84. Dr. Nick Norwitz: Why 'Evidence-Based' Medicine Fails Most People (And What to Do Instead)

The top 10 grossing drugs only help 1 in 4 to 1 in 25 people who take them. Yet they're still considered "evidence-based" and prescribed to millions. In this episode of Extend, I talk with Dr. Nick Norwitz, who reveals why you can't rely on population averages to fix your individual health problems. We explore why the medical system isn't designed to figure out what makes you unique, why "calories in, calories out" fails as a biological model, and how to become your own health scientist using the N=1 approach. We also discuss practical strategies for experimenting with your own biology, from testing ketogenic approaches to understanding why your results might be completely different from everyone else's. Dr. Nick Norwitz is a Harvard-trained MD/PhD who transformed his own health using metabolic interventions after conventional medicine failed him. He's known for his extreme self-experiments and scientific approach to personalized health optimization. We Also Discuss: Why Most "Evidence-Based" Treatments Don't Work for You The N=1 Approach: Becoming Your Own Health Scientist Why Population Averages Can't Predict Individual Results The Calorie Counting Myth That's Keeping You Stuck Ketogenic Diets: When They Work (And When They Don't) How to Design Your Own Health Experiments Why Bio-Individuality Trumps One-Size-Fits-All Solutions Escaping the "Normal" Trap in Modern Medicine Thank You To Our Sponsors: IM8: Try IM8 today with a 30-day money back guarantee. You can get 20% off your first order with code DRSHAH at https://im8health.com/discount/DRSHAH. Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Nick Norwitz: Website:https://www.nicknorwitz.com/ YouTube: https://www.youtube.com/@nicknorwitzMDPhD/featured Instagram: https://www.instagram.com/nicknorwitz/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Dr. Nick, so good to see you here. Thank you for joining me today.

• 0:52Speaker 01

  Thanks for having me.

• 0:54Dr. Darshan Shah?

  Let's talk about metabolic health. Where did metabolic health go wrong? You know, I think this explosion of obesity, diabetes, this is all fairly recent in human history, right? And what led to that?

• 1:09Speaker 01

  I don't think, you know, you'll hear a lot of different things from different people. Some people say it's the sugar. Some people say it's the seed oil. Some people will say it's a sedentary lifestyle, stress, whatever. It's multifactorial. I know that is the bland, academic, hand-wavy, brush-it-under-the-rug answer, but it's true. You know, different things carry different weight in different people. So it is a large system issue. And, you know, I think what is more interesting is the question of, well, why has it perpetuated? And to that, I think I have a better answer. And that answer is people like really simple solutions, and the system and communicators aren't good at introspecting when those solutions are wrong. So I'll honestly point the finger at calories.

• 1:54Speaker 01

  I think it's a pretty easy, it's a good example where people are like, well, it's really just an energy imbalance. You hear this again and again and again. And the fact of the matter is, it's not wrong technically. It's just an entirely useless model. But it's the model that everybody seems to kind of try to converge on again and again. And here's the thing I'm going to say that is going to confuse people until it doesn't. Calories do not cause obesity. They don't. They don't. And I'll explain why. It's not that calories in, calories out equals weight change isn't correct. It is that that equation is just a description of what happened. So if you gain or lose weight, you're like, okay, it can be explained by laws of physics,

• 2:39Speaker 01

  energy conservation. But the question at hand is, what is the biological cascade? What is the biological mechanisms or set of mechanisms? Because there are probably many. To explain why there is an energy imbalance, because really, your body is determining it. Your body can modulate energy output and energy intake over the long arc of time with incredible precision. And we can talk about various mechanisms of that. To the extent that really, you can't effectively consciously toggle calories in, calories out as the independent variables. That are the dependent variables. So when people say, you know, it comes down to calories, or suggests calories cause obesity, what they're doing is they're brushing aside critical thinking about biological mechanisms

• 3:24Speaker 01

  and replacing it with some lazy math equation that is a recapitulation of physics, but is not at all a biological model. So it's not that calories in, calories out is a wrong biological model. It's just not a biological model. So it's useless. I think it's useless in terms of like the long arc of time. And it's, it's not the only problem we have with what caused obesity or what perpetuates obesity. But I think it's a great example of the fact that if you repeat something enough, like that simple idea, people just internalize it as the truth. And then it becomes the background and it's really hard to then steer the ship to say, hang on, maybe it's not that people aren't being compliant with trying to like, you know, balance their energy. Maybe it's that we're giving people the wrong explanation.

