The Desperation, Last-Ditch Cure for Cancer:

Doug Dix, Ph.D.

Professor of Biology and Medical Technology

Department of Health Science

University of Hartford

West Hartford, CT 06117

 

Summary

Cancer cells require certain nutrients to grow. Diets deficient in these nutrients, e.g. folic acid, thiamin, essential amino acids, or glucose will stop tumor growth. The side effects can be tolerated when mild, or treated with small replacement doses of the missing nutrient. The difference in blood perfusion between tumors and normal tissue will carry replacement nutrients preferentially to normal tissue. Diets deficient in ascorbic acid, vitamin B12, niacin, pyridoxine, choline, or essential fatty acids may also be selectively toxic to tumors. Inositol, and selenium or cysteine in dietary excess or deficiency, and moderate doses of vitamin D, might also be beneficial. Hyperthermia, exercise, herbal teas, resveratrol, omega-3 fats, and the visualization of tumor destruction may enhance the benefits of nutrient manipulation. Undernutrition may reverse tumor resistance to conventional chemotherapy, which should be revaluated following a course of nutrient manipulation. Together, reasonable, convenient, inexpensive interventions against terminal cancer constitute the perfect placebo, empowering terminal patients to work, and, in that way, mobilize legitimate hope for remission or cure.

 

Introduction

The placebo is the most powerful therapy ever discovered. When people believe an intervention will heal, it tends to do so, even when the intervention has no inherent healing power. It’s the belief that matters, but belief is fragile. After repeated failures, people can lose hope, and without hope, belief is impossible. This article is about resurrecting hope in terminal cancer patients who want to believe but have lost hope in medicine.

Conventional curative therapy administered under the auspices of a National Cancer Institute Comprehensive Cancer Center is always the best hope for cure. And the majority of cancer cases are cured by this approach. But, in a minority of cases, conventional curative therapy runs its full course and fails. Patients in such cases are called “terminal.” This article is for such patients. It is NOT a substitute for, or alternative to, conventional curative therapy.

When conventional curative therapy has run its course and failed, patients are left with two options: palliative care or unconventional medicine. The former can extinguish hope, and, in that way, aggravate anxiety, pain, nausea, and depression (1). The latter can be burdensome, expensive, and futile or harmful (2). There’s a clear need for a third option, one that supports legitimate hope for remission or cure while being convenient, inexpensive, and safe. Manipulation of critical nutrients can fill this need.

Tumors are poorly vascularized (3). This is one reason chemotherapy fails. Cytotoxic drugs only trickle into tumors while pouring into normal tissue (4). Dietary deprivation of essential nutrients, e.g., vitamins, essential amino acids, glucose turns this table to therapeutic advantage, as replacement does will only trickle into tumors while rescuing normal tissue (5-6).

 

Theory

It’s natural to want to test this theory in animals before recommending it to patients, but animals differ from humans in vitamin and amino acid metabolism (7). And animals aren’t capable of a placebo effect. What’s needed as the third option is the perfect placebo. Nutrient manipulation is that because it makes sense but hasn’t been tested. Physicians can be honest (8) with patients who want honesty (9). The protocol that follows makes good theoretical sense. No one can prove it won’t work, and there is no reason to reject it. And because the protocol is convenient, inexpensive, and relatively safe, it will do little harm. Terminal patients have little to lose and everything to gain.

Interested patients should begin by understanding that tumor growth depends on DNA replication, and protein synthesis, and that these processes depend on dietary folic acid, thiamin, essential amino acids, and glucose Without folic acid, cells can’t make purines and thymidylate. Without thiamine, cells can’t make ribose and deoxyribose. And without even one essential amino acid, cells can’t make protein. And without glucose, cells can’t make the ATP and carbon skeletons they require for reproduction. Diets devoid of these nutrients will stop tumors in their tracks. It’s textbook biochemistry, as are the side effects of anemia, beriberi, protein malnutrition, and hypoglycemic ketoacidosis. These side effects can be tolerated when mild. But the beauty of the protocol comes from the theoretical ability to selectively rescue normal cells with small replacement doses of the missing nutrient(s).

The poor perfusion that protects tumors from cytotoxic drugs thwarts access to small replacement doses of vitamins, essential amino acids, and glucose. The success of high dose methotrexate therapy with leukovorin rescue (10-11) can be explained in part by analogy: More methotrexate gets into the tumor because of the high does, but less leukovorin gets into the tumor than normal tissue because of the perfusion difference between tumors and normal tissue.

