Paving the Path for N=1 Citizen Science

Within the sea of countless scientific studies, reviews, and meta-analyses, become the subject of your own health experiments.

If you want a sense of why I’m so passionate about N = 1 science, please have a read of the opinion article I had published this Halloween: HERE. I’ve also copied it below.

“Harvard Medical Student Eats 720 Eggs” broadcast headlines across the world.

The egg-eating news filled five Google search pages and collected tens of millions of reads and views across media platforms. It rang of frivolous, goofy clickbait—but it’s far more than that.

We will return to my viral “Eggsperiment” shortly, but first, I want to dissect the “why” behind this publicity stunt—its roots planted five years ago and across an ocean.

Part I: Roots of N = 1 Science

I met my first patient—I’ll call her B—well before I started medical school.

B was a middle-aged French woman living in Oxford, England, where I was completing my doctorate. She had a warm smile, a strong accent, and the aura of a person you just wanted to hug.

Unfortunately, B was suffering from early-onset Parkinson’s disease, a debilitating neurodegenerative disease that manifests with tremors, difficulty walking, and—in B’s case—crippling depression. Add to that inflamed joints and obesity, possibly brought about by her pharmacy of medications and the profound physical constraints of Parkinson’s disease. Despite all that, B was a woman who brought your heart to your throat.

B was the epitome of someone who deserved so much better than the hand she was dealt. She entered my life as a participant in a clinical trial I was leading for my doctorate at Oxford. When the trial ended, she asked for my support with her diet, as she wanted to lose the weight she’d gained during her illness. I leaped at the opportunity to help my new friend.

Well, I less leaped than pushed. I pushed her around in a shopping cart at Tesco’s market on Magdalen St. like a toddler since she couldn’t walk at the time. She’d pick items off the shelf and ask questions about them, slowly surrounding herself with a carefully curated sea of groceries by the time we arrived at checkout.

In the coming months, we stayed in constant contact. She’d text me pictures of her meals, reflect on how she felt, and ask for feedback.

We persisted, and she made immense progress.

I’ll never forget a text she sent me in November 2019:

“I’ve hardly had any pain in my right hip today and I even started dancing a bit with my kids… when Paul [my husband] came back from London, I was dancing in the kitchen to some old rock song and he could not believe it! Me neither frankly!”

B had previously been a marvelous dancer. She treasured this activity and thought she’d have to give it up forever. To know she could once again immerse in her favorite activity with her loved ones—well, I don’t have the words to describe how that made me feel.

B planted a seed that would be nourished by the waters of future similar experiences.

The Metabolic Health Space

In the subsequent years of my doctoral studies, the COVID-19 pandemic, and medical school, I’ve remained immersed in the “metabolic health” space as a researcher, scientific communicator, and metabolic health coach. I’ve been shocked by the journeys of transformation I’ve witnessed, including patients recovering from decades-long struggles with endocrine and mental health disorders, autoimmune and inflammatory conditions, and so on.

In my experience, the positive effects of dietary and lifestyle changes are rarely confined to physical health.

Take my friend Dave Danna as an example. When we met, he weighed more than 400 pounds and suffered from mental health issues and financial strain. But I could see in him the glow of a fire—a fierce motivation to get healthy. His fire was tempered by learned helplessness from living in a society flooded with bad advice, patient blaming, dysfunctional social norms, and useless platitudes about health. Nonetheless, the spark was there—it just needed some kindling.

True Science

As with B, Danna expressed curiosity in his health journey. He reflected on how each intervention and lifestyle tweak impacted his health through subjective and objective measures. He asked questions and iterated on his approach.

Think, for a moment, about the process I’m describing. It’s science! True science. Authentic science. It’s testing hypotheses on yourself and evaluating the results with curiosity, rather than judgment, to acquire valuable insights, or—if you prefer—valuable data.

Fast forward, and Danna has lost more weight than I weigh. I won’t tell you exactly how much that is, but you get the point. This physical change coincided with improvements in his mental, financial, and social health. He completed an MBA, married the love of his life, and—to my pleasure—I got fired as his coach—upstaged by someone with a bit more experience in the gym.

I’ve learned many lessons from B, Danna, and the hundreds of other people and patients I’ve had the privilege of getting to know over the early, formative years of my career. It’s cliché, but it’s true: I’ve learned far more outside the classroom and lab than I could ever have learned therein.

