29 Interview with Dr. Michael Greger How Not to Die Nutrition Facts.mp3: Audio automatically transcribed by Sonix
29 Interview with Dr. Michael Greger How Not to Die Nutrition Facts.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Speaker1:
Welcome to the Cancer Secrets podcast. Changing the Cancer Paradigm. Hosted by Dr. Jonathan Steagall, a medical doctor and cancer specialist practicing in Atlanta, Georgia, deeply affected by his grandmother's death from stomach cancer, as well as patients he cared for in medical training, he realized there has to be a better way to treat cancer. Dr. Stegall has a unique and innovative approach to treating cancer called integrative oncology, combining modern medicine with alternative therapies personalized to each patient. This podcast is designed to educate, support and give you a positive voice you can trust. We invite you to join us on this journey as we seek to change the cancer paradigm.
Speaker2:
Hello and welcome back to the Cancer Secrets Podcast. I'm your host, Dr. Jonathan Stegall, and this is season two and episode number 29. In today's episode, I'm honored to be joined by a very special guest, Dr. Michael Greger, a founding member and fellow of the American College of Lifestyle Medicine. Michael Gregor, M.D., is a physician and New York Times bestselling author, an internationally recognized speaker on nutrition, food safety and public health issues. He's lectured at the Conference on World Affairs, testified before Congress, and was invited as an expert witness in the defense of Oprah Winfrey in the infamous meat defamation trial in 2017, Dr. Gregor was honored with the acclaimed Lifestyle Medicine Trailblazer Award. He is a graduate of Cornell University School of Agriculture and Tufts University School of Medicine. His latest book, How Not to Die, became an instant New York Times bestseller. He has videos on more than 2000 health topics freely available at nutrition facts. Org. With new videos and articles uploaded every day, all proceeds he receives from his books, DVDs and speaking engagements is donated to charity. Dr. Greger, welcome to the show.
Speaker3:
So happy to be here.
Speaker2:
It's awesome. And you're joining us while walking on your treadmill, which I understand you do throughout the day.
Speaker3:
Indeed, sedentary behaviors. No. Good for us. Yes. 6 hours or more of sitting a day has negative consequences, adverse health consequences, even if we then go out to the gym after work or something. So ideally a standing desk or a treadmill desk. We just were not meant to sit all day, it turns out.
Speaker2:
I hear you. So let's start with talking about nutrition and how you became interested in nutrition.
Speaker3:
It was really all goes back to my grandmother. I was just a kid when my grandma was diagnosed with end stage heart disease, sent home in a wheelchair to die. She already had so many. Bypass surgery is basically get so scarred up inside. There's nothing more they can do. So age 65, there was two, especially sent home to die. Then I heard about this guy, Nathan Pritikin, one of our early lifestyle medicine pioneers. And what happened next is actually detailed in his biography, talks about Frances Gregor, my grandmother. They wheeled urine and she walked out. She was given a medical death sentence at age 65 thanks to a healthy diet is able to enjoy another 31 years on this plan to age 96 to continue to enjoy her six grandkids including me. That's why I wanted the medicine. That's why I started nutrition facts that are why I wrote How Not to die, why all the proceeds from my books are donated to charity I just wanted to do for everyone's family. Were pretty candid for my family.
Speaker2:
Excellent. I love it. And as you know, since this is a cancer show, we're interested in nutrition and how it relates to cancer prevention and cancer treatment. And those who have listened to my previous episodes know that I recommend a whole food plant based diet, and you certainly do as well. So I wanted to ask, what led you to start recommending that diet and why do you think it's important related to cancer?
Speaker3:
Um, well, so, you know, one can start out by looking at populations around the world with which have exceptionally low cancer rates and people I mean, certainly medical professionals is surprised to learn that cancer rates for whom are common cancers or epithelial cancers like colon cancer, breast cancer, etc., vary a hundredfold around the planet a hundredfold. And so when something varies that much, and particularly when you do migration studies showing that there's not some genetic predisposition among certain populations, when a Japanese man moves from Japan to Hawaii to LA and starts eating and living like an American man, their rates of stomach cancer dropped because they're no longer eating these fermented foods. But they're the salty the salted foods, but their prostate cancer rates shoot up. So it wasn't there wasn't something specific about being Japanese. It was the Japanese lifestyle. And so when you see these dramatically different rates of cancers, then you think, well, there must be something going on. So when you see lung cancer rates, you know, having a large disparity, oh, well, smokers of virus nonsmokers have lower rates. That gives you a clue. There might be something going on. And the reason and and there's lots of reasons to suspect that diet may be playing a role. In fact, you can even do interventional studies and look at things like you can actually do histological progression. So some remarkable studies like the strawberry and in esophageal cancer study see reversal precancerous changes and it's absolutely remarkable that's just adding one food to one's diet. You can still study with, you know, precancerous polyps, for example, with these people at high risk, these familial polyposis where they have all these polyps showing up.
