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Can insulin resistance cause gluttony?

Before we consider whether people who are sick with insulin resistance develop gluttony as a symptom -- let's consider gluttony in healthy, non-obese, non-insulin-resistant people.

"Pure" gluttony, in other words.  Gluttony that's not mitigated by illness.

And we'll use my own definition of gluttony.  Which, by the way, doesn't contradict Aquinas's definitions of "too much, too soon, too eagerly, too daintily (pickily), too expensively" -- it's more that it attempts to clarify them, to show what's meant by "too..." in these clauses.  That is,

 

Gluttony is eating behavior that flouts the restraints

of charity, obedience, resources, health, duty, or manners.

First let's consider a physically healthy person with normal hunger pangs.  When his body runs short on fuel, generally close to mealtime, he starts to get hungry and think about food.

If the healthy, hungry person is not a glutton:

• he is willing to share some of his food with other people
• he is willing to follow household rules such as "don't spoil your dinner" or "don't eat those crackers I'm saving for the party" or institutional rules such as "employees may not eat at their desks"
• he is willing to resist desires for food that doesn't fit into his budget
• he is willing to resist desires for meals that he believes won't promote health  -- even if what he wants is to eat a big bag of chips, he can choose to eat (say) a few chips and some fruit or nuts instead; he knows to stop eating or drinking when he's had so much that he'll feel sick
• he is willing to resist eating if it's not "permitted" -- he is willing to fast from meat on Lenten Fridays, or he is willing to resist eating factory-farmed meat if he believes it's not ethical, or to fast for a number of hours before a medical test, etc.
• he is willing to eat with attention to social norms, e.g., slowly enough to carry on a conversation and to keep from making a mess, and observing cultural norms of graceful dining.

If the healthy, hungry person is a glutton:

• he may say "No, I don't have enough to share; get your own" and may even steal food
• he may not care about rules for when, where, and what may be eaten, and may sneak food 
• he may spend too much money so he can eat the food he wants to eat, when he wants to eat it
• he may care more about eating what he wants to eat than about eating food that will support his health, and may eat or drink so much that he feels physically ill later
• he may complain that it's unbearable to observe required fasts or to abstain from proscribed foods
• he may be focused so narrowly on eating and drinking that he doesn't care if he spills, slurps, belches, or ignores his dining companions

Healthy people, who know better and have free will, commit all these acts from time to time -- and I name these acts "gluttony."  You have seen one balancing a cheeseburger on his steering wheel while he changes lanes.  You have read one griping about Ash Wednesday on her mommyblog.  You have caught one taking the last helping of mashed potatoes without asking if anyone else wants some. One has eaten the cookie dough out of the bowl even though it has raw eggs in it.  Another has said "yes, please" to that tasty stuff that gives him heartburn.   Another has woken up with a terrible hangover.  

Who hasn't done this kind of thing, once in a while? 

But some healthy people do this a lot, and I name them "gluttons."

What is it that turns a healthy person into a glutton?  Concupiscence.  Selfishness.  Narcissism.  Short-term thinking.  Habit.  Mistaking other people's reasonable desires and needs for unreasonable demands.    Mistaking his own wants for needs that must be gratified.  Deciding that the rules don't apply to him, or that it's okay as long as he doesn't get caught.  

Most of us do this at least once in a while, but some do it constantly.  Some have fallen into a habit of gluttony.

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It's important to note that the gluttonous behaviors listed above are gluttonous no matter how hungry the person happens to feel.  They would be gluttonous if the person was only feeling a bit peckish.  They would also be gluttonous if the person had missed a meal and felt positively ravenous.  The culpability of gluttony is mitigated somewhat when hunger feels unbearable, but the behavior is still gluttonous.  

This happened to me the other day.  I came home from church at 12:45 and was feeling woozy from low blood sugar.  (Something about the timing of the eleven o'clock Mass ruins me.  I can't quite figure it out.)  Mark went upstairs to take care of something or other and left me searching  irritably in the kitchen; while children clung to my legs and whined for food and milk, I whined back at them that I had to eat my own lunch first and then I could take care of them.  In one sense, I really did need to eat first, and my judgment was impaired.  But I could at least have asked Mark or an older child for help instead of just yelling.  So, yeah.  Gluttonous, even when very hungry.  But it's not too surprising that I got gluttonous just then, because I was in a weakened state.

So.  Gluttony is more likely when you're weak from feelings of hunger.  It's also mitigated  -- we're less culpable when we're in a weakened state.  

But it's more likely.

