improves our sleep, or magnesium reduces muscle cramps, or reducing salt lowers my blood pressure. Studies give us averages. We want to know what will make a difference for us. Hi, I'm Dr Bobby Du Bois and welcome. To Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome everyone to Episode 27, 27.
Speaker 1:One person, one study revolutionizing your health journey with N of 1 trials. Now, in prior episodes we've talked about N of 1 studies or N of 1 trials. We talked about it in the nutrition episode, the sleep episode and, most recently, when we talked about New Year's resolutions. N of 1 studies is a simple way to test what works for you. It is a scientific study of one person, and that one person is you To answer questions like will cooler bedrooms help me sleep? Or what about a hot shower before bed? Will that help my sleep? Or will reducing saturated fats help our cholesterol levels? Is our blood pressure sensitive to salt? These and many more questions can really really be tested with our N of 1 studies. So for today, I would like to take a bit of time and explore with you the what, the when and the how of N of 1 trials. Now, we've talked a lot about health types before, and if you haven't taken the quiz, please do so because, as you know, I will refer to this a lot.
Speaker 1:If you're a holistic health hacker, somebody who's dialing in the latest and greatest, trying the N of 1 approach is perfect because they want to learn the most about what to do better for their health. Well, if you're a purposeful path planner, you often get lost in the choices. But here again, the N of one approach may allow you to test and find out what's likely to work for you. And find out what's likely to work for you. Even the contentment creator who's happy with their life in general and doesn't wanna give up too much for their health might consider a change if there was a quick test, the end of one approach that might convince them that a small change really really could be powerful. So remind yourself which health type you are and join us for the ride over the next half hour. Well, before diving in any further, I want to say a heartfelt thank you.
Speaker 1:Today, right before sitting down to record this episode, I got an email that I've had my 100,000th download. Now, for major podcasters, that number is pretty tiny. They might get that many in a day or a couple of hours, but for me this is a major milestone, and that's all because of you. My goal is to help you and as many people as I can. As you know, the episodes are free. There's no advertising, there's no subscriptions. It's really just about the enjoyment of helping others, and if you enjoy the show, please share it with a few members of your family and some friends, and so maybe the number of followers will grow and the number of downloads and people helped will also grow.
Speaker 1:Well, nothing new here. I have to start with my end of one personal story, or, in this case, my four personal stories. I've always been fascinated by end of one trials. Going far back is my medical school years and my residency years and my research phases after that. But it really came to fruition for me when I tested things on myself which really had a big difference. So some years ago I was diagnosed with high blood pressure not high high, but enough that it was worth asking myself the question. I wonder, if I cut out salt in my diet, whether that might lower blood pressure. Because if you look at large studies on balance, lower salt does reduce blood pressure. But not all of us are salt sensitive and I'm one of the 25% or so when I reduce my salt or increase my salt. It had no impact on my blood pressure. So a simple test over a couple of weeks of reduced salt diet and I knew what was right for me.
Speaker 1:More recently last year, there was a headline which was apple cider vinegar. Two tablespoons a day led to 12 pounds weight loss. Well, the study seemed like it was well done, but I just thought, you know if it sounds too good to be true, it probably is. But I figured well, what the heck? It's only apple cider vinegar. I'll give it a try and see if it affects my weight in any way. Bottom line this one didn't work. No impact for me and of course, after a few weeks I decided no more apple cider vinegar every morning.
Speaker 1:I've been trying to increase muscle strength, muscle mass, and I've had a whole series of end-of-one trials to figure out what works and specifically ask the question what about creatine as a supplement? It's been shown in studies to help a bunch of people, but not everybody. So I did a DEXA scan which measured my muscle mass and in each of my limbs started the creatine. Of course I had been doing strength training and definitely was eating enough protein. So the new factor that I was testing was creatine. Lo and behold, within six months I had gained several pounds of muscle and I have continued to take creatine. But again, I wouldn't have known that without my N of 1 study.
Speaker 1:And finally, magnesium. Some people say everybody should be on magnesium. Some people say, well, only certain people should be on magnesium. And the data frankly isn't all that great to tell us who should take magnesium or not. Frankly isn't all that great to tell us who should take magnesium or not.