One lesson stands out above the rest: the power of N = 1 science.

Part II: What Is N = 1 Science?

N = 1 science captures the philosophy that every human being has the power to apply the scientific method to their own life by:

• Identifying an element of their health they want to change

• Hypothesizing about what intervention(s) may impact that outcome

• Implementing the intervention

• Assessing their own outcome data (objective or subjective)

• Repeat, ad infinitum

N = 1 science empowers people to become “citizen scientists,” experimenting and refining their health choices to find what works best for their own bodies. This self-application of the scientific method to one’s own metabolic health journey, if properly executed, almost guarantees long-term success. It was the secret to B’s and Danna’s incredible successes, as well as those of countless others.

So, how in the world does this relate to my eating 720 eggs in one month?

As articulated by health journalist and registered nurse Sheramy Tsai in her No. 1 most-read article covering the Eggsperiment:

“Norwitz’s viral egg experiment … [was] an experiment in how science is communicated in the digital age. Using platforms like YouTube, Norwitz transformed a routine self-experiment into a captivating narrative that resonated with a wide audience. His approach shows how science, when presented in an engaging and relatable way, can motivate others to conduct their own health investigations.”

Tsai is exactly right. I don’t subscribe to the idea that there is any one best diet for humans, nor do I care if people eat eggs. But I am keenly aware that the public is confused and frustrated by the firehose of conflicting health advice that floods the media. A solution, as I see it, is arming people with knowledge and a method to find what works best for them in the form of N = 1 science.

Publicity stunts, performed on myself or those performed by friends and colleagues, elicit curiosity and bring people to the table for a deeper dive into the broad field and practical application of metabolic health.

In effect, experiments like 720 Eggs create an access point from which I can speak to a broader audience about basic physiological and scientific principles that arise in the scientific literature I cite in my videos, including Cell, Nature, and Science. I aim to infect my audience with enthusiasm for metabolic health and the application of that knowledge to the scientific method in the framework of their own lives.

In my own social experiment, the feedback, comments, and myriad N = 1 stories shared are my data. They’re how I iterate my approach as a scientific communicator in order to scale my impact and multiply N = 1 stories like those of B and Danna.

Part III: Challenges of N = 1 Science

N = 1 science is not without drawbacks. Just as any drug can have negative side effects, N = 1 science can have unintended negative consequences.

The most obvious drawback of communicating N = 1 science and experiments via social media is that, while the efforts make science relatable, it also risks oversimplifying complex health information. This can either be directly from my mouth or, more often, from the second-hand, larger-scale coverage of the scientific experiments we perform.

Indeed, this is not a risk specific to N = 1 science. In scientific communication, once a story is out there, the original team has limited control over the narrative. It’s like playing with fire. Fire can illuminate but also get out of control.

Thus, there remains a risk of harm. It’s a reality with which we need to contend.

The solution, in my mind, is not depriving the public of information but doubling efforts to leverage enthusiasm for N = 1 science to improve science and health literacy.

I believe science shouldn’t be the domain or property of those with formal training. Science is a process with which every single human being can and should engage.

We can—and we must—find ways to increase health literacy to empower people to take control of their own health journeys.

However, as in physiology and metabolism, there’s always a deeper level of complexity.

For example, the position I just articulated—that science is a process with which every human being can engage—implicitly raises other issues related to education, systemic racial discrimination, socioeconomic disparities, and other matters that form the interface of health care and social justice.

• Education: If a person is not able to attend college, are they not at a disadvantage relative to someone with a doctorate in physiology?

• Discrimination: If an underrepresented minority or female is trying to implement an N = 1 experiment by drawing from literature, are they not at a disadvantage relative to a white man if the present evidence base was collected by white men?

For example, body mass index is most often used to define “healthy” target weight ranges.

However, the standard threshold may be unfairly biased against certain minority groups, including black women. While N = 1 science is a personal endeavor, it is informed by community-established thresholds and targets.

• Socioeconomic disparities: If a person is of limited socioeconomic means and can’t afford healthy food, are they not at a potentially insurmountable disadvantage relative to a financially secure person?

Approximately 11 percent of households in the United States are food insecure. This alone critically handicaps around one in nine people from engaging in N = 1 science as applies to their dietary choices.