• 4:09Speaker 01

  Maybe this isn't even an explanation. And so I think it is a deficit in trying to reevaluate the models we're using. Because when we have the wrong models, we're never going to come to a solution. And I think what we're trying to do is continue along a very similar path and it continues not to work. So I kind of answered the question I wanted to answer, the question I wanted to answer rather than the one you asked. But that's because the question you asked, I just don't think has a... I had a very easy answer. It's so complex.

• 4:37Dr. Darshan Shah?

  No, it's a big question. I think, you know, I was, I was asking that question based on, there are actually two questions in one. One was a question about obesity that you did answer, but I also, you know, I saw a video on your YouTube about our food norms and why we're at the place that we're at. So I was kind of wanting to talk a little bit about our food norms and why they are there and how do we change our norms around?

• 5:01Speaker 01

  Yeah, I, I, I think it starts with every individual. I mean, like, the, the thing about becoming metabolically healthy or adopting, you know, lifestyle change is that it's viral. You know, there, there's a negative social phenomenon when you first start, but then it flips really quickly to a positive social phenomenon when your social circle sees you're getting results. When your friends and family say, wait, if you have excess weight to lose, oh, you lost weight. Oh, your, you know, your mental health is way better. You know, you're, you're ascending in all elements of your life. You know, I've had friends, I don't know if you know, I bring him up as an example, as an example quite often because he is, again, one of those examples of an outlier that can be the norm. His name is Dave Danna.

• 5:43Speaker 01

  And if you don't follow him on social media, you should. Not an academician, he's just a sweetheart with an amazing story, but I met him when he was well over 400 pounds, like depressed and not a great financial place. He's one of these people that just adopted this curiosity mindset to his health, this N equals one scientific approach and just kept on trying things until he found what worked for him and is always iterating with positivity without judgment with curiosity. And in the span of a few years, he's gone from being single, over 400 pounds, depressed and financially strained to being about, what, 200 pounds down, in good financial setting, married, having finished an MBA, expecting his first child,

• 6:25Speaker 01

  a young boy, he's posting pictures of his wife's ultrasound left and right. And, and, you know, to tee it all off, he's like, you know, on, talking with Arnold Schwarzenegger on his podcast, been to Arnold's house, partying on Venice beach with the Terminator, like, life turned around. And, you know, it started for him, like anybody else, with, I'm gonna- To do something that, you know, is a little bit extreme by social norm standards, you know, avoiding the sugar, avoiding the beverages, the alcohol, you know, and there might be a little bit of social stigma initially. But you can see where it led him. So I think it's not about, you know, we needing to change social norms on a population level overnight because that's not going to happen. It's about every individual being like, hey, do I want to be normal?

• 7:10Speaker 01

  Given what normal is now, coming to the answer that probably don't. And then going through the process of just dealing with those everyday adult decisions of, I'm gonna buck the norms because the health I want is more valuable. And then becoming comfortable with that, and then that spreads. And I think over time, it'll just naturally scale up as more and more people join. Sounds like it's influencer-y to say it, but this metabolic health movement, because that's what it is. So that's my answer.

• 7:39Dr. Darshan Shah?

  Yeah, no, that's great. I mean, I think, I think what you say about applying these changes on N of one basis makes total sense. And, you know, you're a big fan of N of one research. And actually, the book I'm writing right now, title is The Working Title Until the Editor Makes Me Change. It is N of one, because just like everything in medicine, you know, all this medical research has been done and we look at a bell shaped curve and we see what happens to most people in the middle. But who knows where your particular biology is on that bell shaped curve, right? And don't you actually run some experiments and find?

• 8:14Speaker 01

  Exactly.

• 8:15Dr. Darshan Shah?

  And you're a big fan of N of one experiments. I mean, I see you do this, you ate 720 eggs, is that right?