 

Practice

A palatable diet for achieving folic acid deficiency has been published (12). Diets based on polished rice are famous for inducing thiamin deficiency (13). Almost any food can be rendered free of all water-soluble vitamins by shredding it and boiling it repeatedly in large volumes of water. The resulting mash can be made appetizing by being toasted, fried, broiled, or baked, and flavored with salt, vinegar, alcohol, and fat, as well as artificial ingredients. Non-targeted water-soluble vitamins and minerals must be replaced as supplements.

Dietary proteins deficient in one or more essential amino acids (leucine, isoleucine, valine, phenylalanine, tryptophan, threonine, lysine, and methionine) are well known. Rice, wheat, and corn are deficient in lysine. Corn is also deficient in tryptophan. Legumes (beans, soybeans, peas, lentils, and peanuts) are deficient in methionine, but rich in lysine. Prepared diets for treating phenylketoneuria (PKU) are deficient in phenylalanine. Prepared diets for treating maple syrup urine disease are deficient in leucine, isoleucine, and valine.

In addition, to the essential amino acids and folic acid and thiamin, some other water-soluble vitamins are essential to proliferating cells. These include ascorbic acid, vitamin B12, niacin, pyridoxine, and biotin. These vitamins can be removed by the method described above, i.e., shredding all food and boiling it repeatedly in large volumes of water. Removal of ascorbic acid will lead to scurvy, of vitamin B12 to pernicious anemia and subtle nerve damage, of niacin to pellagra, and of pyridoxine to lymphopenia, seborrheic dermatitis, and peripheral neuropathy. Vitamin B12 is naturally absent from plant foods.

Ascorbic acid protects folate reductase, which catalyzes the generation of tetrahydrofolic acid, which, in its methenyl and formyl forms, is necessary for purine and thymidylate synthesis. Vitamin B12 recycles tetrahydrofolic acid. In the absence of vitamin B12, tetrahydrofolic acid is trapped in a methyl form that prevents purine and thymidylate synthesis. Combination deficiencies of vitamin B12, and ascorbic and folic acids should be explored for synergistic toxicity to tumors. Proliferating cells require biomass and need NADH and NADPH to make it (14). Without NADPH, cells can’t make ribose, deoxyribose, or free fatty acids. This precludes synthesis of nucleic acids and membranes. Tryptophan deficiency enhances the impact of niacin deficiency, and vice versa. Combination deficiencies of thiamin, niacin, and tryptophan should be explored for synergistic toxicity to tumors. Because proliferating cells are more dependent on protein synthesis than are normal cells, they are more dependent on amino acid transamination, transulfuration, and decarboxylation, and the vitamin necessary for those reactions, pyridoxine. Diets deficient in pyridoxine might be selectively toxic to tumors (15). Pyridoxine deficiency might be particularly effective against lymphocytic leukemia, as lymphopenia is a symptom of pyridoxine deficiency.

Dividing cells must double their membrane content, and require biotin and NADPH to make the necessary free fatty acids. Biotin deficiency would preclude membrane synthesis. It might be selectively toxic to tumors, perhaps synergistically so in combination with niacin deficiency. Biotin is also required for purine synthesis. But biotin deficiency cannot easily be achieved by removing biotin from food because normal intestinal flora produce biotin. Consumption of the raw egg-white protein, avidin, can cause biotin deficiency, but raw eggs are a source of Salmonella, which would be particularly dangerous to terminal cancer patients. Unfortunately, heating eggs to kill Salmonella destroys avidin. Perhaps a method can be developed for killing Salmonella in eggs, e.g., by ionizing radiation, while sparing the avidin. Or perhaps eggs can be screened for Salmonella to identify those that could be safely consumed raw. Or perhaps avidin can be obtained from some other safe source. Without safe avidin, however, biotin deficiency is an impractical, although tantalizing, weapon.

Pyridoxine deficiency might mimic some of the effects of biotin deficiency, for pyridoxine is required in the first step of sphingosine synthesis. Without pyridoxine, ceramides cannot be formed. These function as membrane components and powerful signaling molecules. Some ceramides enhance hypoxic injury, while others inhibit it (16). Cancer cells are resistant to hypoxic injury (17). Disturbing their ceremide composition might diminish this resistance.