Furthermore, food insecurity is associated with greater rates of stress, anxiety, and depression, which could be considered additional methodological confounders in an N = 1 approach.

In a correspondence published in Nature Food, Adam Drewnowski, director of the Center for Public Health Nutrition at the University of Washington, said:

“For many people, the ability to make healthy food choices was removed long ago by stagnating wages, economic hardships, and time poverty. Education may not help much.‘The only label that we ever look at is the one that says 79 cents,’ someone memorably told me years ago.”

Food insecurity, which drives people to purchase lower-cost foods rich in sugar and with low nutrient density, in turn predisposes them to fat gain, creating an “optics trap” whereby food insecurity is associated with obesity. However, this reality is set against a backdrop of a society that understands obesity through the lens of an insultingly simplistic calorie-centric model.

I do not have solutions to these widespread systemic problems. Nor am I of the illusion that N = 1 science could escape the grasp of these interlocking social justice issues.

However, I think N = 1 holds an advantage over the conventional approach insofar as it puts the patient at the helm of their ship. As the only person with a full picture of the obstacles set in front of them, the patient is best set to navigate their own N = 1 voyage. That doesn’t mean they won’t require help—and we should afford it—but they are the captain.

Part IV: Legit Bait?

When it comes to communicating science through media, it’s critical to reflect on the real-world effect as a form of “information autopsy.” So, let’s conduct such an autopsy on my last two public N = 1 experiments.

The first was the Oreos versus statins experiment, in which I lowered my cholesterol by eating Oreo cookies in a 5-month crossover experiment as a demonstration of a metabolic model—the Lipid Energy Model—developed by myself and colleagues.

I intended and achieved increasing awareness of this model. However, I did not originally intend to impact clinical care.

Within weeks of publishing the study, I was receiving a stream of emails from primary care physicians, cardiologists, and lipidologists stating they had become aware of the broader literature on our model and were leveraging its principles to treat their patients with remarkable effects. One example is an email from a cardiologist in March:

“Thanks for your work, Dr. Norwitz. After reading your Oreo manuscript, after having a good laugh, I realized I had several lean mass hyper-responders in my clinic who I can now correctly identify. While one remains on [standard of care] pharmacotherapy, two had a preference experimenting with carbohydrate titration vis-à-vis the lipid energy model and have each responded brilliantly with 64% and 79% reductions in LDL-C on 150 net grams …”

I’ve lost count of how many emails of this flavor I’ve received from clinicians and patients.

My other N = 1 experiment was the Eggsperiment, of which I’m sure you’re now aware.

Impact of Unintended Consequences 

An unexpected consequence of the media attention around this metabolic demonstration was the establishment of an ongoing series on metabolic health in at least one legacy media outlet.

The stunt revealed immense enthusiasm among the public for learning about metabolic health, creating an opening for colleagues and me to amplify the discussion around the importance of diet, exercise, sleep, light, and other lifestyle interventions on health and wellness. We will draw from the latest literature while hopefully feeding the public’s passion for this important field and inspiring lifestyle changes that will make a real difference.

Part V: Final Thoughts

The mark of a good scientist and a good doctor is humility—to know what you know (and know it well), know the boundaries of your knowledge, and what questions you need to ask to best expand those boundaries.

I know a lot about metabolism by virtue of spending 11 years studying biology, biochemistry, metabolism, and medicine. Now, on the cusp of finishing my second doctoral degree, I find myself brutally aware of the knowledge and skills I need to acquire to have the impact I want to have in my career.

I want to “make metabolic health mainstream,” which I now believe I can do best by empowering every single person to be their own N = 1 scientist.

It’s just about communicating science in a provocative, engaging, and inspiring way. It’s also about helping people to internalize that “Holy $&!t! This stuff is awesome! My body is so cool! And approaching my health journey through the lens of science is not only productive but fun! I can’t wait to learn more!”

In the spirit of being a good scientist and a doctor, I must also remain aware that some of my models will be wrong. I’ll make mistakes. I’ll always have deficits in my knowledge and unconscious biases. That’s not bad—it’s reality. It’s a reality with which I can best contend if I listen and seek the support of my community, including my audience, my patients, and my friends.

I could even say my N = 1 journey is a community effort. I hope you'll join me.