And if the insulin-resistance crowd is to be believed, then people with insulin resistance spend a lot of time in that weakened state.  They get hungrier, and they get hungry more often.  So they're maybe more often tempted to behave gluttonously:  eating uncharitably, breaking rules, ignoring manners.

Their guilt is mitigated because they are weak.  God knows they are weak.  God knows that illness makes it harder for them.

But they still have to live with the consequences imposed by nature.

And one of the natural consequences of frequently indulging in abnormal behavior is that it becomes its own new norm.  It becomes a habit.

Just as a healthy person who ignores constraints too often can develop a habit of gluttony, a sick person, giving in frequently to strong temptations that overcome the "shoulds" and "oughts," can develop a habit of gluttony.  

And after a while, the sick person might start to believe that hunger is not resistable under any circumstances.  The sick person might start to fear the discomfort of hunger.  And isn't so much sin grounded in an unreasonable fear of suffering -- even slight suffering?

She can't give some of her French fries to her children, because she might be too hungry later.  She can't resist storing some snacks in a desk drawer, though it's against workplace rules, and she rationalizes that she (unlike those others) really needs it.  She can't wait to get home for lunch even though she and her husband agreed to curtail the restaurant budget.  She always has to finish the first plate of food before she comes up for air and conversation.  She must taste the soup one more time to make sure it's good enough before she serves it.  

Frequent out-of-line behavior, in response to frequent understandable weakness, becomes frequent out-of-line behavior, in response to... less and less.   Habit reinforces habit.  And many gluttonous indulgences makes one glutton.

Years of insulin resistance, of unrestrained eating in response to physiological weakness, can -- I think -- generate more unrestrained eating in response to the force of habit.  That habit may stand between the sickness and the cure, and I suspect it can even persist after physiological "cure" has been achieved.

Gluttony doesn't (typically) cause obesity.

A couple of days ago, I wrote that the existing competing narratives of obesity don't really "get" the role of gluttony right, because they lack philosophical grounding in the nature of gluttony.  

The calorie-is-a-calorie crowd say that gluttony -- eating too much -- is the whole problem, with some contribution from sloth, and if people would just eat less they'd get thin.  They've got the biochemistry wrong, and have unfairly accused fat people of causing their own disease by being gluttons.  

The insulin-resistance people (think Gary Taubes) have the chemistry right, in my opinion, but they reject the idea of gluttony playing a part at all.  I think that's wrong too.  Even though I'm convinced that metabolic syndrome exists and is caused by a diet high in refined carbohydrates and sugar and that it perpetuates a vicious cycle of eating and craving, I think gluttony is involved, and beating gluttony is part of the cure.

In this post (and a couple more) I want to explore the role of gluttony in obesity.  Starting with the question:  Does gluttony -- technically defined gluttony -- cause obesity?

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The insulin-resistance crowd, whom I think is correct as regards the biochemistry, says No:  Gluttony, or "eating too much," does not cause obesity; obesity is caused by eating the wrong things, not too much of everything.  Eating more than you burn doesn't cause weight gain; weight gain causes eating more than you burn.

But we aren't actually interested in that answer, because it's the answer to the wrong question.  The common, ordinary meaning of "glutton" is just "someone who eats too much."  That's the definition they are using.  But moral philosophers have defined "gluttony" more broadly than that for hundreds of years.  Recall that Aquinas subdivided gluttony into five categories:  eating too expensively, too daintily, too much, too soon, or too eagerly. Aquinas was also perfectly aware that it didn't count as a sin if you didn't realize you were eating out of order, or if you had doctor's orders, or something like that.  

More recently, I proposed an alternate definition of gluttony that drew brighter lines:   Gluttony, I wrote, is eating behavior that flouts the restraints of charity, obedience, resources, health, duty, or manners.  These sound more promising ways to pin the blame on gluttony, especially when it comes to the "health" bit.  But I agree with Aquinas that it can't count as a sin if you don't know your eating is wrong -- if you think you need the food. 

If we use Aquinas's definitions, the following are obvious:

1. Gluttony could  be a cause of obesity, if eating too much causes obesity.  
2. But even if eating too much did cause obesity,  gluttony wouldn't necessarily be the problem because eating too much doesn't qualify as gluttony if the eater has good reason to believe it wasn't too much.  For example, if he was truly experiencing feelings of hunger.

Seeking out food when you're hungry is not gluttonous behavior; it's normal behavior.

And guess what?  One of the things that metabolic syndrome causes is hunger and carbohydrate cravings.  This is from Why We Get Fat:

Even before we begin eating, insulin works to increase our feeling of hunger.... we begin secreting insulin just by thinking about eating... and this insulin secretion then increases within seconds of taking our first bite.  It happens even before we begin to digest the meal, and before any glucose appears in the bloodstream.  This insulin serves to prepare our bodies for the upcoming flood of glucose by storing away other nutrients in the circulation -- particularly fatty acids. ...

