At the Roots: Natural Healing for Cystic Fibrosis
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Eat Your Fats!

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Oh my gosh, I am so pumped for this section! Fats get me all excited. They are truly a powerful source of energy storage, and have twice the amount of calories per gram than carbs or proteins (that means twice the amount of energy!). Fat is an incredibly misunderstood substance in our society. There is a TON of misinformation and bad science out there about fats, and unfortunately the post-WWII myths about saturated fat as the cause of heart disease are still running rampant. The truth is that rancid polyunsaturated vegetable oils contribute to heart disease and the saturated fats in butter, lard, and coconut oil are good for your heart, not the other way around. Chris Kresser has done a whole series on this topic, so I would suggest you take a look at his articles for a more in-depth analysis of the science behind saturated fat/cholesterol/heart disease controversy. He is a very thorough researcher, and a very smart dude. This topic is also discussed in Nourishing Traditions. 

Fats are a large part of pretty much every traditional diet. In fact, during certain seasons the traditional Alaskan Inuit got about 80% of their calories from seafood fat! With proper digestion, fat can be the most powerful source of energy nature has to offer us, and the highest quality fats (i.e. wild or grass-fed animal fats) contain high levels of bioavailable fat-soluble nutrients such as pre-formed vitamin A (retinol), vitamin D3, and absorbable essential fatty acids AA, DHA, and EPA. The fats that were traditionally sought after were animal fats (all of them saturated), and the fatty tissues of animals were much preferred over meats and protein-rich tissues. Animal fats have been considered a health food for millennia, but only recently since the advent of "food science" have animal fats been demonized as the cause of heart disease and obesity. The reality is that high-quality fats are absolutely critical to optimum health, and for those of us with fat malabsorption issues, we must choose our fats very wisely in order to maximize their benefit to us. 

I will outline here the basic do's and don'ts of fats for CFers, and what I've discovered in terms of their impacts on my health. But first, a brief lesson on the chemistry of fats. If you have further interest in reading about the details of fat digestion, I suggest you read Dr. Mary Enig's article Digestion and Absorption of Food Fats. 

What are fats?
Dietary fats are really mixtures of different types of fatty acids. There are three general types of fatty acids: saturated, monounsaturated, and polyunsaturated. All natural fats in our diet are made up of all three of these types of fats in different proportions, but for expediency's sake we often label a fat under one of the three categories depending on which is most prevalent. Fatty acids are made up of hydrocarbon molecules linked together in long chains by their carbon atoms in either single bonds or double bonds. Single bonds are more stable links between hydrocarbons, and fatty acid chains with only single bonds are called saturated fats. Double bonds are less stable and prone to oxidation, which can cause a fatty acid chain to break apart, causing rancidity and a toxic effect in the body. A fatty acid chain with one double bond is called a monounsaturated fat. A fatty acid chain with more than one double bond is called a polyunsaturated fat. Saturated fats are more environmentally stable, keep better at higher temperatures, and are less prone to rancidity. The more double bonds in a fat, the more likely it is to oxidize and become rancid. Oxidized, or rancid, oils release free radical electrons into the body, which can damage cells, create carcinogenic compounds, trigger inflammation, and reduce immunity. The regular consumption of rancid oils is linked to cancer, arteriosclerosis, heart disease, and digestive disease. 

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The kink in the unsaturated fatty acid chain is what makes polyunsaturated fats so vulnerable to oxidation and racidity.
Oils that have rancidified by exposure to heat, light, or air are broken up into unnatural pieces so that the body cannot digest them properly and cannot store them in the right places for energy use. Undigested oils pass through you, and as they do they can pull fat-soluble vitamins from your guts, depleting your stores of A, D, E, and K. Foods containing rancid oils used to give me a significant amount on GI trouble. Even now, eating too many deep-fried french fries will give me loose stools and intestinal pain for days (therefore I rarely eat them anymore). It's not just cooking oils that can rancidify though. The polyunsaturated oils in nuts and seeds can racidify easily, and often do when improperly cooked (roasted) or left out exposed to heat, light, and air. I used to have a similar nasty reaction from eating rancid nuts snatched from the bulk bins at the coop. Be very careful with any nuts or seed that you eat. Make sure they've been stored without exposure to heat, light, and air - this may rule out buying them from the bulk section at your coop. It is best to buy them with the shell on and to shell them yourself. If this is too time consuming however, instead you may want to seek out a source of high-quality raw nuts or seeds sealed in air-tight containers, then process them yourself. Remember that nuts and seeds also contain high levels of phytic acid, an enzyme inhibitor, making them very hard to digest if not properly processed in the traditional way. For more info on properly preparing nuts and seeds, click here. In theory, nut butters can have the same problems, but because they're usually stored in air-tight containers, they may be safer. Many people with issues absorbing fats can have issues digesting nut butters, so be sure to eat them in moderation, according to what your guts can handle. Try to choose a nut butter whose only ingredient is the nut/seed. If oil is added to it, there is a risk that the oil has gone rancid, since it's most likely a polyunsaturated oil that is added (e.g. sunflower oil). 

