Competition from Generic Insulin Would Do a Lot to Reduce Medical Costs; But Reducing the Incidence of Type II Diabetes by Changes in the American Diet Would Do Much More

The social welfare benefits from improving the American diet (and the diet for most other countries) are large. One of the most important diseases fostered by a bad diet is Type II diabetes. In the article shown above, “Biohackers With Diabetes Are Making Their Own Insulin” Dana G. Smith gives this figure:

Diabetes has become the most expensive disease in the United States, reaching $327 billion a year in health care costs, $15 billion of which comes from insulin.

Dana explains the two forms of diabetes this way:

Insulin enables cells in the body to use glucose circulating in the blood as fuel. People with Type 1 diabetes don’t produce enough insulin, while people with Type 2 diabetes have become resistant to it. Without sufficient insulin, people experience high blood sugar, or hyperglycemia, which, over the long term, can cause heart disease, stroke, kidney disease, and nerve damage. In severe cases of insulin insufficiency, ketoacidosis sets in, where the liver releases too many ketones into the blood, turning the blood acidic and potentially ending in death.

Although Type I diabetes may be fostered by feeding the wrong type of cow’s milk to infants (see “Exorcising the Devil in the Milk,”and “How Important is A1 Milk Protein as a Public Health Issue) I want to focus on Type II diabetes.

Since insulin’s job is to tell cells to take up sugar from the bloodstream, the more sugar enters the bloodstream, the harder insulin’s job is. The harder insulin’s job is, the more insulin has to be produced. And when a lot of insulin is produced, the cells that are being asked to take up sugar start to turn a partially deaf ear to the insulin—the phenomenon of insulin resistance. Since letting too much sugar remain in the bloodstream is very bad news, if cells become partially deaf to insulin, more insulin is produced in order to more loudly tell cells to take up insulin from the bloodstream, continuing the vicious cycle, unless something changes in the diet. At some point, if the vicious cycle continues to get worse, the resistance of cells to insulin outstrips the ability of the body to make insulin. That is what Type II diabetes is: insulin resistance so strong that bodily insulin production loses the race. Then the usual treatment is to inject insulin as a drug in order to shout even louder to cells to take up blood sugar.

But there is another way to treat diabetes once any acute emergency is taken care of: to change one’s diet to put less sugar in the bloodstream in the first place. Then, even with insulin resistance, the need for insulin is lessened. If blood sugar never gets that high to begin with, then modest levels of insulin will be enough to keep blood sugar at a reasonable level. What is even better, there is hope that the vicious cycle can be reversed into a virtuous circle, in which less insulin makes it so cells listen harder to the insulin that is produced. That is, there is hope the insulin resistance can be partly reversed if food-driven insulin production is reduced.

In addition, to the extent one eats in a way that drives up blood sugar less, less insulin is needed—whether produced by the body or injected—to keep blood sugar under control. This approach of using dietary changes to keep the need for insulin low is the approach of diabetes specialist Jason Fung, whose book The Obesity Code is featured in “Obesity Is Always and Everywhere an Insulin Phenomenon” and "Five Books That Have Changed My Life."

Which foods drive high insulin production and thereby incur the risk of insulin resistance? I address that question in “Forget Calorie Counting; It's the Insulin Index, Stupid.” The insulin index directly measures food-drive insulin production. It is highly correlated with the glycemic index, which measures what foods drive up blood sugar, that I discuss in “Using the Glycemic Index as a Supplement to the Insulin Index.” But there are some differences between the insulin index and the glycemic index, as I discuss in “Why a Low-Insulin-Index Diet Isn't Exactly a 'Lowcarb' Diet.” Notably, some kinds of meat lead the body to produce substantial amounts of insulin.

So far in this post I have emphasized the role of excessive food-driven insulin production as something that can lead to Type II diabetes. But there is more. When sugar is taken up out of the blood, where does it go? Some goes to muscles. But some of the blood sugar typically goes to fat cells to be turned into body fat. So the very moderation of food-driven insulin production that can help ward off Type II diabetes can also help ward off obesity.

As long as people continue to get either Type I or Type II diabetes, it is shameful that the drug companies are keeping insulin prices so high by various strategies. It is possible what they are doing is illegal. Dana writes:

There are currently several lawsuits accusing the three drug companies of price fixing. One class action complaint claims Eli Lilly, Sanofi, and Novo Nordisk raised the list price of insulin in lockstep over the last 20 years, stating that the companies have been “unlawfully inflating the benchmark prices of rapid- and long-acting analog insulin drugs,” and placing them in violation of the Racketeer Influenced and Corrupt Organizations Act.

But the production of generic insulin would only affect the $15 billion spend on insulin annually in the US, not the other $312 billion spent annually on other US diabetes-related health-care costs. And the production of generic insulin won’t do much to reduce the enormous nonfinancial suffering caused by diabetes. By contrast, changing the American diet could do a lot to reduce that $312 billion per year on other diabetes-related health care costs and the nonfinancial suffering attendant upon diabetes.

Unlike some nutrition experts, I don’t think the bad American diet is all about companies and culture pulling people away from clearly articulated principles of healthy eating. I don’t think the principles of healthy eating are articulated that well at all to the general public. In “Crafting Simple, Accurate Messages about Complex Problems” I write the following (and in square brackets I extend my statement to diabetes):

I believe that fighting obesity [and preventing Type II diabetes] requires more focused advice. Not “Do everything right, and here is the long list.” Instead, start with one action: go off sugar. I give some advice for that in “Letting Go of Sugar.” Don’t worry about anything else in the area of diet and health until you have accomplished that. After that, you can see where to go next in “4 Propositions on Weight Loss.” And if that all becomes old hat, then I recommend a reading program. I hope my blog posts are of some help, but those blog posts also point to some useful books to read. (To summarize, see “3 Achievable Resolutions for Weight Loss.”)

I list other blog posts about diet and health below. If you are interested in diabetes and insulin, use control-f (or option-f) to search for the word “insulin” or “diabetes” on this page. To go beyond that, put “insulin” or “diabetes” in the blog search box at the top of the webpage. But if you do that, you’ll get a large fraction of all the posts below: insulin is central to my view of diet and health.

Don’t miss my other posts on diet and health:

I. The Basics

II. Sugar as a Slow Poison

III. Anti-Cancer Eating

IV. Eating Tips

V. Calories In/Calories Out

VI. Other Health Issues

VII. Wonkish

VIII. Debates about Particular Foods and about Exercise

IX. Gary Taubes

X. Twitter Discussions

XI. On My Interest in Diet and Health

See the last section of "Five Books That Have Changed My Life" and the podcast "Miles Kimball Explains to Tracy Alloway and Joe Weisenthal Why Losing Weight Is Like Defeating Inflation." If you want to know how I got interested in diet and health and fighting obesity and a little more about my own experience with weight gain and weight loss, see “Diana Kimball: Listening Creates Possibilities” and my post "A Barycentric Autobiography. I defend the ability of economists like me to make a contribution to understanding diet and health in “On the Epistemology of Diet and Health: Miles Refuses to `Stay in His Lane’” and “Crafting Simple, Accurate Messages about Complex Problems.”