Speaker 1:I live in Texas, very hot, I work on the ranch, I sweat a lot during the summer and I get really tough muscle cramps. So I decided oh, I'll try an N of 1 study with magnesium. Well, took magnesium for a while, cramping seemed to be better. Stopped the magnesium for a while, cramping seemed to be better. Stopped the magnesium for a while, cramping came back. Started it up again, cramping got better. So for me the end-of-one trials have really helped me to personalize what I do and refine how I approach my health. Well, end-of-one trials were not invented by me, certainly and refine how I approach my health. Well, n of 1 trials were not invented by me, certainly. Maybe I've popularized them quite a bit, but certainly I didn't invent it.
Speaker 1:In fact it goes back to the 1600s where the first reported N of 1 trial happened. There was a surgeon who took care of King Charles II and this surgeon had a patient. He came in with leg edema, large swollen legs where fluid was collecting. It was so bad he was getting skin ulceration. He wasn't able to walk a lot, couldn't go out in the carriage in the nice air in the 1600s and it was a real problem. So he decided, the surgeon, to put some laced stockings that would compress the leg. Lo and behold, the patient got better, was able to walk around, go in his carriage, enjoy his life so much more. But then somebody said to him oh, wait a second, those stockings could be harmful to you. And so he stopped the stockings and you can probably guess what happened next the swelling came back, the edema came back, the ulcers of his skin came back. Well, they waited about six weeks, got the ulcers and the skin cured, put him back on the lace stockings and once again he was much better. So that's the first recorded N of 1 trial. Perhaps there were ones before that, but that's the first one that was recorded.
Speaker 1:Well, about 100 years ago, around 1930, there were a set of principles that were developed by a scientific group and these were about how to do N of 1 studies properly. Now this was largely ignored and so nobody really did a lot of N of 1 studies at all. Then there was a really important article that came out in the New England Journal of Medicine in 1986 describing a patient with asthma that was really poorly controlled. Asthma had a hard time feeling comfortable. Poorly controlled asthma had a hard time feeling comfortable and the patient was on a theophylline which at the time was a very common way to treat asthma a beta agonist like the inhalers that people often use today, and a steroid on prednisone and they decided they were going to do an N of 1 trial where they would either give the patient theophylline along with their other medications or a placebo, and the patient didn't know what they were getting. So they were on the first approach for a while. Patient then determined their symptoms and they were on the other approach, alternating back and forth between the placebo and the theophylline, and the patient was like oh, I absolutely feel better when I take pill A than I do when I take pill B. Of course everybody thought the pillA was going to be theophylline. Well, it turned out it was actually the placebo. He felt better on the placebo, not because the placebo was benefiting him, but the theophylline actually was making his asthma worse. So it was a win-win-win Patient felt better on fewer meds, spent less money on drugs, and this article led to a lot of excitement.
Speaker 1:But N of 1 studies still didn't catch on and to this day most people feel that the best evidence is a randomized, controlled trial of a large group of people and that the N of 1 approach may not be as easily performed or analyzable in the ways that people might want. Now, that may be true if you're looking at trying to get a drug approved or a certain new treatment. But if you're trying to figure out whether a particular treatment works for you, especially if it's not a prescribed drug, like the things I've been talking about, the N of 1 approach just like I shared has been helpful to me and I think it can be really helpful for you. Well, what are N of 1 trials? It's a way of testing what works for you, a desire to create a personalized medicine approach. Now, if you do a study in lots of people, you'll get an average. Well, on average, when patients take a certain blood pressure medicine, their blood pressure falls three to five points, but that's an average. Some people's blood pressure falls a lot more and, frankly, some people's blood pressure falls very, very, very little. But all we know in the published trials is the average. That doesn't necessarily mean the average will apply to you. Similarly, we know that going out in the morning and getting some sunlight helps to set our circadian rhythms and may help people sleep better, but again, this is on average. We also know that for large studies, plant-based diets might lower cholesterol, but again, that's for some people, not for everyone, and there are also times where we frankly just don't have any real evidence of what 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 of opportunities to use it. So an NF1 trial at its highest level.