Choline is a component of phospholipids (lecithins) that function in membranes and mediate mitogenic signals. It is an essential, water-soluble, nutrient for humans (18). Metabolites of choline are found in higher concentration in breast cancer than in benign breast lesions or normal breast tissue (19). Choline will be removed from food by repeat shredding and boiling, as described above, but diets deficient in choline have been described (20-21). Choline deficiency might be particularly effective against lymphocytic leukemia because it has been linked to increased lymphocyte apoptosis (22). Because choline is involved in one-carbon metabolism, choline deficiency might be synergistically toxic to tumors in combination with folate, vitamin B12, and methionine deficiency. Like all nutrient manipulations, choline deficiency must be monitored, for it will cause fatty liver and alterations in blood lipids.

Inositol is an essential, water-soluble nutrient that has the potential to be selectively toxic to tumors in excess (23) or deficiency (24). Inositol is a component of a large variety of important signaling lipids (25-26). Alternating pulses of inositol excess and deficiency might be worthy of exploration. The consequence of inositol deficiency is alopecia and eczema.

Linoleic, linolenic, and aracidonic acids are polyunsaturated fatty acids that are essential in the diet. They function as membrane components and precursors of prostaglandins and can be deficient in popular low-fat diets. The popular trend to replace polyunsaturated with monounsaturated fats and to use commercial fat substitutes aggravates the risk of essential fatty acid deficiency (27). Depleting arachidonic acid from the diet is a means of reducing prostaglandins and thromboxanes. Asprin is another means to this end as it inhibits conversion of arachidonic acid to prostaglandins. Anecdotal evidence (but not controlled clinical trial) suggests that asprin can be useful against some cancers (28). Perhaps asprin in combination with essential fatty acid deficiency would be synergistically toxic to tumors. The conspicuous consequence of essential fatty acid deficiency is dermatitis.

Activation of the blood coagulation pathway is essential to metastasis, and thromboxanes are components of that pathway. Anticoagulants prolong survival in cancer patients, perhaps by inhibiting metastasis (29). Perhaps essential fatty acid deficiency, alone or in combination with asprin, might inhibit metastasis.

 

Choices

Much research can be devoted to finding the optimal diet for terminal cancer. Should essential nutrients be deprived simultaneously or sequentially? Should the nutrients be depleted or eliminated? Would a diet deficient, but tolerable, in folic acid, thiamin, ascorbic acid, vitamin B12, niacin, and pyridoxine as well as one or more essential amino acids, as well as choline, inositol, and essential fatty acids provide the best anti-tumor effect? Or, would better control come from severe sequential depletion, e.g., a folic acid – free diet that was maintained until anemia became intolerable, followed by a thiamin-free diet until beriberi became intolerable, followed by an ascorbic acid-free diet until scurvy became intolerable, followed by a vitamin B12-free diet until pernicious anemia became intolerable, followed by a niacin-free diet until pellagra became intolerable, followed by a diet depleted in one or more essential amino acids until protein-malnutrition became intolerable, followed by a pyridoxine-free diet until leucopenia and dermatitis became intolerable, followed by a choline-free diet until liver and blood lipid changes became intolerable, followed by an inositol-free diet until eczema became intolerable, followed by a diet free of essential fatty acids until dermatitis became intolerable, and then beginning again with a folic-acid free diet? What sequence of depletions at what levels of severity would be optimal? It is likely that the correct answer will vary among patients and tumors. Presently, the correct answer is not as important as engaging the patient in pursuit of any reasonable answer.

In any sequence, nutrient depletion would maintain a block on tumor growth while permitting some or all normal cells to recover.

Low-protein diets might enhance the impact of essential amino acid depletion as some nonessential amino acids have a sparing effect on essential amino acids. Nonessential cysteine reduces the need for methionine, as does nonessential tyrosine for phenylalanine.

Whether in sequence or simultaneous combination, nutrient depletion has the potential to cause tumor lysis syndrome (30). This is a potentially life-threatening complication of rapid tumor destruction. The safe route is to gently taper off from a normal diet to nutrient deficiency rather than suddenly eliminating nutrients from the diet. But terminal patients may not have time for this safe route. They should collaborate with their physicians as full partners in deciding how fast to deplete nutrients. Those who choose to suddenly eliminate critical nutrients, should be aware of the risks, and their physicians should be ready to support them with hydration, allopurinol, electrolytes, etc. in the event of tumor lysis syndrome.