Speaker3:
And so you can give them turmeric or not randomize them and you can show, you can actually decrease, you can actually reverse part of this process. And so both observational studies, interventional studies suggest that the more whole plant foods we can send our diets around, the better. And that may be a combination of things in terms of the beneficial anti-inflammatory antioxidant of components to plant foods, a high fiber content. Or maybe we're avoiding some of the pro carcinogenic aspects in other foods, either processed foods or animal foods, or whether it's polycyclic aromatic hydrocarbons in barbecued meats or the heterocyclic means is something like grilled chicken or meat kind of go down the list. Some of these these these toxic organic pollutants like PCBs and DDT, tend to increase up the food chain. So eating lower on the food chain reduces our exposure to these industrial toxins. There's all sorts of reasons that could explain the lower cancer rates, but in a certain sense, who knows? Who cares, right? I mean, look, if eating this way will decrease your risk of getting cancer, then we don't have to know why exactly smoking causes cancer. I mean, there's all sorts of things in tobacco and smoke and combustion byproducts that can increase cancer. But do we need to know the exact mechanism before we tell people to stop smoking? No, we can tell people to stop smoking now and then. Yeah, it's fascinating research problem. Let's keep looking into it. But until then, we can give people practical advice to reduce their risk.
Speaker2:
Absolutely. And what amazes me is, you know, most doctors and I hate to say this because we both are, but most doctors don't talk to their patients about nutrition and seemingly aren't even interested in learning about it. And it amazes me, especially when we're talking about cancer, because there's great study showing that cancer can be prevented or greatly reduced when we eat well.
Speaker3:
Absolutely amazing. Right. And, you know, randomized controlled trials like the famous Ornish trial with these early stage prostate cancer, right where we actually saw, you know, the slopes of their PSA were in dire opposite directions, suggesting a shrinkage of the tumors just by changing diet and lifestyle. Really remarkable stuff. But look, how much can you blame doctors? And we weren't taught any of this. I mean, I think well, look, when I go around to speak of medical schools, I mean, the interest is there, but there's just not so much medical education is funded by big pharma. There's just like there's just not a lot of ways to get this information out there. But that's why I started in search, in fact, because there's this mountain of good evidence out there, but there's no corporate budget kind of driving. It's promotion to get into people's hands. Some new study coming out saying broccoli is good for you or apples. Who's going to I mean, there's not going to be a press release and no one's making money. These are perishable foods, unfortunately. I mean, the healthiest foods are the least profitable where you want something shelf stable that sits on the shelf, good for shelf life, bad for human life.
Speaker3:
So unfortunately, just the system is set up not to support healthy eating habits. But yeah, the more we can we can avail doctors to these tools, the better. And of course, it's not either or. It's like regardless of what you choose to do, you and your doctor choose to do it. You can always eat healthier in addition to whatever else you want to choose. I mean, there's just there's I mean, what disease entity couldn't benefit from just better nutrition, even if it's even if it has doesn't help the condition at all, but just helps your body deal with the treatment or helps your body in other ways. I mean, the last thing you need when you're battling an illness is to have illness number two creep up. I mean, you know, I mean, so, you know, people come to me and say, you know, some esoteric, you know, condition where there's just no science either way, like ankylosing spondylitis, we don't have a lot of good science either way. But okay, it's a similar condition to rheumatoid and some of these other inflammatory autoimmune conditions. So maybe it helps, but it's like, what's the downside of eating healthier, right? I mean, it just needs to be kind of this different bar of evidence when it comes to safe, simple side effect, free solutions.