Speaker 1:You find a focus or a treatment you're interested in testing. You measure a baseline when am I today? You try that new intervention, maybe a new diet, maybe a colder bedroom it could be any of number of things. Wait a period of time, measure what's happened. If something good has happened you got better Stop the intervention. See if your symptoms go back to the way they used to be. If your symptoms go back to the way they used to be, restart the intervention. See if it gets better again. And you can repeat this as many times as you feel you want to, and then you'll get your answer. So that's what it is at a high level.
Speaker 1:Now, all the examples that I've talked about are related to health issues, but it can also be used in non-health issues. Perhaps your test will be getting up early and getting into work early. Are you more productive? Are things better at work for you than when you come in later? Or you might find a new approach to talking with your spouse or your kids. You could test it, try an alternative approach, so on and so forth. So you may find that the techniques we're going to talk about may be applicable more broadly.
Speaker 1:Okay, so when might you think about doing an N of 1 trial? It can't solve all the world's problems. It can't solve every question known to man, but there are some characteristics of when it might be very helpful. First, when the data aren't so obvious. For example, some people argue that magnesium helps sleep and the studies, frankly, are very confused on this topic. But it may help certain people. Why not do an N of 1 trial and see if it helps you? As I've talked about, lowering salt in my diet didn't affect my blood pressure and when I tried changing my diet to reduce cholesterol levels didn't do much of anything for me. So when the data aren't obvious about what to do, might be a good time to think about an N of 1 study. Secondly, really important, an N of 1 study really works great when the outcome, the change you're looking for, can happen in the near term. So if I'm going to try a new technique for sleep and on my episode on sleep.
Speaker 1:I talk about 12 different things you 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 to see if that helped, you're going to know within days whether it works. Or maybe you're going to cut out alcohol and see if that improves your sleep Again a couple of days you'll have an answer. For me, when I was testing creatine, it took a couple of months weeks to months. So again, these are short-term changes that you can measure Now.
Speaker 1:An N of 1 study will not work if it's a lifelong intervention. For example, some people would argue omega-3 fatty acids reduce the risk of cardiovascular disease or dementia or any of the other things. Large studies don't show that it works. But you would think, could I do something of an N of 1 nature and test it in me? Well, the problem is that you're not going to know the answer for 20, 30, or 40 years. It's not something you can start, see a benefit, stop, see that it goes away. Similarly, you wouldn't want to do an end-of-one study on should I treat my diabetes and will it prevent heart disease, because, again, it's a 30-year proposition and you're not stopping and starting Now.
Speaker 1:The other characteristic of when to consider an N of 1 study is that it's safe to start and stop the intervention, like when we're talking about sleep and you're thinking about a cold bedroom. There's no harm in having a normal temperature and a low temperature, going back and forth. If your blood pressure isn't sky high, just borderline high again, no harm in trying a low-salt diet for a while and seeing what happens, then going back to a regular diet and back and forth. Now the final criteria is when you really can't do an N of 1 trial, and that's when you have a single chance to get it right. You have a bad case of cancer and you need chemotherapy. Well, you can't do an N of one trial here. You're going to go forth with the chemotherapy regimen based upon the clinical studies and hope for the best. Not a real opportunity to do testing in yourself If you have a very serious infection and you need antibiotics again, it's not something you're going to test in the end of one way, but there are many, many things you can use this technique for and I hope you will give it a try.
Speaker 1:Okay, let's get down to bread and butter or brass tacks or whatever words you want to use. How can we do one? Well, you can't even think about doing one until you figure out. What am I trying to test? What is it that I think might make a difference in my life and what would I accomplish? What is the improvement that I'm hoping I can measure? Okay, with that as the preamble, there are a series of steps.
Speaker 1:Step one figure out what that intervention is going to be. I've given you a number of different examples intervention is going to be. I've given you a number of different examples and then determine what your outcome. What are you going to measure? And think also about the duration. Is this something that's going to take a week to figure out? A month or longer? So, if you're thinking of diet and blood pressure or diet and cholesterol, now you've identified the intervention, you've identified what the outcome is and you'll have to figure out how long you want to test it for. Or maybe it's going to be one of the 12 approaches to sleep. That's step one. Step two measure your baseline.