...The insulin makes us hungry by temporarily diverting nutrients out of the circulation and into storage... The greater the blood sugar and insulin response to a particular food, the more we like it -- the better we think it tastes....

[T]he fatter [predisposed people] get, the more they'll crave carbohydrate-rich foods, because their insulin will be more effective at stashing fat and protein in their muscle and fat tissue, where they can't be used for fuel.

Once we get resistant to insulin... we'll ... have longer periods during every twenty-four hours when the only fuel we can burn is the glucose from carbohydrates.  The insulin, remember, is working to keep protein and fat and even glycogen... safely stashed away for later.  It's telling our cellls that there is blood sugar in excess to be burned, but there's not.  So it's glucose we crave.

Grossly oversimplified, elevated insulin is supposed to make you hungry, makes you want to eat carbs in particular, and makes you store fat at the same time.  So even though from the outside, a heavy person may appear to be eating too much, from the inside the person may be experiencing unbearable hunger.  And hunger is the normal drive to eat.  

I live with one of those weird, always-lean people:

Mostly he eats pretty moderately:  oatmeal for breakfast, soup and salad at lunch, maybe a couple helpings at dinner, a little ice cream at bedtime.  On occasion, however, I have seen him put away what looks to me like an enormous amount of food.  The equivalent of two or three cheeseburgers or something like that in the space of a few minutes.  Is he a closet, occasional glutton?  Perhaps suffering from binge disorder?

No.  The "binges" happen after a day of skiing, or hiking at altitude, or heavy yard work, or maybe rock climbing.  When he exerts himself, he needs to eat more.

As astonishing as it is to people like me who have had to think about food their whole lives, I hear that this is what actually happens in metabolically healthy people.  They don't need to think "Does that workout mean I get to eat more?" because their body tells them to eat more.  So they do.  And we never accuse those people of gluttony -- because they don't look fat.

Anyway, there is no moral difference between a fat person who gets extra-hungry and therefore eats extra food, and a thin person who gets extra-hungry and therefore eats extra food.  Even if the reason for the hunger is different -- in one person, excess insulin, and in the other person, excess physical activity -- the subjective experience of the need for food may be the same.

 Look, Aquinas knows this:

 ...[T]he sin of gluttony is rather extenuated than aggravated...in consideration of the necessity of taking food, as also on account of the difficulty of discerning and regulating what is suitable on such occasions.

Gluttony is mitigated insofar as it is difficult to "discern" and "regulate" what is suitable.  Metabolic syndrome creates a feeling of hunger, and that is exactly what makes it difficult to discern and regulate what is suitable to eat.

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So, if it's true that eating the wrong things (too much sugar and white flour and potatoes, for instance) creates metabolic syndrome, can that count as gluttony?  Maybe under the "too expensively" or "too daintily" categories?  

It might, if a person (before they developed the syndrome) knew that they were eating too much of the wrong things and obstinately persisted.  

Culpability is hard to establish, though, because in many cases it isn't an entirely free choice to do so:

•  many people begin to develop metabolic syndrome while they are still children, being fed by parents and institutions; 
• government policy has been giving us counterproductive advice for more than a generation;
• the low-fat doctrine is still pushed heavily by schools and physicians; 
• we seemingly reasonably assume that if we're not visibly obese yet, we must be doing okay;
•  the food that promotes metabolic syndrome is ubiquitous, widely advertised, and cheap.

It isn't impossible for gluttony to cause obesity.  But for that to happen you'd have to posit an apparently healthy individual who, as an adult, and knowing that it was bad for him, made a free choice to begin consuming large portions of sugar and white flour until he wrecked his metabolism.

 I think this might happen sometimes.  It's the sort of thing that people say will happen to kids who are raised in homes barren of soda pop and sugary cereal:  As soon as they're out on their own, they'll go crazy, subsisting on fast food, Cheez Whiz, and Captain Crunch.  (One of my friends in grad school claimed to have known a guy in her college dorm who actually got scurvy his freshman year.)

Most of the time, though, I think we just sort of slide into metabolic syndrome, not by eating a diet that is obviously unhealthy, but by eating... the normal American diet.  Normal Americans drink soda, eat white bread and white rice, and consume a lot of sugar in the course of an ordinary day.  Some are more susceptible than others, and those people develop metabolic syndrome, gain weight, and get hungrier -- so they begin to eat regularly in a way that looks like gluttony, from the outside.  But because of the subjective experience of hunger, we can't automatically call it that.