Speaker3:
Right? When a new drug comes out, you want to be darn sure that it's been tested on thousands of people with really good randomized controlled trials with independent researchers, because there's could be tremendous downside, right? Adverse effects for medications may kill 106,000 Americans every year. It's like the fourth leading cause of death. So absolutely the benefits have to far outweigh the risk. But when it comes to something like some new study comes out saying that, oh, if you eat apples, you know, randomize people to eat apples and, you know, it improves their triglycerides or something. I mean, do we have endpoints, hard endpoints in terms of, you know, disease, you know, hospitalizations, death, etc.? No, but it's like, what's the worst that can happen if, you know, if we tell people to eat apples, they'll just benefit from all the other ways apples help us. Right? So we just have to, I think, think differently when it comes to medical devices, when it comes to new surgical approaches and new medications and these really kind of basic common sense lifestyle principles.
Speaker2:
Absolutely. I agree. So you have a fascinating video on your website about Methionine and its relationship to cancer. Could you explain a little bit about what Methionine is and why it's it's probably a good idea for us to try to avoid it or at least reduce it in our diets.
Speaker3:
Yeah, it's interesting. So methionine is is a sulfur containing amino acid. So amino acids are the building blocks of proteins. And so there's approximately 20 or so amino acids. So if you think about those letters of the alphabet and so you can jumble those letters together to form different words, different sentences, different proteins. And so proteins can be composed of a different variety and ratio of different amino acids and cancer cells. Specifically, there's other things without restriction may help with, but cancer cells appear to have a biochemical defect and that they have this kind of absolute, absolute methionine dependency, such that normally if you take your healthy cells in a petri dish and you starve them with iron, they can kind of get around it. The normal cells can figure a way to get around it, but cancer cells die off. Cancer cells need that thiamine or else. And so the strategy then would be for people and you can do this not just on cells and pictures, you actually take tumors out of people. And you can do you do similar kind of studies showing this kind of methionine dependency. And so, you know, big pharma, others looking for ways to block methionine absorption or try to to find ways to enhance its metabolism in the body. But it's like, why not just take a step back and not eat so much in the first place? I mean, the level of sight in your blood is determined in large part by how much you put in your mouth. And so we can kind of stay away from the thiamine rich foods. And predominantly, I think chicken fish have the most but then red meat and then, you know, eggs, dairy on down list are the lowest kind of methionine sources of protein or plant of protein. So legumes, beans, but peas, chickpeas, lentils, that's the way you get your protein, but relatively low methionine intake. And which may explain why people who eat more plant based diets have tend to have lower cancer rates kind of across the board. Maybe Methionine is playing a role there.
Speaker2:
I think so, and I think it makes sense to restrict it. So that's what I tell my patients. You know, let's let's restrict methionine. We're already eating a plant based diet anyway. That's a real value. I think to it. You make a protein and I'm glad you did. You know, there's a lot of a lot of concern when by some patients when we say, okay, well, let's let's eat a whole food plant based diet, they say, well, where does my protein come from? We've been flooded with these messages of, you need more protein, you're active, you need protein need, protein shakes, animal protein. We kind of it's becoming our pop culture like we need more protein. And the people's concern is if they're eating a plant based diet, they won't get enough. So what do you say to that?
Speaker3:
Yeah, anyone who doesn't know how to get protein on a plant based diet doesn't know beans. They're literally, of course. Right. So legumes are the protein superstars of the plant kingdoms. And so so that's been split. Peas, chickpeas and lentils have all the things you'd expect from high protein foods like protein, iron, zinc, but of course, doesn't have the saturated fat and cholesterol and has all these bonus stuff found in kind of the vegetable kingdom, like high folate and potassium and fiber. And so it's really the best of both worlds. And so actually beans right in the US federal plate, the latest guidelines, beans have this unique position as counting as both protein foods and vegetable foods because they have a kind of the best of both worlds. And so that's really where I mean, that's kind of the ideal source. You also get an old range. Now, see, the other is basically everything is low protein in it, a Whole Foods, but those are the concentrated sources. You can be able to get more than enough protein that you need. And in fact, when it comes something like cancer, the concern actually is the opposite, right? People are dying of protein deficiency. People aren't. How many squash your court cases did you see protein, energy, malnutrition last year and how many cases of, you know, diabetes and obesity and high blood pressure and things that we see every day? These are diseases of dietary access to what sodium to what saturated fat, too much.