Diets deficient in water-soluble vitamins will tend also to be deficient in minerals and trace elements. These can be replaced as supplements, but physicians should insure that consumption of minerals and trace elements is neither deficient nor excessive.

 

Speculation

Disruption of critical sulfhydryl-disulfide equilibria causes rapid lysis of mouse leukemia cells in culture (31). If this phenomenon applies to human cancer cells in vivo, cysteine supplements might be beneficial. Selenium maintains glutathione homeostasis and might be beneficial in excess or deficiency (32). Using cysteine and/or selenium in excess or deficiency against terminal cancer is purely speculative, however. No data suggests that manipulating either agent will be effective. This is in contrast to the previously mentioned nutrient manipulations, each of which has a biochemical basis for efficacy.

 

Research

In order to avoid the need for Institutional Review Board approval, physicians must not collect data for the purpose of discovering knowledge that can be generalized to people other than their patient. But it is essential to collect data on patients for the purpose of making reasonable choices concerning their own treatment. Patients should take the lead in creating the precise protocol to follow. In this way, each patient will optimize his/her preferences for food taste and texture and her/his ability to tolerate side effects. Compliance will be enhanced and the placebo effect maximized. From the outset, physicians must emphasize that the protocol is untested and will probably require modification. Patients must appreciate that whatever protocol they select, it is a trial and, like all trials, may be accompanied by much error.

While physicians cannot collect data for the purpose of research without Institutional Review Board approval, patients certainly can, and physicians should encourage patients to keep a diary or log with objective data. Measurements on tumor burden and serum nutrient levels are essential before beginning a protocol and at regular intervals during intervention. Patients and physicians should record these values. Physicians should watch for side effects and be ready to begin rescue efforts when side effects become serious. From the beginning, patients should be full partners in this effort. Any lessening in tumor burden should be communicated to patients to enhance compliance and embellish the placebo effect. Failure to observe a decrease in tumor burden after achieving serum nutrient depletion is reason to consider modifying the protocol. Patients should be fully prepared for this possibility from the beginning so as not to lose hope or diminish the placebo effect.

Because no prescription medicines are utilized in the nutrient-depletion protocols, physician-permission is not required. Patients can prepare the modified diets in their own kitchens. But physician-oversight is essential for patient-safety and for scientific credibility, should patients decide to record their data for research purposes.

 

The Best and the Simplest

The above is an overview of the reasons to believe that nutrient manipulation can cure even so-called “incurable” or “terminal” cancer. It is the conditioning required to achieve the intellectual capacity to embrace hope. Every terminal patient who understands the above is prepared to fight his/her terminal cancer and win a cure or remission. And while the protocols described above are reasonable and worthy of consideration, they are not the best or the simplest tactic. The best and simplest way to cure terminal cancer is simply to adopt an Atkins diet, i.e., eat no carbohydrates.

Tumors, unlike most normal tissues, are locked into glycolysis (33). This is the consequence of continuous proliferation and not hypoxia, as it applies even to well-oxygenated tumors, e.g., leukemias (34) and airway tumors (35). Metastatic tumor cells are also locked into proliferative metabolism (36). Proliferation is the target common to all cancers. Deprivation of the nutrient most needed for proliferation, therefore, should be selectively toxic to all cancer cells, i.e., to leukemia cells and solid tumor cells and metastatic cells, irrespective of their state of oxygenation. What is that most needed nutrient? Glucose. Cancer cells need more of it than normal cells and die without it. Normal cells can live on fat and protein. The only source of glucose is carbohydrate in the diet. Cancer patients who stop eating carbohydrates will deplete their bodies of glucose and kill their cancer (37).

 

Embellishments

Tumors are heterogeneous collections of cells. At any given time, some are hypoxic or anoxic and dormant or necrotic, while others are well-oxygenated and actively dividing (38-39). It may not be necessary to kill all cells in a tumor. Some may act like stem cells in sustaining and spreading tumors (40-41). They’ll be killed by nutrient manipulation. Dormant or necrotic cells aren’t dangerous unless they begin dividing, in which case, they’ll be killed by nutrient manipulation.