Hydrogenated fats are another type of fat, but they are completely unnatural and man-made. These are polyunsaturated vegetable oils whose double bonds have been artificially changed to mimic more stable single bonds through an industrial process. This is what makes up margarine, and margarine use is strongly linked to heart disease. Hydrogenation makes a polyunsaturated fat, which is usually liquid at room temp, able to remain solid at room temp. This is highly desirable for corporations, because it increases the shelf-life of a product, allowing them to make more profit. Partially-hydrogenated fats are also called trans fats, which are similarly toxic to the body. Both hydrogenated and partially-hydrogenated fats are highly toxic because there are no enzymes found in nature that know how to break down such an unnatural substance (i.e. your enzyme pills don't work on them). The body, not knowing what to do with these kinds of fats, stores them in the adipose tissue but cannot retrieve them to make energy out of them, so they lead to a build up of body fat. They may also lead to a rise in serum triglycerides, which is a risk factor for cardiovascular disease. 

Why do we need fats?
Fats insulate our bodies, protect the vital organs, hold them in place, and are vehicles for assimilation of fat-soluble vitamins, primarily A, D, E, and K (the ones CFers are commonly deficient in; that's why we take ADEK supplements). Furthermore, fats are the body's preferred method of energy storage. The body can easily convert stored fats into glucose for supplying the cells with energy. That's why it's important to have an adequate supply of excess body fat, in case we're sick or don't eat enough, so we've got a back up supply to fuel our bodies for a little while. Fats support the yin principle in the body, which is grounding and soothing, builds the tissues, enhances fluid metabolism, and directs nutrients into the organs [1], all things CFers need extra help with. Certain fats, such as omega-3 essential fatty acids, are highly anti-inflammatory and can help us reduce oxidative stress in the body. 

Essential Fatty Acids
There are some fats that the body needs for a variety of processes, but that it cannot synthesize itself. These are called essential fatty acids, and must be obtained from the diet. Essential fatty acids (EFAs) are long-chain polyunsaturated fats. The EFAs that we are most concerned about, and that you may have heard of before, are called omega-3 and omega-6 fatty acids. There are three most basic EFA precursors, and these are linoleic acid or LA (an omega-6), arachidonic acid or AA (an omega-6), and alpha-linolenic acid or ALA (an omega-3). In a healthy body, enzyme conversions make other important EFAs from LA and ALA. Gamma-linolenic acid or GLA (an omega-6) is made from LA, while eicosapentaenoic acid (EPA) and docohexaaeonic acid (DHA) are both omega-3's derived from ALA. 

In general, omega-6's are inflammatory, and omega-3's are anti-inflammatory, so we should aim to have our omega-6 to omega-3 ratio as low as possible, ideally between 1:1 and 3:1. The modern American diet, which is highly inflammatory, can have an omega-6 to omega-3 ratio of about 10:1! Yikes! Furthermore, the presence of omega-6's like LA can inhibit the conversion of the omega-3 ALA to DHA. While all EFAs are necessary in varying amounts, the EFAs we need to be most concerned about getting enough of are the animal-formed omega-3's, EPA and DHA. 