Speaker3:
So that's what we tend to see. We're not seeing the scurvy in the plague or as in the berry berries, these nutrient deficiency diseases, we're actually getting too much. And so that's where something like this methionine comes in where, you know, eating these high doses of these so called high quality proteins is giving your body signals to grow. And when we're adult height, the last thing we need is grow, grow, grow signals within our bodies. And so that we get like IGF one and here and tau and leucine is branched chain amino acids which cause insulin resistance. And so, so really we may want to kind of scale back. In fact, you can do studies where you randomize people. It's funny, in the studies, they call them a protein restricted group. What do they restrict people? 2.8 grams per kilogram body weight. That's the recommendation. That's the Institute of Medicine recommendation. So they said that should be the recommended protein group. And the other one that's suffering because of it, because it should be the excess protein group as opposed to the normal protein group. And you can show improved weight loss and also a whole bunch of things when you randomize people to just get the amount of protein they're supposed to get, as opposed to getting about twice as much typically than the estimated average requirement.
Speaker2:
Excellent. So we talked about protein. We kind of addressed that myth. Let's move on to carbohydrates. There's this saying out there that's very prevalent these days. You know, sugar feeds cancer and people talk about PET scans, use radio labeled sugar. So therefore, should we not restrict sugar in the diet and eat more of a ketogenic diet? How do you answer that?
Speaker3:
Yeah. Yeah. So, I mean, this whole thing that, you know, cancer cells feed on sugar, you know, all cells feed on sugar. I mean, it's just like saying, you know, Hitler breathed air, therefore boycott oxygen. It's like, well, wait a second, it doesn't make any sense. Right? So now is it possible that certain brain tumors, for example, may respond to a ketogenic diet? There's there's potential theoretical underpinnings. Unfortunately, all the data to date has been a colossal failure. But there are I think there's 13 trials undergoing right now. And God bless them and let's see what can happen. But guess what? Cancer cells feed off ketones. Do I mean I mean so it's not in fact there was actually study looking at the response of breast cancer cells to ketones actually predicted aggressiveness in the tumor and so and so I mean we may not we want beef. I mean, basically cancer cells are really good at adapting to any kind of available energy supply. Best thing to do is prevent cancer or formation in the first place. And then, of course, to support your body through that process, you want to eat the healthiest possible diet. And then ketogenic diet is like almost the antithesis of a healthy diet where you're just robbing your body of what it needs to to fight off or defend itself to support its immune system. It's just, you know, you can't think of the worst diet to put people on in terms of cancer prevention or cancer treatment, you know, maybe for some intractable cases of pediatric epilepsy, but but certainly not for health, certainly not for cancer.
Speaker2:
I'm glad you mentioned the fact that cancer is so adaptable because that's so true. I mean, we have studies showing that cancer can use sugar, protein, fat, ketones, iron hormones, copper, I mean, you name it. Cancer is going to adapt if you try to just remove a micronutrient like that. So.
Speaker3:
Right. And look and it makes it so it makes its own estrogen. Right? It takes aromatase. Right. So we block it with Tamoxifen. Right. And hey, fine. Well, I'll make my own fuel. Right? And so that's where the aromatase inhibitors come in. I mean, you know, it's. Yeah, yeah, unfortunately. I mean, that's one of the reasons why it's been so difficult to fight the disease because it's just so it's kind of stays one, one, one step ahead of us. We knock out 90%. Well, the 10% that's around is resistant to whatever. We just knocked it out and then it starts growing again. And so, right. Prevention is the key. And in the very least and then if we already are battling cancer, then obviously the healthier the diet, the better we can take care of ourselves across the board, the better.
Speaker2:
Absolutely. So we've talked about carbohydrates, protein. Let's talk about the other macronutrients, talk about fat. So we've kind of seen an up and down, you know, love affair with fat. You know, we had the fat phobia for a while and then and then we saw fat sort of make a resurgence and people starting to eat some of these high fat diets. So what do you counsel patients on regarding fat intake?