Because tumor cells are locked into glycolysis, lactic acid is produced in excess. Poor perfusion retards dissipation from tumors, and, as a result, lactic acid accumulates to the detriment of tumors (42-43). Rare, short pulses of hyperglycemia might be beneficial against a long, constant background of hypoglycemia. Patients may achieve hyperglycemia by gorging on candy or sugary beverages for a brief time period.

Hyperthermia (hot baths, electric blanket treatments, or sauna sessions) might be effective against advanced cancer (44). Hyperthermia can also be a means to comfort for patients. There is a hint that moderate does of vitamin D might be useful (45-46). Omega-3 fats may lower fatigue from cancer (47) Exercise might be beneficial psychologically as well as physiologically (48-49). Herbal teas can be useful (50-51) as can visualizing tumor cell destruction (52). The above interventions give terminal cancer patients legitimate hope for remission or cure. Such hope is the means to belief, which is the means to efficacy.

 

Implications

Whenever cancer cells are treated with cytotoxic drugs, resistance is a risk, and, unless drugs are used in combination, inevitable. This is the primary reason for the failure of chemotherapy to cure cancer. But resistance to the nutrient manipulations described above is inconceivable. Tumor cells cannot acquire the ability to make DNA, RNA, protein, and lipids without glucose, and the vitamins and essential amino- and fatty acids mentioned above. Without new DNA, RNA, protein, and lipid, tumor cells cannot divide. And tumor cells that can’t divide will die eventually and are not dangerous. Patients need to be convinced of this fact of nature, and physicians should help.

Patients should trace the biochemical pathways to cell division and nucleic acid and protein and lipid synthesis to see precisely how depletions of the above nutrients will stop tumor growth. The hyperthermia, vitamin D supplementation, exercise, herbal teas, and visualizations are adjuncts. They provide terminal patients with opportunities to take action against their tumors while nutrient deprivation is killing those tumors. Taken together, the package will maximize the placebo effect.

 

Perspective

Terminal cancer patients can become obsessed with suffering and death, and that obsession can ruin their time alive. Pain, nausea, anxiety, panic, depression, and loneliness are corollaries of cancer obsession. Palliative care can alleviate some of those corollaries, but it can also aggravate them. Not all terminal patients are ready, willing, or able to surrender hope of remission or cure. And young cancer patients and their families are never ready to surrender (53). For terminal patients who need to fight on after conventional medicine has run it’s course and failed, nutrient manipulation is ideal, first because it will kill cancer cells, and second because it gives terminal patients a means of escape from cancer obsession.

The placebo effect is an ancient and revered fact of medical research. Anecdotal evidence suggests it works against cancer (54). Controlled clinical trials show it can suppress benign epidermal tumors, i.e. warts (55). When a physician pronounces a hex on warts, they tend to disappear. Warts are caused by members of the same group of viruses (papiloma) that cause cervical and genital cancers, and possibly laryngeal and oral cancers, and lung cancer. We should not quickly dismiss the potential utility of placebos against terminal cancer. But the placebo effect is currently out of vogue against terminal cancer because patient’s emotional functioning did not predict survival (56). The absence of objective evidence for a placebo effect against terminal cancer, together with the traditionally deceptive nature of placebo therapy makes physicians reluctant to employ it. Nutrient manipulation as described above gives physicians cause to revaluate. The protocol should work. There’s no need for deception, and no advantage in denying patients the benefits of a placebo effect.

On close inspection the data of Coyne et al. (56) does not refute the placebo effect. Perhaps the placebo effect works by altering emotions, but there is no proof of this, and even if it were true, there is no reason to assume that the emotions measured by Coyne et al. were identical to those that might be created by a placebo. To have a chance at eliciting the placebo effect, treatment must be recommended in the identical manner that an effective drug would be recommended. It may well be that the placebo effect is mediated by faith in the physician, or reason, instead of emotion. Nutrient manipulation as described above can be recommended by physicians just as they recommend effective medicine. And physicians can give patients reason to believe nutrient deprivation will kill tumors.