Both EPA and DHA are anti-inflammatory. EPA is good for healing the circulatory system, while DHA is critical in brain and mental development. ALA is the precursor to EPA and DHA, and is found in plants. Flaxseed oil is high in ALA, as are all chlorophyll-rich foods, including leafy greens and seaweeds. The ability to convert ALA into EPA and DHA is dependent on one's health, and even in healthy people the conversion rate is very low, about 5% for EPA and 0.5% for DHA [2]. CFers are unusually low in EFAs, especially the beneficial omega-3's EPA and DHA [3], so including omega-3-rich foods in the diet and supplementation are very important. Because CFers have a harder time than usual making the conversion of ALA to DHA and EPA, we need to take the already-converted forms of these. Animals fed on ALA-rich foods (i.e. wild and grass-fed animals) make the conversion of ALA to DHA/EPA for us and store it in their tissues. So we must consume animal products in order to get these important omega-3's. The best sources of these are fish (the oilier the better), raw grass-fed dairy, and grass-fed meats. I also recommend taking a high-DHA/EPA fish oil supplement, which I will discuss in the Supplements and Herbs section. 

Including more EPA and DHA in our diet is really important, but we must also remember to reduce our ingestion of omega-6's as much as is practical. This means avoiding all polyunsaturated vegetable oils (except unheated olive oil) and being conscious of our ingestion of foods that have a high omega-6 to omega-3 ratio, such as nuts and seeds. In addition, grain-fed meat from animals raised in CAFOs or other unnatural environments have a higher ratio of omega-6 to omega-3, and so should be avoided. Grass-fed meats contain must more omega-3's, since they are feeding on chlorophyll-rich plants and converting that ALA into EPA and DHA for us. Arachidonic acid (AA) is particularly inflammatory in large quantities, but is essential in small quantity for our body's vital processes. An overabundance of AA can produce breast lumps and arthritis, can stimulate cell division, and derivatives of AA are responsible for blood clotting, pain, and fever. Asprin, NSAIDs, and steroids actually work by blocking PGE2 formation, an AA derivative [1]. AA is found in low quality animal products, such as chicken, eggs, pasteurized dairy, and grain-fed meats. 

Even though pre-formed GLA is an omega-6, it does have some important beneficial effects on the body. The body further converts EFAs into prostaglandins (PGs), which are hormone-like substances that support a variety of body functions. GLA converts to PGE1, and DHA/EPA convert to PGE3. Both PGE1 and PGE3 have similar beneficial properties, so I'll discuss their effects together. They help the immune system kill and inhibit the proliferation of cancer cells; treat inflammatory diseases such as eczema and arthritis, as well as auto-immune diseases; control blood pressure; regulate brain function and nerve impulses; act as human growth factors; regulate insulin production; regulate prostate problems, PMS, and breast lumps; speed up metabolism in those with obesity. Furthermore, having more PGE1 and PGE3 in your system inhibits the production of PGE2, an inflammatory agent described above [1]. Most Americans have an overabundance of PGE2 in their systems from ingestion of toxic foods (low-quality meats, rancid oils, refined grains, etc.), so we should make sure that we are focused on getting more GLA/DHA/EPA to wipe out that PGE2! You can get GLA from spirulina, and the seed oils of borage, black currant, and evening primrose. These can be taken as medicinal supplements in capsule or liquid form. 

In summary, eat more animal sources of omega-3's (DHA and EPA in oily fish, raw grass-fed dairy, and grass-fed meats), take fish oil supplements, and reduce your intake of omega-6's in polyunsaturated vegetable oils and low-quality animal products. 

Good Fats, Bad Fats

Now you've got a good grounding in what fats are and how specific characteristics of fats produce different effects, so let's put all this into perspective by discussing which dietary sources of fat are best and which should be avoided. By now you know that all polyunsaturated vegetable oils should be avoided like the Plague (except for those GLA oils you may be taking medicinally). These include sunflower, safflower, canola, sesame, corn, soy, cottonseed, walnut, and generic "vegetable" oil. But which oils should we eat?

