N=1 - limitations of research

Returning home after hosting the IHCAN Functional Sports Nutrition conference in London recently, I must say that I was incredibly inspired with regard to where we are currently moving within the context of working with athletes and active individuals.

Granted, I picked the speakers, which would throw in a slight bias, but we had four individuals from very different backgrounds: functional medicine, nutritional therapy, medicine, and performance nutrition. Although their topics were all quite different (depression and gut health; heart rate variability, blood sugar control and macronutrient balance; hormonal regulation in athletes; and science to practice), there were a number of common threads throughout the day.

Most significantly, all four speakers talked about an n = 1 concept, meaning that we need to work individually with each athlete instead of relying on averaged-out statistics from large randomised controlled clinical trials. These carefully constructed research studies are essential for adding theoretical constructs to our understanding of important concepts in sports nutrition, but when it comes down to the level of working with an individual athlete, we need a large tool box of possibilities to choose from.

According to Dr James Neil, research director at the Centre for Nutrition Education in Berkshire, randomised controlled trials (RCTs) assess the effect of variable ‘x’ on variable ‘y’. It is a clear-cut research question and it is possible to accurately assess the relationship between the two variables. The problem comes when you are dealing with a complex system (most notably - our body) that has a multitude of variables. For example, a system with 10 variables, each with two possible outcomes, means 1024 combinations (2x2x2x2x2x2x2x2x2x2). Even the most heavily funded research studies don’t research so many combinations, but yet, ten variables, each with two possible outcomes, would be a simple model of our body, especially when sporting performance is also thrown in.

Dr Rupert Sheldrake is a eminent scientist who was among the top 100 Global Thought Leaders for 2013. He wrote a book called Science Delusion - in the very first chapter, he made the meaningful observation that scientists have been trying to measure the mechanism of nature via mathematical modelling since the 17th century, without concern for a person’s mind and soul. In his own words, he said: “I have written this book because I believe that the sciences will be more exciting and engaging when they move beyond the dogmas that restrict free enquiry and imprison imagination.”

Talking about dogmas, in South Africa where I live, the low-carb high-fat notion has recently been regurgitated by eminent Professor Tim Noakes (University of Cape Town) 15 years after Atkins. When it comes to weight loss and insulin control, it is an approach that has worked for him personally, which has led to him shouting about it from the rooftops and authoring a best-seller book called Real Meal Revolution. His ‘ideas’ were initially a welcome relief from the prevailing low-fat high-carb dietetic norm in the country, but it is now like a pendulum that’s swung too far in the other direction.

I haven’t been the only person disgruntled by his persistent dogmatic approach to food. His ex-student, now respected sports scientist, Ross Tucker published a blog post in 2016, airing his plea for scientific rigour and death to dogma (Read here). His piece was incredibly well written, starting with some story telling in which he reminisced about his tutorial experiences with such an evolved scientific brain as Professor Noakes. He led onto the following quote, which for me rounds up what needs to be said: “if our intentions are genuine, and we want the best possible outcome for the highest possible number of people….. we’ll see that some people benefit more from x, and others from y. If we are rigid, and defensive, and if we own our own position too strongly, then we make it LESS LIKELY that this ever happens.” This statement starts to dip into the realm of individuality, of which I am so much in favour.

Dr Tucker went on to quote eminent doctor, Sir Roger Bannister, most known for being the first person to break the four-minute mile. Bannister has said: “the human body is centuries in advance of the physiologist, and can perform an integration of heart, lungs and muscles, which is too complex for the scientist to analyse.” In response, I feel that the power of science nowadays is such that we are starting to understand and appreciate the complexities of the human body, but I agree firmly that human physiology is still centuries ahead of the scientist. In other words; there are many things that from a scientific perspective, we don’t ‘know’ yet, but that skilled practitioners, who read widely and who don’t get caught up in limiting scientific beliefs, can work with and treat via means of nutritional, physical, lifestyle and emotional-spiritual interventions.

Returning to the limitations of science, I refer to a point made by my good friend Pete Williams at Sports Nutrition Live (the precursor to the IHCAN conference) two years ago. He quoted a study from 1998, pointing out that if we read two research studies per day out of the six million articles published each year; in one year we would fall 82 centuries behind in our reading. From this point, Pete said; “take comfort in the fact that we are all in the same boat and that it’s ok to say “I don’t know” because to some degree, we are all guessing.”

Very interestingly, current scientific knowledge is influenced by more factors that just what we need to know, or should know about the human body. It can also be heavily influenced by historical research patterns and even equipment availability. To try and frame the current sports nutrition literature, I recently wrote an article on the history of modern sports nutrition research, which took me back into the exercise physiology labs of the 1960’s. It was extremely enlightening that what we think we ‘know’ about sports nutrition in this modern day has a firm base in the study of muscle glycogen in the 1960’s and 70’s.

My history of sports nutrition article (http://intsportsnutrition.com/resources/articles/163-history-of-sports-nutrition-a-50-year-review)