Johnny Cash, the Man in Black

Johnny Cash wrote more than 1500 country songs and became America’s most famous country singer.   His fans included every president in his lifetime from Richard Nixon on, and almost everyone recognizes his voice.  In his fifties he was diagnosed with diabetes, an avoidable and curable disease that made him miserable for the last two decades of his life. He died prematurely at age 71 because he broke almost every rule for living a healthful life: he smoked heavily, drank alcohol to excess, took excessive amounts of illicit and prescription drugs, was overweight, did not exercise and ate an unhealthful diet.  Out-of-control diabetes can damage nerves everywhere in the body, and in his case, it damaged the involuntary nerves that control breathing, digestion, heart rate, and blood pressure to cause a condition called Multi System Atrophy that eventually killed him.

He was born in 1932, during the Great Depression, with a given name of  “J.R. Cash”. By age five, he was working in the cotton fields and in his teens, he enlisted in the United States Air Force where he was told that he needed a name rather than just initials, so he chose John Cash.  After three years in the Air Force, he married Vivian Liberto, moved to Memphis, Tennessee and sold appliances. He auditioned at Sun Records and at age 24, he recorded “I Walk the Line” which remained at the top of the Country Charts for  43 weeks and sold more than two million records.  To get himself through his grueling schedule of touring all the time, he took massive amounts of alcohol and prescription and recreational drugs. In 1966, his wife filed for divorce.  At that time, he was touring with the Carter Family that included their three daughters, Anita, June and Helen. In 1968, at age 36, he tried to commit suicide. June Carter and other members of the Carter Family moved into Cash’s mansion for a month, and he told June that he had decided to live if she would marry him.  Thirteen years after they first met backstage at the Grand Ole Opry, Cash proposed publicly to June Carter during a live performance in London, Ontario.  They were married on March 1, 1968 and worked together for 35 years.

Because he often sang about prison life, people assumed that he was speaking from his own experience, but actually he never spent more than one night in jail for any of his offenses. He was arrested seven times, including:

• In 1965, El Paso narcotic officers found 688 Dexedrine capsules and 475 Equanil tablets inside Cash’s guitar case. He received a suspended sentence.

• That same year, he was arrested in Starkville, Mississippi, for trespassing to pick flowers on private property late at night.

• In 1967 in Walker County, Georgia, he was in an automobile accident and officers found a bag full of prescription pills.

His many brushes with the law caused him to become an advocate for prison reform. He often sang while dressed in a long black knee-length coat. In 1971, Cash wrote the song “Man in Black”, to help explain why he dressed as he did. “I wear black on behalf of the poor and hungry, on behalf of the prisoner who has long paid for his crime, on behalf of those who have been betrayed by age or drugs . . . with the Vietnam War as painful in my mind as it was in most other Americans’, I wore it ‘in mourning’ for the lives that could have been. The old are still neglected, the poor are still poor, the young are still dying before their time, and we’re not making many moves to make things right. There’s still plenty of darkness to carry off.”

In 1988, at age 56, he went to the hospital to visit Waylon Jennings, who was recovering from a heart attack. Jennings suggested that Cash check into the hospital for his own heart condition. He did that and the doctors found that the arteries leading to his heart were blocked, and Cash underwent double bypass surgery. Both recovered, and Cash later said that during his operation, he had what he called a “near death experience.”

In 1997, Cash was diagnosed with a rare nerve disease called Multiple System Atrophy (MSA), that has no known cause and no effective treatment. He was also diagnosed with diabetes, a disease that routinely damages nerves. His diabetes was out of control and his diet, excess weight, lack of exercise, smoking, alcohol, drugs and almost everything else he did caused more nerve damage.

Later he was diagnosed as having Parkinson’s disease because his hands shook, he was unsteady on his feet and his thought process was slowing down. All of these symptoms can be caused by Multiple System Atrophy, which is sometimes described as a rare type of Parkinson’s disease.  However, out-of-control diabetes can damage your brain and every nerve in your body.

At age 71, he was an invalid. The nerves in his legs were so badly damaged that he was unable to walk and he had to use a wheelchair to get around. He wore leg braces and had to be fitted with special shoes. He was hospitalized several times for pneumonia.  On July 12, 2003, less than four months after the death of his wife, he was hospitalized at Baptist Hospital in Nashville and died of heart, lung and kidney failure, which could all have been caused by out-of-control diabetes.

Most cases of Type II diabetes are caused by having excess fat in the liver.  Everybody’s blood sugar rises after they eat.  To keep your blood sugar from rising too high, your pancreas releases insulin which lowers blood sugar levels by driving the sugar from your bloodstream into your liver, but if your liver is full of fat, your liver does not accept the sugar and blood sugar levels rise even higher.   This causes sugar to stick to the outer membranes of cells throughout the body. Once stuck on a cell membrane, sugar can never get off. It is eventually converted to sorbitol that destroys the cell. Diabetes can cause:

• plaques to form in arteries that start the process that leads to heart attacks

• nerve damage that can cause impotence, dementia, loss of feeling and pain in the legs and everywhere else, and in his case, inability to walk

• kidney damage

• liver damage

• brain damage and dementia

Most Type II diabetes could be be prevented or cured with lifestyle changes.  The drugs available for diabetes can help to control the disease but do not cure it.  For a long and healthful life, follow the lifestyle rules that Cash ignored:

• avoid being overweight

• exercise

• eat plenty of fruits, nuts, beans, seeds and vegetables

• restrict sugared drinks, sugar-added foods, fried foods, refined carbohydrates and red and processed meat

• do not smoke

• avoid alcohol

• avoid recreational drugs and unnecessary prescription drugs

• get blood levels of hydroxy vitamin D above 30 ng/mL