Speaker3:
It's not quantity. It's all about source. So whole food sources of fat, nuts, seeds, avocados, that's where we should get our fat. In fact, that's where we should get all our macronutrients right is from whole food sources, you know, wall off your calories. Basically, it's like make sure your calories, your protein, your carbs, your fat is surrounded by fiber. And how do we do that? By plant cell walls. And that's how we should do it. So that's not only a plant based diet, but that's a diet that cuts out some of these flower products, which can, even if it's whole grain flour, can have a bit of a glycemic surge and cause triglyceride problems for some people. But I mean, that's the way our bodies were meant to get nutrition, at least for the first 90% of our evolution, before we started figuring out how to boil sugar cane meal grains and then sharpened spears.
Speaker2:
That's right. So that brings us to to your daily dozen. I'd like to talk about that for a minute. Tell our listeners what your daily does and is and kind of how they can use that as a guideline.
Speaker3:
Yeah. So I wanted my, my last book, How Not to Die, not to just be kind a reference book, but, you know, a kind of a practical day to day grocery store type decisions. So I came up with a list of like the healthiest of healthy foods. So, you know, not just the fruit every day, but berries, the healthiest fruit greens, the healthiest special tablespoon of ground, flaxseed quarter, teaspoon of turmeric, the best beverages, best sweeteners, how much exercise to get in hopes of just kind of inspiring people to encourage some of the best of the best in their daily routine. And some of it actually has a real cancer focus. So, you know, the tablespoon of ground flaxseed, yes, it has an organic acid and has fiber, but those lignans so I mean, flax are basically really the only major dietary source of lignans. You don't need flax knocking them in your diet. And we just see remarkable effects in terms of, you know, you can do these placebo controlled randomized studies where you bake muffins, essentially flax muffins or placebo muffins without flax randomize breast cancer survivor and see remarkable differences. And because of these cancer lignans, which are found, a few other seeds like sesame seeds, but mainly flax seeds don't if flaxseeds don't get them. It's not like all I mean, some nutrients like vitamin C kind of found throughout the plant kingdom. Right. So you're not going to get scurvy even if you don't eat oranges and tropical fruits, bell peppers, broccoli, the high sources of vitamin C, it's found a little bit everywhere. But there are some nutrients like sulforaphane, cancer finding compound found in cruciferous or cabbage, family vegetables. If you don't eat those vegetables, you're just not going to get it in your diet. So variety is also important, not just eating healthy foods, but a variety of healthy foods. And so the deal that was the thought behind the Daily Dozen is to just make sure people are hitting some of the really high points and it's available as a free app on iPhone. Android. Dr. Greggs Daily doesn't hope you'll check it out.
Speaker2:
It's a great app. I have it on my phone. I use it all the time.
Speaker3:
Oh, great.
Speaker2:
So I have a question about food supply. Do you have any concerns that our food supply is is not what it used to be in terms of the soil and the air and the water quality and any concern about pesticides, things like that.
Speaker3:
Well, you know, I mean, some of that is is kind of a lot of marketing bunk from, for example, some of the manufacturers, they're trying to sell you trace mineral supplements. You know, they like to make it sound like, you know, the soil has been so stripped that you need to take supplements. But look, you can look at the signs and there is actually USDA does studies every decade. And it's true, there's been some crop nutrient decline, but we're talking on the order of maximum like 15%. So, yes, you know, you know, to get five florets of broccoli worth of nutrition, you have to eat six these days instead of five. But I mean, that's what we're talking about. It's not like they're completely stripped out of these. I mean, these are plants. The plants need certain nutrients to grow. And if there's not enough nutrients, they literally will not grow. I mean, so so they have to have I mean, that's what's in chlorophyll magnesium like. If you don't you don't get chlorophyll. If you don't get I mean, you need these these nutrients. And so if you have a plant, by definition, you have this minimum set of of of nutrients. And so a lot of that is kind of marketing bunk. But, but yeah, so oh, we just have to eat even more healthy plant foods. Sign me up.
Speaker2:
That's right. Oh, the horror. Right. So we talked a lot about food. And I appreciate all your great advice from all your your research and clinical experience. But actually want to use my last question to ask you about what happens if we don't eat? And more specifically, what about fasting? A lot of people are looking into fasting and potential health benefits or longevity benefits. What are your thoughts on fasting, whether that's for a day or two at a time or even just part of the day? Every day?