• 8:21Speaker 01

  Yeah, yeah. So just to double click on the N of one thing to make it very, you know, clear to the listener, we talked before about like, you know, the way the medical system works, randomized control trials, quote, evidence-based medicine. People should realize you can run an RCT, get a statistically significant positive result. So then have like a drug approved that then gets prescribed to a bunch of people when it does not help the majority of people. In fact, The top 10 grossing drugs only help between 1 and 4 in 1025 people who take them. But there's still quote evidence-based rigorous, you know, trials behind them. The fact of the matter is you in some way, shape or form are never gonna, you know,

• 9:02Speaker 01

  you're never gonna be the group average mean, you know, and median for everything across the board. So there's gonna be a lot of interventions that are quote evidence-based that are just not gonna help you. And our model is not set up to suss out what makes you different and what's gonna help you the most. And the only person right now who can do that is you. And that's the idea of this N equals one approach. It's like, no, you're not gonna get the silver bullet off the bat. But if you approach your life as an experiment, toggle, you know, choose intervention, choose an outcome that matters to you and then try different interventions and assess your own data, then you will find a solution eventually. It's the scientific process applied to the individual.

• 9:42Dr. Darshan Shah?

  Yes.

• 9:42Speaker 01

  But yes, to your N equals, your N equals one question, I've done a lot of N equals ones. I did, my most famous probably was the 728 experiment. And my purpose in doing them is, is one of the most valuable tools I've found when it comes to communicating science is metabolic demonstrations. People love stories. People like, you know, gloss over statistics. It's just the way we are as humans. So the way that developed is I had done a breakdown video on a paper about the discovery of this hormone cholestin, which is how our body regulates cholesterol and responds to dietary cholesterol. To find video, you know, I went through the, the figures in the paper. And then I had this thought, it was a social experiment for me. What if I just prove the point by just eating a lot of eggs and demonstrating my cholesterol didn't change?

• 10:26Speaker 01

  Now, I was not the first person to do this. It's just optics. It's one thing when somebody on the internet eats, you know, even more eggs than me. People have done more. It's another thing when a Harvard medical student in PhD does it. I know that. I know what the optics are. So I lean into that and I use the tools at my disposal. In this case, I just demonstrated I ate 720 eggs in a month. My cholesterol didn't change and people ate it up. But it was a teaching tool, like anything else to say, if you go into the video, it's like, look, and this is how the mechanism works. And I do that for all sorts of stuff. And the point is never to, and I say this outright in the videos. I did one recently where I ate 2,000 calories of saturated fat every day.

• 11:09Speaker 01

  I ate more than that. There was 2,000 calories from the saturated fat component alone. And again, my cholesterol didn't change. Or another one I did where I ate Oreo cookies and dropped my cholesterol by a ton. Like over 70%. So more than a stat. And it was actually a crossover trial that I then published. Anyway, all that aside.

• 11:25Dr. Darshan Shah?

  Were you on the keto diet when you did this?

• 11:26Speaker 01

  It was a, it was a baseline keto diet that I locked in. Then I did a 16 day Oreo intervention where I added Oreos to the keto diet. Then I did a three month washout. Then I did six weeks of high intensity statin therapy. It was like a protocol designed with a lipidologist with my PCP on board with a Harvard institutional review board exemption letter that I then published. So I know how to dot my i's and cross my t's with these things.

• 11:48Dr. Darshan Shah?

  Right, obviously.

• 11:49Speaker 01

  The point, bringing it back to N equals one is I'm not prescribing you or recommending you eat tons of butter or, you know, goodness forbid, Oreo cookies. The point, every single time, is huh. My results, my personal results, like break from expectations. And then the question is why? Why, why, why? And why can I predict it? What is the mechanism underlying that? And what it gets people to do, and I know because I've seen this, you know, feedback from people or their doctors. Get into that later, is it gets people to think huh? In what ways am I an outlier? What is unique about my metabolism that would get me to respond uniquely to different interventions?