We should be eating primarily saturated fats, but within that category there are some that may be more beneficial for CFers. In particular, CFers should consume a lot of unrefined, cold-pressed, organic coconut oil. Ghee (clarified butter) is generally a safe bet because all of the lactose, casein, and milk solids have been removed from the butter fat, and if it's grass-fed it can be a good source of vitamins A and D. Olive oil is great on salads and any unheated applications, but cannot be cooked with because it's high unsaturated fatty acid content (90%) gives it a burn point low and makes it relatively vulnerable to rancidity. Only saturated fats should be cooked or baked with (i.e. coconut oil, ghee, or lard) because they have higher burn points, depending on the particular kind of fat. Animal fats such as lard (pig fat), tallow/suet (beef or sheep fat), and duck or goose fat are all great for multiple uses. Of course, all of these should be from grass-fed, free-range/pastured, and humanely-raised animals to ensure they contain all the vitamins, minerals, and omega-3's that we want, and don't have the toxins, hormones, antibiotics, and omega-6's that we don't want.  

Coconut Oil: Fat of the Gods
Okay, I kind of worship coconut oil. A little bit. But seriously, it is an incredible substance. It is made up of 92% saturated fat, 6% monounsaturated fat, and 2% polyunsaturated fat, so it is very environmentally stable. It is also made up of what are called medium-chain fatty acids. Most oils - whether from plants or animals, saturated or unsaturated - are made up of long-chain fatty acids. This just means that they have a large number of hydrocarbons in their fatty acid chains, and so these chains need to be broken up into many small pieces before the body can thoroughly assimilate and utilize them. So medium-chain fatty acids (MCFAs) have shorter chains that require less bile and fewer enzymes to them break down in order to be absorbed through the intestines. The enzymes in your saliva and the juices in the stomach are enough to break them down, so they can be absorbed right away when the MCFAs reach the intestines [10]. This is AWESOME for CF, because pancreatic enzymes and bile production aren't even necessary to digest coconut oil! MCFAs are absorbed through the intestinal wall and into the portal vein, which brings them to the liver where they are used directly as a fuel, acting more like carbohydrates than fats (and without the impact on blood sugar). Most fats are stored away in body tissue before being burned as energy, but MCFAs are burned up right away, making them an easily absorbable and powerful energy source for folks with poor digestion. This is why MCFAs are often found in medical foods for premature or sick infants, folks with intestinal diseases, or older people with damaged digestive tracts. Furthermore, since MCFAs are so easily absorbable and provide the high calorie power of fats, that athletes are using them when they need quick bursts of energy and enhanced endurance [5]. They still, however, need to be emulsified before being absorbed, and for those with deficient bile production I suggest taking bitters with coconut oil and/or lecithin. One of my good CF friends has no gallbladder and could not take bitters for complicated reasons. The coconut oil would go right through her. But when she added lecithin to her food, she could finally absorb all fats, including coconut oil! 

In addition, The MCFAs in coconut oil and human milk are high in lauric acid, which has anti-bacterial, anti-viral, and antioxidant properties [6], another important reason why CFers should eat more of it (and be breast-fed for as long as possible)! Coconut oil is medicinal in so many other ways, I couldn't possibly list them all, but I will add that it has anti-inflammatory and fever-reducing properties, reduces oxidative stress within the bone to prevent osteoporosis, and can even be used as a moisturizing lotion and sunscreen [7]! Can you see now why I'm a little bit obsessed? This stuff is incredible. 

I recommend eating as much coconut oil as possible. Literally add it to everything you eat (being aware of the food combining rules). You can find it at your local coop or health food store, or order it in bulk online (better to order it in bulk from your coop to support local business). You can keep it in your pantry and doesn't need refrigeration. You can cook and bake with unrefined coconut oil at temperatures up to 350 degrees F, and refined coconut oil can withstand temperatures up to 450 degrees [8]. There are only drawbacks to coconut oil that I can think of: 1) its cultivation is not local to the US, so it's shipped from far away (usually southeast Asia), giving it a larger carbon footprint, and 2) it gets solid at room temp or below, so it can become a little tricky when trying to add it to cold foods (e.g. smoothies). 

Lard, Tallow, Suet, Duck and Goose Fat
These are also great saturated fats that have anti-microbial properties and contain a good amount of omega-3's if they are from grass-fed or pastured animals. They are also important vehicles of the fat-soluble vitamins A, D, E, and K. These fats generally can be used for cooking at higher temperatures. The great thing about these is that you can capture them when cooking meats, which makes them even more economical. After frying your bacon, make sure to capture the leftover fat in the pan, and put it in a glass jar on the fridge for cooking with later. Animal fats also add a lot of flavor to foods. Experiment and see which fat your body loves best. Another great thing about animal fats is that you can get them from a local source pretty much anywhere on earth. You can keep it in your pantry and doesn't technically need to be refrigerated, but I do, just to be safe. 

