Obesity, diabetes, and living the gospel.
Pounding the pavement in my neighborhood on Halloween night when I was a kid, going door to door on my quest for refined sugar, taught me some of my first lessons in the value of work. When it comes to motivating children, carbohydrates speak louder than cash.
The feast of Halloween was a mere punctuation in the perpetual pancreatic stress test of my childhood. It seems like every holiday in America, no matter its original meaning or relative importance, has been transformed into a candy holiday.
There are many reasons for the current obesity epidemic, and I don’t want to oversimplify a complex public health dilemma, but it seems clear that culture, specifically our food culture, is playing a large role in this. Graphics like these really illustrate the scale and urgency of the problem:
In many ways human beings are blind to their own culture until they have an immersion experience in another one. Such was the case with me as a young man when I served a mission in England. British cuisine is generally less sugary than what you will eat in a typical American household, and desserts without added sugar took some getting used to. Also, in England there wasn’t any celebration of Halloween that I could detect. No one walked around the neighborhood asking for candy handouts from neighbors, and English people I spoke with were a little shocked that my parents had ever let me do such a thing when I was younger. That was the first time I thought to myself that it might not be entirely normal to wander through the neighborhood in disguise, threatening people with some “trick” unless they give a “treat,” and then spending the rest of the evening and the next several days eating thousands of calories of high fructose corn syrup as fast as humanly possible. Anyway, after 24 months of detoxification in England it was shocking to return home to the old beta cell flogging.
But the bigger change happened when I got married, and then discovered that my wife doesn’t like to eat sugar. I’m still not sure how I failed to notice that during our courtship. After seeing the complications of diabetes mellitus firsthand in medical school and residency, and after years of living with Marisa, I became ready to embrace the unsweetened life. Or at least the life without candy binges. (For the record, Marisa more than makes up in personality sweetness whatever she lacks in its dietary counterpart.)
A Quick Physiology Lesson
What does the body do with sugar that you eat, and what goes wrong with this system when you have diabetes? I think the disease mechanism can teach us something about human nature. Refer to the cartoon schematic below or a decent human physiology textbook for more details, but the big picture is that insulin makes blood sugar levels go down by instructing muscle, fat, and liver cells to do something with it.
Type 1 diabetes is when your pancreas can no longer make insulin, and type 2 diabetes is when your cells stop responding as well to insulin. Type 2 diabetics usually spend years or decades of eating too much simple sugar and not exercising enough before the disease develops. As the body’s insulin response decreases the pancreas releases more and more insulin in a frantic effort to control rising blood sugars, and eventually the cells that make insulin can’t keep up anymore and fail.
In type 2 diabetes the pancreas is like a parent raising his voice to his kids, saying, “I need help here! This house is a total mess and I need you to get off the couch and help me clean up!” And the muscle, liver, and fat cells are the kids lying around the house like slugs, barely lifting a finger to help.
We sometimes act like that with the Lord, ignoring the Holy Spirit so long that we become “past feeling, that [we can] not feel his words.” We do this by neglecting our prayers and gospel study, and by failing to do our duties in the Church. This is the spiritual equivalent of type 2 diabetes.
Priorities and Consequences
The medical complications of diabetes include:
- heart attack and heart failure
- dementia and stroke
- kidney failure
- limb amputation
The spiritual equivalent of type 2 diabetes impairs your ability to:
- see what is true
- walk in the light of the gospel
- feel what is right
- clear out from your life what is no longer wanted
- remember the Lord’s goodness
- love your neighbor
Most people who drift away from the covenant path don’t do so deliberately, at least not at first. I think back to the October 2007 General Conference address by Dallin H. Oaks, entitled “Good, Better, Best:”
“We should begin by recognizing the reality that just because something is good is not a sufficient reason for doing it. The number of good things we can do far exceeds the time available to accomplish them. Some things are better than good, and these are the things that should command priority attention in our lives. […]
“We have to forego some good things in order to choose others that are better or best because they develop faith in the Lord Jesus Christ and strengthen our families.”
The timing of this counsel, at the dawning age of social media, could not have been better. (Facebook opened to the public in 2006.)
President Oaks recently revisited this topic in the April 2019 conference:
“There is nothing bad about playing video games or texting or watching TV or talking on a cell phone. But each of these involves what is called ‘opportunity cost,’ meaning that if we spend time doing one thing, we lose the opportunity to do another. I am sure you can see that we need to measure thoughtfully what we are losing by the time we spend on one activity, even if it is perfectly good in itself.”