• 12:30Speaker 01

  And what is the relative, you know, power and weight of different factors in my diet? Because it's not until you start thinking about yourself as a metabolic, you know, a bio individual metabolic entity, that you, you can really refine your approach to health. Because there is no one size fits all diet. So in the extreme metabolic demonstrations, I'm trying to reveal a deeper truth, which is yeah, we're all bio individuals. But you, irrespective of your academic background, can find the unique protocol that works for you. And you're never going to find the perfect protocol. Because your rules are always changing, but you're going to asymptotically

• 13:10Speaker 01

  approach perfection and be on a lifelong journey of like, you know, a chronic ascension rather than a chronic descension. If you just realize that fact and realize how much power you have through the N equals one process.

• 13:23Dr. Darshan Shah?

  Yeah, incredible demonstrations. Some of them are pretty extreme. I think you did one where you ate like 6,000 calories a day. Yeah. Or something like that, right? And I encourage everyone listening to watch some of these videos because I love how you describe the underlying science of what you're doing. It's not just, I did this and this happened. It's the science also very much a focus of this.

• 13:50Dr. Darshan Shah?

  Hi, Dr. Shaw here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30-year-old people with cells that look like they're pushing retirement. And I've also seen 60-year-olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells you see are like phones and they have limited cellphone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IMA. IMA powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula

• 14:32Dr. Darshan Shah?

  designed specifically for cellular health and longevity. I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection. The clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IMA actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMA had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies

• 15:13Dr. Darshan Shah?

  and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should, unfortunately. You don't have to be one of them. Try IMA. I actually have a discount secured for you if you go to drshah.com/ima or go to imathhealth.com/dshah and you can get 20% off with my discount code, Dr. Shaw. You can also find the link below.

• 15:43Dr. Darshan Shah?

  You know, back to kind of N of one experiments for my audience. What are some experiments that you believe people should try on themselves as far as like metabolic interventions go? Is the keto diet something that people should try and for what reason? And are there other metabolic interventions that you think people should give a shot to? And what are some of the ways they can follow their results? Continuous glucose monitors, what are some of these things that you recommend?

• 16:10Speaker 01

  I think the only way to answer that question is first to define what outcome you care about. When you're designing a study, you need to define what do you care about for an outcome? So the question, what interventions do someone try depends, you know, first on what are we talking about? So let's start there. You can choose anything as an example.

• 16:27Dr. Darshan Shah?

  Let me, let me choose weight loss because that's a very common one for most people.

• 16:30Speaker 01

  So I, you know, I think weight loss for most people in the modern era, I do think a ketogenic diet is worth trying. I will say that outright. I think there are good data to suggest that there is a unique benefit of lowering your carb intake, lowering your insulin levels and that that can promote weight loss. I won't say it's going to work for a hundred percent of people with respect to effectiveness. Now I'm going to put my scientist, scientist hat on it again and, and explain some jargon to you, which is there's a difference between efficacy and effectiveness. Efficacy is like, how well would something work under optimal conditions? Say I control your diet in the lab. Effectiveness is something entirely different. It is, how does it actually like work out in a real world setting?

• 17:13Speaker 01

  So for various reasons, any given diet, say a ketogenic diet might not work for someone. Maybe it's social reasons, food preferences, whatever. So I'm not saying it's a silver bullet, but I do think it's something to try out. I think lowering insulin levels can help kind of unlock, let's just say fat mobilization, decrease hunger. There's a lot of data, including randomized control trials on that. So that's something to start with. Now for weight loss, it doesn't actually matter if you're in ketosis that much. So you can just do a lower carb diet or a slower carb diet. So say you ate, you know, instead of going like full keto, like you could do carnivore if you want to try carnivore or like zero carbs. Or you could say, I'm going to go below a hundred grams of carbs and I'm not going to eat any sugar.

• 17:58Speaker 01

  And you know, the carbs I do going to eat, I am going to eat are like whole foods generally with like a high fiber to net carb ratio. That's an approach. You know, it doesn't have to be like one form of ketogenic diet. But I do think therapeutic carbohydrate restriction is something that everybody trying to lose weight, if they're continuing to struggle, should give a serious try. Yeah.

• 18:19Dr. Darshan Shah?

  And on the keto diet, just diving in a little bit further, do you look at the keto diet as a temporary intervention? Or are you or patients or people that you know, using it more long term? You know, there's a lot of talk right now on social media about longer term keto diets causing symptoms, or I would say metabolic abnormalities and lab work abnormalities. What are your thoughts around that?