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The next question I want to consider is whether metabolic syndrome causes gluttony, of any of the types that Aquinas identified or that I reclassified.  I've already written that eating in response to real hunger isn't, I think, gluttonous.  But is that the only kind of behavior change created by metabolic syndrome?  

I'm going to cover that in another post.

Where to start with gluttony: some links back to my archives.

Christine, in the comments to the last posts, asked "Where to start with gluttony?"

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I reviewed Gary Taubes's book some time ago in three parts, and I think these are some of my best gluttony posts, especially the second and third one.

•  here is an introduction, 
• here is where I explain why the book lacks the necessary real-life context to be considered a "diet book," 
• here is where I start to explore why gluttony isn't off the hook -- even if it doesn't cause fatness.

 

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Here is the part where I cheekily suggest a definition of gluttony, complete with new categories, that I prefer to Thomas Aquinas's.  (Yes, I really am claiming to have improved on the Summa Theologica.) Here's my new post-Summa definition of gluttony:

The sin of gluttony is the refusal to eat within the restraints imposed on us by charity, obedience, resources, health, religious/ethical duties, and manners.   

(The weakness of gluttony is the inability to eat within those restraints.)

 

Aquinas's definition of gluttony seems to have one glaring problem:  it lacks a bright-line rule.  "Gluttony means inordinate appetite in eating," he tells us, and we rightly ask:  What do you mean, "inordinate?"  Out of accord with the natural order of things, one supposes....

We've been over this before:   we can be a glutton by eating too expensively, too daintily ("pickily"), too much, too soon, or too eagerly.  

This is a nice categorization because it expands the usual definition of gluttony, but it still leaves us asking:  But Thomas, what do you mean by "too" anything?  If one can eat "too" expensively, then surely one can eat "just expensively enough," and so forth.  Where is the line?  How do we know when we've crossed over from eating promptly, to eating "too soon?"  Eating with relish, and eating "too eagerly?"   Selecting good food and being a glutton of pickiness?

I think the answer is that gluttony, like most concupiscence, abhors restraint; what makes gluttony different from other vices, such as sloth or lust, is that the restraints it abhors all have to do with food.  

Different people live under different sets of restraints, some more stringent than others; and different times call for different restraints; so the boundaries of gluttony cannot be defined clearly as a set of rules that are appropriate for everyone.   And so eating quite a lot of food, or eating expensive food, or eating at odd times, isn't inherently gluttonous; what makes it gluttonous is if the eater is supposed to be exercising restraint, but isn't.

If I may say so myself, I think it's worth reading the whole thing.  Rather than Aquinas's categories of gluttony as eating "too expensively, too pickily, too much, too soon, or too eagerly" my categories -- stripped of the vague modifier "too" -- could be phrased as 

• eating inconsiderately
• eating disobediently
• eating wastefully
• eating unhealthfully
• eating irreligiously (or, if you are not religious, substitute "unethically")
• eating rudely.

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Oh, and for the people who would like to eat low-carb but feel bad about the environmental impact of consuming so many more animal products:   here are some things to keep in mind for improving the sustainability of lower-carb eating.  I am rather fond of this article.  The short of it is:

1. Eating enough fats and oils, and not too much protein, will alleviate the famous unpleasant side effects of low-carb diets. 
2. Don't overestimate your daily protein requirements.  Three grams for each ten pounds you weigh is a good rule of thumb for the minimum.  You could eat more, of course, but you don't necessarily need more.
3. Eat your veggies, and eat them with plenty of tasty, tasty fats and oils -- enough to give you all the energy you require over and above your calories from protein.
4. Don't waste so damn much food, especially protein.  Avoidable food waste is the most shameful portion of our environmental impact.  
5. Choose animal products that make efficient use of agricultural protein.  In order, the most efficient "ordinary" sources from the grocery store are dairy; eggs, tied with aquacultured fish; chickens; pork; beef.  (Wholly grass-fed beef, or beef fed on non-human-edible agricultural residue, is great if you can get it, but not everyone can get it).

Untangling the threads of gluttony.

As I have been struggling with weight maintenance more than usual this month, I have found myself contemplating the two dominant narratives about weight loss and weight gain, and why neither of them ultimately satisfies.

Here they are, in brief:

"A calorie is a calorie." Weight gain is caused by eating more calories than you burn, and storing the extra as fat; to lose weight, burn all the calories that you eat, plus extra that come out of your fat stores. In this narrative, the amount of calories is far more important than the type of food the calories come from. People who cannot lose weight are people who have a gluttony problem.