Speaker 1:Ideally, the end-of-one approach is going to be based on something quantitative that you can measure and remeasure. So, if you're thinking about blood pressure and diet. Get a home blood pressure monitor, go to your local pharmacy costs about $100, and now you can take your blood pressure at home as often as you want. Or maybe you're going to test your 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 be able to get a blood test for your cholesterol at your local pharmacy and make it convenient when you're going to the drugstore for other reasons or the market down the street. Or if you want to focus on sleep, if you have an Oura ring or a Fitbit or even many of the smartwatches, you can use that. But again, it's quantitative.
Speaker 1:If you're going to be doing an intervention and you're hoping it will maybe reduce your anxiety level or reduce the amount of sadness that you have over the course of a day, maybe you're going to test exercise to see if it helps those. Yes, you could ask yourself each day on a scale of one to five you know how's my anxiety level? Five, you know how's my anxiety level. But there are so many questionnaires on the web for almost any symptom you might want to know and you could take these five, question eight, question 10, question questionnaires and get a number and then you can compare that number over time. I'm very big on having something quantitative.
Speaker 1:Step three, the obvious one try the new thing, whether it's the diet, the sleep aid, whatever it might be. Next, measure the response. Do that same baseline measurement again, whether it's your blood pressure, it's your weight, it's your sleep scores or the questionnaire that you're doing. So you'll then measure again If it's successful. We want to make sure that it's real. Maybe it was a placebo effect. Oh, by the way, placebo effect will be my next podcast that will be coming out. So you want to stop the intervention and see if the problem recurs. The blood pressure goes back up, the sleep gets worse, the anxiety level is no longer under control and then, if you wish, restart the intervention, remeasure, and you can start and stop as many times as you want to convince yourself that what you're doing truly has personalized your approach to health and wellness.
Speaker 1:Here's a tricky one, and we'll talk about this a lot more on the episode related to placebo. But let's say I was thinking magnesium might help my sleep. Well, the placebo effect means that, as I take the magnesium, even if the magnesium isn't actually technically biochemically helping me, actually technically biochemically helping me. If I believe it's going to help my sleep, it might actually help my sleep. Now I have nothing against placebos and we're going to talk and learn about that. But ideally, if you're going to test something like magnesium in your sleep, create your own placebo meaning perhaps have your spouse go to the market and buy magnesium in a pill or capsule and buy something else Maybe it's calcium or something that looks like a pill and then have your spouse give you the pills and say, okay, for the next week you're going to use this round pill and then the week after we're going to give you the red pill. Now you're not going to know which one was actually the magnesium and which was something else that wasn't going to help your sleep, but eventually you will ask your spouse which was which, just like the theophylline story I told you about in the New England Journal of Medicine article and you'll break the code and know whether the magnesium in fact helped your sleep. This is a more kind of an added step, 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 your sleep. You know, you can't really tell the difference. Maybe somebody buys you two sets of glasses One is blue light, one's not and again you can get rid of the placebo effect.
Speaker 1:Time to wrap up, the end of one study or trial or approach. The concept is quite straightforward Test and figure out what works for you. The technique as I've talked about isn't difficult and I will have a blog article about this. So by all means, go to my website, drbobbylivelongandwellcom, and you can see the various steps written out. If you need help on doing N of 1 studies and making it apply to you, go to my website. Again, look at the blog and on my website there'll be ways you could request to work with me directly.
Speaker 1:I mentioned at the outset that you could try the N of 1 approach for non-health issues. You might say well, I wonder if volunteering at a local organization might make me happier and you could again measure a happiness questionnaire. Volunteer a couple of weeks in a row, remeasure your happiness. Then do something else for those same hours, see if your happiness level is lower. Or maybe you'll call your mother more often and you'll test how connected you feel to her and how connected you think she is with you. Or, as I said earlier, you might get to the office 30 minutes earlier and see if you're more productive. So that's it.
Speaker 1:I hope you try the end of one approach. I really would like you to give me some feedback both on the episode and my podcast in general, and if you try the end of one approach, you can reply within your podcast app and send me a note, or you can go to the website drbobbylivelongandwellcom. Until next time, may you try and succeed with N of 1 approaches to live long and well. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobblivelongandwellcom. That's, doctor, as in D-R Bobby live long and wellcom.