Ghee
Ghee is a medicinal fat often used in Indian cooking and applied in the ancient Indian medical system called Ayurveda. Ghee is clarified butter, meaning that the butter is boiled and the milk solids, casein, and lactose are removed, leaving behind only the butter fat. People who are lactose intolerant and/or allergic to milk can usually tolerate ghee, though I cannot. Ghee is 65% saturated fat, 5% monounsaturated fat, and 30% polyunsaturated fat. In Ayurveda, ghee is understood to strengthen the ojas, the essence that governs the tissues and balances hormones. It also stimulates digestive fire and can heal gastrointestinal injuries and inflammation. Ghee contains butyric acid, which is a fatty acid with antiviral and anti-cancer properties, and it has also been found to prevent and treat Alzheimer's [1]. Ghee from grass-fed cows is high in fat-soluble vitamins. Its can be used in cooking and baking at temperatures up to 485 degrees F, so it is the best choice for high-temp baking and frying. I recommend using ghee if you absolutely can't live without butter. Ghee is made from cow butter, so like lard/tallow/etc. it can be sourced locally pretty much anywhere in the US, if you don't mind making it yourself. You can also buy it pre-made in your local coop, Asian market, or health food store. You can keep it in the pantry and it does not need to be refrigerated. 

Nuts and Nut Butters
Nuts, seeds, and their butters should be considered as fats for the purposes of proper food combining. Most nuts and seeds have at least two times more fat than protein, especially when made into "butter". Nut butters can be a great source of both fat and protein conveniently bundled up in one whole food. It's a great snack, quick and convenient, but can also be made added into many recipes and sauces. I eat some raw almond butter, and make my own nut butters out of mac nuts, sunflower seeds, and pumpkin seeds. I have been experimenting for years with peanut butter alternatives, and am seeking the ones that my body finds most digestible. Peanuts are not a very healthy food. In addition to be legumes (which puts them on the "no" list for the SCD and the Paleo diet), they are high in enzyme-inhibitors and the way they are improperly processed in modern society causes them to trigger allergic reactions in so many people. They are also high in inflammatory omega-6's. So it's a good idea to find an alternative. Sunflower seed and pumpkin seed butters are great because they rarely causes allergies (it's neither a tree nut nor a legume), they're lower in phytic acid than other nuts/seeds, they're relatively cheap to make, and they're really delicious! I prefer the taste of sunbutter even to almond butter. That's the truth. Plus, if you're really dedicated to being a localvore you can probably find a local source of organic sunflower seeds and make sunbutter yourself in a food processor. And you can soak or sprout them before processing them if they're raw. It'd be a heck of a lot cheaper too. If you buy sunbutter in the store, beware that there is no added oil, because that oil is most likely rancid. 

I'm not a huge fan of nuts really, but I have discovered the incredible power and sweetness of macadamia nuts. They are incredibly high in fat and calories (1/4 cup has 237 calories and 25 grams of fat!), and they have an very sweet flavor. I add them to my smoothies. They are much lower in phytic acid than other nuts, so you don't have to worry about soaking or processing them - you can eat them raw without a problem. Plus they contain a good amount of potassium, phosphorus, magnesium, calcium, vitamin E, B vitamins, niacin, and folate [9]. Furthermore, if you eat them raw they'll have lipase in them, which will help you digest their fats. I get my mac nuts from Hawai'i. I suggest you order them online at Hamakua Nut Company. 

Again, avoid buying nuts/seeds and their butters in the bulk sections of health food stores and coops, even if they are cheaper. The polyunsaturated oils in nuts/seeds go rancid a heck of a lot quicker in bulk sections since they're exposed to a lot of air, light, and heat. It's best to buy these foods in air-tight containers protected from light and heat. This might be the only time I tell you to choose a packaged food over a bulk food. I hate to encourage more packaging waste, but in this case it may save you from a nasty gut reaction. 