A few weeks ago I noticed that I was spending too much time reading good things so that I didn’t have as much time to read the essential things. I found that I was forgetting to read the scriptures until I was getting into bed, and then hurrying through a chapter before closing my eyes, struggling sometimes to stay awake while doing the most important reading of my day. It is hard to hear the voice of the Lord in the scriptures when you read them this way. After some reflection I decided to make it my habit to study at least one chapter from The Book of Mormon in the morning before I start my work day, and I have found that this makes it easier to limit the time I spend on less important things.
A Moral Vice
My friend Erik told me about a time many years ago when he invited one of his workmates to a potluck Christmas dinner at their church building. His friend was not a member of the Church, and this was his first visit to one of our meetinghouses. As they stood in line for the food his friend observed something unusual.
“Hey Erik,” he said. “Why is there one table of dinner food and three tables of desserts?”
“Well, we aren’t allowed many other vices,” he said.
Despite our otherwise strong value in health, the obesity epidemic has not spared the membership of The Church of Jesus Christ of Latter-day Saints. This is the part of the argument where I am supposed to start scolding you for participating in and perpetuating this cultural glucose tolerance test (which we are failing), but I’ve probably already done enough of that. Some people think that obesity is somehow sinful, that it represents a moral failing. But I disagree. Obesity is not a sin, and having diabetes is not a marker for spiritual pathology any more than euglycemia is a marker for righteousness. We all need to eat right and exercise, just like we all need to repent.
The Word of Wisdom endorses healthy eating and prohibits a few specific things, but says not a word about refined sugar. Moderation is key when it comes to high-calorie foods, and exercise gives you more wiggle room for an occasional indulgence. My personal rule when someone brings treats into the office is that if it is home-made, then I can eat one. And if I went running that morning, then I can eat two.
The Inaugural Diabetes Awareness Day
A few years ago I posted a sign on our front door on Halloween. It read:
“NOTICE: This household is observing Diabetes Awareness Day on October 31st . We will not be distributing candy. We apologize for any inconvenience.”
[At the bottom of the sign was a picture of the crystal structure of insulin. ]
Marisa was embarrassed and took the sign down before anyone actually came to our door.
That night I made a deal with my kids that I would take them out to a Chinese buffet and they could eat all of the calories they wanted, but they couldn’t go trick-or-treating. “Halloween,” I explained, “is a useless holiday. It has no redeeming religious or culinary virtues.” They accepted my offer, and stuffed themselves silly with noodles, rice, meats, won-tons, vegetables, and also desserts. But as we sat at the restaurant one of them asked me, “Dad, can we go trick-or-treating just to our street?”
Of course the answer was no! Emphatically no! I was offended at the very inquiry, and at the ingratitude manifest even in the very act of overfilling their stomachs with the balanced meal I had purchased for them.
I still have mixed feelings about sending my kids out trick-or-treating. Every year we make the same trip to the Chinese buffet, and have the same discussion about how they want to get Halloween candy anyway. There is no insulating them from our candy culture; it is everywhere. If I am too strict on them now, will they be unable or unwilling to restrain themselves later? I don’t really want to control them; what I want is their self-control. (And I realize that taking kids to an all-you-can-eat buffet is not the best way to teach them moderation …)
Exercise and Action
Obesity is really just an accounting problem; to maintain a steady state, your energy income has to equal your energy expenditures. In a household budget it is good to maximize your income and keep your expenses down so that you can save for a rainy day and for retirement. But when it comes to energy metabolism in the body it is better to break even. (If you had to carry your cash reserves around on your body at all times, then we might feel differently about saving money.) Physical exercise is the best way to spend calories, and even people with type 2 diabetes benefit from doing this. Diabetics who exercise 30 minutes, 5 times a week, have lower blood sugars and a better insulin response.
The gospel message is “sweet above all that is sweet,” but it can only take you so far unless you put into practice what you learn. Sometimes gospel learners, like diabetics, have a hard time doing this. You need to “feast upon the words of Christ” like it’s Halloween night, but then “exercise your faith” and act on what you have learned.
“Wherefore, do the things which I have told you I have seen that your Lord and your Redeemer should do; for, for this cause have they been shown unto me, that ye might know the gate by which ye should enter. For the gate by which ye should enter is repentance and baptism by water; and then cometh a remission of your sins by fire and by the Holy Ghost. And then are ye in this strait and narrow path which leads to eternal life. […]
“Wherefore, if ye shall press forward, feasting upon the word of Christ, and endure to the end, behold, thus saith the Father: Ye shall have eternal life” (2 Nephi 31:17-18,20).