"Insulin resistance and glycemic load." Gluttony does not cause people to gain weight. Excess adiposity -- fatness -- is a symptom of metabolic syndrome, an endocrine disease. The disease comes from a diet that has more sugar and refined carbohydrate than the body can handle, because of an environment that constantly pushes such foods. The only cure for the endocrine system is to cut back on carbohydrate load, and some people have to cut back drastically for a long time to see results. People who cannot lose weight are people who have not tried the right cure, who have not tried a drastic enough cure, or who have not yet given it enough time to work.

I think the insulin-resistance theory has the chemistry right, but it gets gluttony wrong. It is enormously comforting for a heavy person to hear that gluttony is not the cause of his fatness, and it is even more comforting to hear that it is unnecessary to beat gluttony in order to get better. The message from the insulin-resistance crowd is "You are not bad or weak; you are just sick. Take the cure and you will get better."

The calorie-is-a-calorie theory has the chemistry wrong, but it doesn't have the gluttony part entirely right either. It persists, by the way, because it is so comforting to the not-fat people. The people who can control their weight get to go on, like Job's friends, believing in the essential justice of the universe: that person can't get thinner because she is weak-willed and lazy. The laws of thermodynamics make it so. Perversely, there is some comfort for heavy people: I am this way because I deserve it and because the universe is just; but there is hope for me, because if only I can become a better person, I will surely lose the weight and become beautiful and accepted. Someday I will.

Americans don't grok gluttony because they don't grok sin and human failings in general. We believe in an essential dichotomy: Either a man's failing is his own damn fault, so we stigmatize and punish it, and maybe (if we are religious) call it "sin;" or it is someone else's fault, so we try to pass laws and social programs, and de-stigmatize it and raise awareness. The only difference as you move from Left to Right is which failings are your own damn fault and which failings are someone else's.

But the reality is that we each participate, with varying degrees of freedom, in the flaws and failings that nature and society have thrust upon us. Sin and failings beget sin and failings -- sometimes in other people -- so they spread like a disease. And so it can simultaneously be true that a fat person is sick through no fault of her own, and that she struggles with the sin of gluttony.

Here is what I think is the right way to look at it:

• Gluttony does not cause excess adiposity, nor metabolic syndrome. 
• Too many refined carbs for the particular body to handle causes metabolic syndrome. Of that, excess adiposity -- fatness -- is a symptom.
• Metabolic syndrome contributes to the development of certain types of gluttony. You could say that gluttony is another symptom, along with fatness.
• A person who has metabolic syndrome must fight and beat gluttony in order to apply the prescribed cure.

So the insulin-resistance crowd is correct that gluttony did not make the fat person fat. But the calorie-is-a-calorie crowd is correct that the fat person must overcome gluttony to become thin.

(You have to overcome gluttony, but you have to do it the right way.)

Did I really just say that gluttony, technically a sin for many people and at minimum a human failing of will, is a symptom of a disease? Doesn't the disease mean they aren't guilty of the sin?

 Guilt is mitigated where will is limited, sure, but the mitigation of guilt doesn't destroy the effects of the fault. We all know this, and so does our legal system. Abusers are likely to have been abused themselves, but we don't give them a free pass; if we are merciful we try to help them change, but we do insist that they stop abusing others. So -- gluttons are likely to be sick, and mercy should move us to compassion rather than sneering, but it doesn't change the fact that they will not get better without doing the hard work to overcome gluttony.

It is a sort of hysteresis of disease. We amble accidentally along an easy path from health to sickness. The path from sickness to health is not just the return trip. It is a different, and more arduous one, and it requires from us strengths that we may not find entirely within ourselves.

 

More on this later.

Bipartisanship.

This blog post at the NYT has some fun graphs up showing how various cable networks, alcoholic beverages, cars, and fast food chains skew Republican or Democrat.  

It turns out that our family drives on the center-left side of the road, as we own a VW and a Toyota, both favored by Dems.  (I suspect the Toyota numbers vary a lot by model, and that the eight-seater Sienna we drive probably shows up to the right of, say, the Prius.)

I don't watch enough TV or eat enough fast food to register very well on those measures, and I don't have enough brand loyalty to Big Beer to register much on the alcohol spectrum as well.  

Being rather interested in bipartisanship, I was wondering what cultural forces can bring people together.  It turns out that we can all get along by watching HGTV, A&E, and Spike; driving Chevrolets; dining at Wendy's; looking up movie listings on the Internet; and, in the one behavior I think I can endorse with reasonable enthusiasm, drinking Guinness.  Now at least you know what to serve at those uncomfortable family get-togethers.

h/t Darwin Catholic, who drinks center-right