Part of that reason is by analogy to the effectiveness of nutrient deprivation against other diseases. Nutrient deprivation is the protocol of choice against obesity, non-insulin dependent diabetes mellitus, and atherosclerosis. It shrinks atherosclerotic plaque (57). This is interesting because plaque resembles a benign tumor, with growth due in part to the proliferation of smooth muscle cells, which normally are non-proliferative (58). Amino acid diets that have been used against Crohn’s disease may, with depletion of one or more essential amino acids, be useful in the above protocol against cancer (59). Conversely, provision of nutrients in abundance has not been found effective against terminal cancer (60), and supplementation with folic acid, vitamin B6, and vitamin B12 did not reduce the risk of cancer (61). Nutrient deprivation is a natural and reasonable intervention for terminal patients who want to fight for remission or cure.

Physicians might offer to quantify prognosis for terminal cancer patients according to objective criteria (62). This information could be useful for those patients who choose to record their own data for research purposes.

 

Cachexia

Nutrient deprivation is the natural response to cancer. The vast majority of terminal cancer patients exhibit anorexia and cachexia (63). This is often assumed to be harmful, and to the extent that it is caused by fear or depression, it can be alleviated by the above protocol. But fever was once commonly considered harmful, but is now regarded as part of the body’s best effort to cure infection. We might be wise to consider cachexia in a similar light.

The fetus qualifies as a benign tumor, and undernutrition has a profound effect on the fetus, precisely when it is growing in cell number or size (64-65). It is not unreasonable to imagine that anorexia- cachexia is the body’s last, best defense against cancer. Calorie restriction is the most effective non-pharmacological intervention against aging and metabolic disease (66-67). Patients on nutrient deprivation protocols should consume large quantities of water to wash out the targeted nutrients, protect against kidney stones and tumor lysis syndrome, and create a condition of caloric restriction (68).

In response to this condition, patients’ basal metabolic rate will decline. They’ll need less nutrition as a result. Tumors, on the other hand, continually select for faster-dividing, more nutrient-demanding, cells. Patients on undernutrition therapy will take the metabolic advantage from their tumors (69). When they do that, resveratrol (found in red grapes, red grape juice, and red wine) may be beneficial (70).

Tumors evolve by natural selection. Chemotherapy triggers an arms race. Tumors survive by evolving resistance mechanisms (71). Membrane transporter proteins rank among the most important means to multidrug resistance. They are induced by redox signals in response to chemotherapeutics. Glutathione is the most abundant physiologic antioxidant (72). This is a reason to consider therapy with cysteine and/or selenium in excess or deficiency.

Hypoxia induces HIF-1 alpha that activates genes that permit cancer cell to flourish in hypoxic environment (73). As nutrient deprivation kills hypoxic cells and allows vacation from chemotherapy, natural selection may favor the more sensitive phenotype. After a period of nutrient manipulation, standard curative chemotherapy should be reconsidered.

Cancer cells increase SIRT1 in response to hypoglycemia (74). Pulses of hyperglycemia might be beneficial not only for the localized lactic acid it generates, but also for suppressing SIRT1. Resistance to chemotherapy is enhanced by SIRT1 and by DNA methylation (75). Deficiencies in methyl-donors, e.g., methionine, choline, folic acid, and vitamin B12 may reverse resistance by preventing methylation (76). In normal cells, hypomethylation can cause cancer (77). Terminal cancer patients deficient in methionine, choline, folic acid, or vitamin B12, should be monitored closely and rescued quickly. Terminal cancer patients who return to curative chemotherapy will benefit from the placebo-induced mood up-lift and from exercise.

 

Conclusion

Curative therapy for terminal cancer is an open book. As new, reasonable, convenient, inexpensive, and relatively safe interventions are discovered, they can be added to the list. In this way, patients who want to fight on after conventional medicine has failed can be supported in their efforts without compromising the integrity of scientific medicine.

But in the end, and there is always an end, all efforts are futile, for death is inevitable, and before death, suffering, if only from fear of death, is routine. Suffering can seem impossible to endure. In some forms, it is impossible. In some forms, it is worse than that. But despite our best efforts, suffering isn’t likely to become extinct. And, while it exists, it is our incentive to change perspective. Who are we, really, and where are we headed, and what matters and what doesn’t?

In the final analysis, death can’t matter, for true self, like true love and true gravity and true everything, never changes. The bodies we inhabit change because they aren’t true, and can’t be us if we are true. Despite the pain, sorrow, fear, agony, and more that our bodies endure, there is reason to celebrate, for nothing true is lost or gained. Only boundaries are rearranged, and boundaries never matter. In all that does matter, we are the same, now and forever (78). The protocol described above buys time to cultivate this joyful perspective.

 

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