• 18:45Speaker 01

  There are no good data suggesting that a ketogenic diet is not long term, sustainable, and can be formulated in a healthy way. I'll be clear. There are definitely like individual cases. I won't speak to any one individual, like if for whatever reason you have a thyroid abnormality, or you know, a severe, you know, refractory hypertriglyceridemia, fine, you might have like a genetic quirk, or there might be something that needs to be optimized. So, you know, I won't reject that some people might be having negative consequences over the long term, but there are no data suggesting that a long term ketogenic diet can't be healthy and sustainable. What I would say to your question is, for those needing it therapeutically, maybe someone

• 19:26Speaker 01

  like me, or someone that's using it for severe, you know, mental health disorder, or other metabolic condition, they might opt to stay on it for the rest of their life. And that's totally fine. For other people, say you're just using it for weight loss, you can stay on it for the rest of your life. I don't think it's necessary. I generally see people evolve their approach in the spirit of this N equals one experimentation. So maybe someone will, you know, if it's working, they might want to, they might be most comfortable sticking to it. So maybe like three years will be like hardcore keto. But then they're like, hmm, I'm going to try adding in some like strategic carbs. And you, you develop these more advanced protocols, like maybe I'm going to have targeted carbs, 50 grams after a workout, when you know, the glucose receptors are, you know,

• 20:10Speaker 01

  up on those muscle cell membranes, so I can, you know, replete my glycogen, my muscles faster. You can develop like carb cycling protocols and get to a more advanced level. You don't have to be religious about it, but I would say that develops naturally. It's not something that's like premeditated years in advance. So, yeah.

• 20:27Dr. Darshan Shah?

  Yeah, that's exactly right. I mean, I think I've seen probably 200 plus patients utilize a ketogenic diet and some of them, like you said, don't lose any weight and they just can't do it.

• 20:39Speaker 01

  Yeah.

• 20:39Dr. Darshan Shah?

  Other people are on it for six months to achieve their goal and they bring carbs back in and they do so without gaining weight and they become, they've just got it more metabolically flexible so they don't gain weight as quickly. And then others that love it and they just want to stay on it. And to them, I say, that's fine. If you feel great, your blood work looks good, there's no reason not to stay on it if you feel great and you can maintain it.

• 21:02Speaker 01

  Yeah. And I love your attitude towards that because I think something that, that is a strength and a big weakness of diet culture right now is you do develop these in-groups.

• 21:14Dr. Darshan Shah?

  Right.

• 21:14Speaker 01

  And then there's a negative, is a social pressure that like prevents people from branching out and trying something different, almost like you're a traitor. Like if you're like, you know, carnivore and then you like go off carnivore, like you are a traitor to the, to the tribe.

• 21:27Dr. Darshan Shah?

  Right.

• 21:27Speaker 01

  And what I find so interesting, and I genuinely, this is not, I'm saying this with judgment, I find this very fascinating about human behavior, is that people seem threatened when other people or just data contradict or don't align with their narrative of how they found health. And people make the assumption about other people, people make the assumption about me, like that I won't be, you know, excited about new data about like a cool new, you know, fiber, because I don't eat a lot of fiber and fiber obsesses my stomach. I'm like, no, like, me finding health through a ketogenic diet for my IVD is not threatened by some new paper. Like my journey is my journey, another person's journey is their journey. I'm genuinely happy for anybody when they find metabolic health.

• 22:10Speaker 01

  And if we just approach this with more like humility and curiosity, I think it would just be a better space. But it, isn't it fascinating that, that people are threatened by other people's journeys? Or they need to find something wrong with it if someone else got to a similar place of health but via a different route. It's still unnecessary.

• 22:29Dr. Darshan Shah?

  It's unnecessary and also it doesn't show that the understanding that every human's biology is different from every other human's biology and our biology is constantly changing. So something might work for you now and it might not work for you later.

• 22:43Speaker 01

  Right.

• 22:43Dr. Darshan Shah?

  It's just, it's just a normal human existence and.

• 22:48Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.