How to Use Good Fats

There are just a few things to keep in mind when using the "good fats" I have described above. Here are a few tips:

Baking/Recipes
Saturated fats are safest to bake with and cook with at higher temperatures. All of the good fats mentioned above have high levels of saturated and monounsaturated fatty acids, so they are solid at room temp. When a recipe calls for an "oil", as in something that stays liquid at room temp, just replace it with one of the above good fats. Melt these in a sauce pan before adding it to a recipe that calls for a liquidy fat. Avoid microwaving fats. Cooking things the old-fashioned way with regular old heat is the safest and most natural way to prepare foods. 

Don't Overdo it
Fats are difficult and energy-intensive to digest even for healthy people. This means that when we eat fats, we must eat them with other foods only in certain combinations, in moderation, and keeping their individual characteristics in mind. For coconut oil, this is not as important because it's so easily digestible that it'd be very hard to eat too much of it. But with other oils that digest slower and require more energy to break down and absorb, eating too much of them in one sitting can cause G.I. upset or can cause only partial digestion of fats. Undigested fats may go rancid in your guts, causing inflammation, and when they eventually pass through into the stool they will take your fat-soluble vitamins along with them. So making sure that we digest all of the fats we ingest is very important, because it's not always guaranteed. Of course, you will take your pancreatic enzyme pills and digestive bitters (I should have convinced you of their importance by now!). For some people with poor bile flow or who have had their gallbladder removed, taking lecithin with a high-fat meal can be very helpful in absorbing fats. Lecithin emulsifies fats (what bile does), which must be done before pancreatic enzymes (lipase) can break down fats further into fatty acids. Beet kvass, raw garlic, apple cider vinegar, and lemon water taken before a meal also stimulate bile secretion to some extent, but bitters have the strongest effect. If bile secretion is deficient, doctors sometimes put people on supplemental bile salts, but these may be less effective than lecithin. As a side note, I believe the main reason why people gain weight on Ensure and other junk-food drinks doctors prescribe is not because they're nutritious, it's because of the lecithin in them! So instead, make your own smoothies/shakes and add lecithin, and see if you can absorb the fats better that way! The maximum amount of fat you can absorb in a sitting depends on the type of fat and on the person. So again, it's about experimentation and seeing what feels good to your body. 

Cold-Pressed and Unrefined
If we are using an extracted oil like coconut oil or olive oil, we must make sure that it is extra-virgin, cold- or expeller-pressed, unrefined, and unfiltered. What does this all mean? Expeller-pressed means that the nut or olive is mechanically squeezed at below 160 degrees F, and may be filtered once to remove the residues (you can buy completely unfiltered coconut oil and olive oil though, which I would recommend because the more plant-solids you have in the oil, the more nutrients will be present). Cold-pressed means that they were mechanically processed at below 100 degrees F, which is ensures that the oil is not damaged during processing. Look for cold-pressed oils whenever possible. If you buy flaxseed oil, it must be cold-pressed, as it rancidifies very easily otherwise. Unrefined oils retain their vitamin E, which is an antioxidant and protects the oil from rancidity. Never eat oils that were extracted using chemical solvents (i.e. most polyunsaturated vegetable oils). Refined oils are stripped of their nutrients and flavor-giving properties, plus they may have traces of the refining chemicals left in them, so these should be avoided completely. Choose unrefined and unfiltered oils whenever possible because these oils still have in them their beneficial nutrients including lecithin, chlorophyll, vitamin E, beta-carotene or vitamin A, calcium, magnesium, iron, copper, and phosphorus [1]. 


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[1] Healing with Whole Foods. Paul Pitchford. 
[2] http://chriskresser.com/why-fish-stomps-flax-as-a-source-of-omega-3 
[3] http://www.cfmedicine.com/htmldocs/CFText/efa.htm
[4] http://chriskresser.com/how-too-much-omega-6-and-not-enough-omega-3-is-making-us-sick
[5] http://www.coconutresearchcenter.org/article10612.htm 
[6] http://chriskresser.com/beyond-paleo-3 
[7] http://www.greenmedinfo.com/blog/13-evidence-based-medicinal-properties-coconut-oil 
[8] http://en.wikipedia.org/wiki/Smoke_point 
[9] http://macadamias.org/pages/health-benefits
[10] http://chriskresser.com/rhr-could-copper-zinc-imbalance-be-making-you-sick
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