Hacker News Reader

and why he recommends his diet.

...which is the key. McDougall's claim to fame is fad diets and prepackaged food for the same since the 80s, and anything where his bottom line is involved is suspect. He's the vegan equivalent of Robert Atkins, basically.

McDougall is not who I look to for nutritional (or really any) advice. I'm sure he's right sometimes, but his credibility is so compromised by his business that I'd need to hear it from someone else first with their data proving it before I'd ever believe it. If he told me the sky is blue, I'd get a second opinion.

I am mostly familiar with McDougall because of his extensive, high-quality, free youtube lectures. I have exactly the opposite impression of him than you. Instead of advocating a fad diet, he advocates a low fat, whole food, starch-based diet. He justifies it first on the grounds that every successful civilization has had this diet. Pick any civilization, country, or people group that is healthy and you will find that their diet is based on starch. His diet is the opposite of a fad diet: it's the diet that has sustained civilization.

His diet is cheap and accessible. You can follow his diet by eating locally produced wheat, potatoes, oats, rice, corn, millet, beans, etc, in all parts of the world that have an agriculture season. A feature of his diet is that starchy foods store well. Indeed, he says that the reason humans became so successful is because they were able to have a food supply that was high in energy and could be stored.

McDougall does not sell pills or supplements. He specifically counsels against them, saying that they are unnecessary with a good diet and potentially harmful.

In addition to a lot of free educational content, his website (drmcdougall.com) features different programs, including a 10 day live-in program which includes medical care plus meals and education for $6,060 for a single, full participant. You can also buy books, podcasts, and apparel. I didn't see any prepackaged food on the site.

I've considered him a source of high-quality, unbiased advice for several years. His presentations are clear and logical. He's not trying to sell me something. He is conservative in the sense that he prefers cheap, simple solutions before expensive, complex ones. For example, he would recommend that before you try medication and surgery, you should first try to change your diet. If you're not feeling well, make sure you're eating eating a low-fat, whole food, starch-based diet before trying to find a missing miracle vitamin or supplement.

Can't speak to the claims in this comment around type 2 diabetes, but worth noting this article and pill is specifically for type 1 diabetes, which is in no way related to weight or metabolism, but rather an autoimmune disease.

I think there's a lot of confusion/ignorance with Type 1 and Type 2 and most people just lump them both under the same diabetes umbrella. Diet and exercise will never be enough for Type 1's since the disease is an autoimmune disorder where the pancreas is attacked to the point where it makes little or no insulin (thus the need for external insulin). Type 2, as I understand it, is a progressive disease where the cell's insulin receptors become nonreceptive. I think, in some cases, though, Type 2's can become Type 1's due to their pancreas being overworked to the point where they need insulin. And on the flip side, Type 1's can become Type 2's as a result of eating poorly and overusing insulin. But I wish each disease had it's own name to avoid confusion over how each one should be treated.

This is a huge problem. I wish the medical industry would stop using "type" and assign specific names to disease variations. So type 1 would be diabetes but type 2 would be dropped from convention and called insulin resistance (or a new name, I dunno, setebaid). Some other words that have probably cost the world billions of dollars and interfered with public opinion:

* Hepatitis A/B and C (A and B were cured early on so name should be livervirus or whatever, C should remain hepatitis until it's eradicated)

* Herpes types 1 and 2 (1 should be renamed to cold sores since almost everyone has it, 2 should remain herpes until it's cured)

* Nonfatal cancers (especially of the skin) need new names to prevent scaring people, especially if they've been largely cured.

* SSH "private key" and "public key" (should have been called "secret" and "share" so that people would know which to keep secret and which to share.. yes I realize they are symmetric)

I could go on, but you get the drift. I think a problem here is that experts in various fields may have exceptional problem solving skills but be terrible at naming things. I've met many programmers with this affliction!

I think the naming of private/public keys is already pretty clear ...

I know several Type 2 diabetics who are not (and have never been) obese. While obesity is definitely a cause for the disease, it is not the only cause there is.

I googled "diabetes in thin people" and found the term "skinny fat", slim but with a high percentage of body fat. These are people who may appear to their body to have enough fat stored to survive a tough winter. (This was how McDougall describes the onset of diabetes.) Can people with low body fat get diabetes?

Did you mean, can a person with low body fat get Type 2 diabetes?

yes

Dominique Wilkins has type 2 diabetes. I would imagine his body fat is pretty low.

Yep- it's in my family. Nothing to do with bodyfat. A body weight change of +/- 50 pounds makes no difference in fasting blood sugar. Hits later in life though (50s).

This is extremely myopic...

Once you're diabetic, a lot of "bad things" happen. People don't take insulin then just to continue eating...

McDougall points out at one point that it's common for people to gain weight after their doctor tells them to lose weight and puts them on insulin. Insulin promotes weight gain.

It doesn't. Eating too much and exercising too little promotes weight gain.

Right. And the insulin injections allow them to continue their lifestyle of eating too much and exercising too little. Their body is literally rejecting food and that's the problem insulin solves. It does not solve the root issue.

If you spend a lot of time around diabetics you'll met many people who have lost appendages and continue to live an morbidly unhealthy lifestyle.

The insulin injections also allow diabetics to regulate their blood sugar so that they don't have to deal with even bigger problems.

I have spent a lot of time around 4 diabetics in my family, none of which had morbidly unhealthy lifestyles. Sure, they could all use a little more exercise and moderation in their diet, but then again most people can.

How about you educate yourself before spitting out nonsense: https://www.ncbi.nlm.nih.gov/pubmed/17924864

https://www.joslin.org/info/why_did_i_gain_weight_when_i_sta...

> ...described type 2 diabetes as the body's natural way to limit weight gain.

Hogwash. If that were true, I'd be skinny. Aside from the standard low fat calorie restricted diets preferred by nutritionists, I've noticed that there seems to be two prevalent themes with respect to currently marketed dietary advice targeted towards T2 diabetics:

Theory #1. High fat intake or the "wrong" fat intake causes insulin resistance by infiltrating the cells or "clogging up" the insulin receptors on cells. Solution: buy my low fat vegan diet plan.

Theory #2. Eating carbs spikes glucose, which intern spikes insulin. "Insulin resistance is a function of having high insulin levels all the time." Solution: buy my low carb diet plan, or buy my book on intermittent fasting.

How would this be reconciled with significant weight loss often being a symptom of type 2 diabetes?

> How would this be reconciled with significant weight loss often being a symptom of type 2 diabetes?

I don't know, but here is my guess:

At the beginning of the lecture McDougall talks about there being three kinds of diabetes: type 1 (pancreas produces no insulin), type 2 (pancreas produces enough insulin, but it doesn't work because of insulin resistance), type 1.5 (not enough insulin is being produced to cover the body's needs). Significant weight loss seems to fit in the type 1 and type 1.5. McDougall will prescribe insulin if a person is in danger of losing too much weight.

Sadly it's easier to staple stomachs than produce lasting behavior change