Speaker3:
Yeah, fascinating question. So there's this whole new field of chronobiology, right? The 2017 Nobel Prize in Medicine. I went to this team of researchers that uncovered these clock genes throughout in our peripheral tissues. Absolutely remarkable effects. Look, even in a field of oncology, there's these remarkable studies where you give the same dose, same chemotherapy. And if you give them at different times of the day, it can be five times less toxic, twice as effective. You do a similar things with blood pressure medications. There's large studies of suicides, self poisonings with pesticides, for example, taking it same dose, different time of the day. You double your risk of dying because of your circadian rhythms and the way our bodies metabolism differs and its detoxification differs. And and so eating, for example, 2000 calories in the morning is more fattening. Excuse me? Less fattening. They mean 2000, exact same 2000 calories in the evening. Absolutely remarkable studies. I mean, just kind of mind blowing stuff. And the basically the bottom line is probably the healthiest way would be kind of time restricted feeding. But early we want to shove our calories towards the morning breakfast like a king prince like, you know, eat lunch like a prince, more calories earlier than a day. And then there is a benefit from restricted feeding and not eating for at least maybe 12 to 16 hours.
Speaker3:
But you do that by, if anything, skipping supper and not skipping breakfast. There's real concerns about alternative day fasting because it can increase your cholesterol, although there was this amazing study back in Spain 50 years ago that suggests some longevity benefits, certainly morbidity benefits. And so I'm so I've chapters in the new book coming out about five to fasting and kind of on down the list of the water only fasting stuff's really fascinating it's kind of a way to kick start a drop in blood pressure. So you take something like exercise low salt diets, plant based diets, and you can get five to maybe 15. Of systolic blood pressure as you put people you fast people order for a week or two then put them on a plant based diet and get a 27 point drop. I mean, that's that's just that's just remarkable. More than you more than any single low blood pressure drug out there. And if you keep on a healthy diet, you actually retain those benefits, you know, and certainly in your field you know to north publishes this interesting set of of of these cases on this one with lymphoma water only fasting they have this beautiful imagery for an after and they just gave like the five seven year follow up in British Medical Journal.
Speaker3:
In case reports, autoimmune diseases is probably the best body of research we have in terms of decreasing inflammation and kind of auto immune kind of rheumatic diseases. But just kind of I mean, obviously it's the most unsustainable diet ever. What water only fast and guaranteed to kill you in a few months if you do it right. But but it does have some remarkable benefits. The important thing is that anybody severely restricting calories for more than one or two days needs to do it under medical supervision. And that's and this is not just medical mumbo jumbo or legalistic mumbo jumbo. Your kidneys, as soon as you stop eating, going to sodium conservation mode and to retain your sodium. And it's just a remarkable process. But sometimes that breaks down and you don't know until it's too late because you just get these kind of vague symptoms like fatigue and little do you know you're washing sodium out from your brain. You can end up dead. And that's why it's critical that water only fasting only done under medical supervision, even better inpatient. So we can worry about things like orthostatic hypotension. You know, there's some real risks involved. And so you'll it's not something you want to do at all.
Speaker2:
All right. Thank you for mentioning that. Well, Dr. Greger, how can our listeners learn more about you and connect with you online?
Speaker3:
Nutrition facts dot org. Where everything's free, no ads, just put it up. It's kind of a public service and you can subscribe free for a newsletter there. And if there's ever anything I can do to help you or your family, let me know. Oh, there's a great book you should check out at your local public library.
Speaker2:
That's right. How not to die. It stays on my bookshelf. Except, of course. Well. Dr. Greger, thank you so much for your time today. I know you're busy and really appreciate you carving out some time for us. This has been just a really great episode.
Speaker3:
Oh, I had so much fun. Keep up the great work.
Speaker2:
Thank you. I will. And just a reminder to our listeners, all of our previous episodes are available on Cancer Secrets dot com. Click on the podcast tab. And certainly if you're enjoying these episodes, please leave us a good positive review on iTunes. We have more great episodes coming your way. Dr. Greger, thank you again.
Speaker3:
Thank you.
Speaker2:
Bye bye.
Speaker1:
Thank you for listening to the Cancer Secrets podcast. If you were encouraged by this show, please share it with a loved one or friend. Help support the show by leaving us a rating and review on iTunes. The more reviews, the more friends like you can find the show. Finally, to learn more, visit us online at Doctor Stay Google.com. The Cancer Secrets Podcast. Changing the Cancer Paradigm.
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