Go With Your GutJun 10, 2020
Dr. Mary Pardee is a functional medicine and naturopathic doctor who specializes in gastroenterology. Often these days we hear the words, "gut health". But what does it actually mean? Our bodies, and especially our guts, are all built differently and it can become easy to end up going down the wrong gut health path when you're not aware of what's right for you. Learn how, in working with your doctor, you can get to the root of your own gut health and find ways to thrive both inside and out.
Try the first 5-days of Dr. Mary Pardee's course on Gut Health for free today!
Mary Pardee: My name is Dr. Mary Pardee. I'm a functional medicine and naturopathic doctor, so I see patients, and I really focus though on the root cause, so a nerd when it comes to nutrition, all the new things going on in health, which there are tons of, and I specialize in functional gastroenterology, so looking at integrative therapies for stomach conditions as well as hormone balancing.
Jeff: God, I should come and see you. That's my Achilles' heel.
Mary Pardee: Your weakness, yeah?
Jeff: Yeah, and many others, and I'm sure we can talk about intestinal permeability at some point maybe on this podcast or maybe after, but give us a little bit more of a broader definition of functional medicine for those of us who are not as aware of that term.
Mary Pardee: Absolutely, so functional medicine is really the future of medicine. If we look at what's going on in the nation, about 75% of the US healthcare spending dollars are going to preventable chronic diseases, and conventional medicine is amazing when it comes to certain things. You break your leg. You're going to the ER. They do it really well.
Mary Pardee: Traumas, yeah. For things that are chronic and for a prolonged period of time and preventable, conventional medicine is not the answer. It doesn't do a great job at that, and so that's where functional medicine comes in. We look for the root cause. We're doing lifestyle modifications, diet, exercise, all the things that we know that we need, but finding a way to apply them and really helping people, so, if we look, one in two Americans has a chronic disease. That's incredible. One in four have multiple chronic diseases, and about 70% of the population is overweight.
Jeff: When you say chronic disease, mostly diabetes...
Mary Pardee: Yeah, diabetes...
Jeff: ... any inflammation or... Yeah.
Mary Pardee: ... hypertension, high cholesterol, so, in my field, integrative gastro, IBS, irritable bowel syndrome, 20% of the population, about 15 to 20% has IBS. That's unheard of, and, also, these are the things that people keep going back to the doctor for. You don't go in one time because you got a fracture or something and then you never see that person again. These are the conditions where you have to go back and back, and that's where we're using all the healthcare spending dollars as well as really tying up what's going on in the healthcare field.
Jeff: You're saying that the western allopathic medicine is really good at dealing with traumatic issues, but that we as individuals actually have a lot of control over our health even though we are not conditioned to think that way. Is that a true statement?
Mary Pardee: 100%. You're the CEO of your own health, and I think that this is really where we're going with functional medicine, too, and really trying to empower people to take control of their own health, and so we talk about it in the Hacking Your Healthcare course, but what should you ask your doctor, and you really should be interviewing your doctor. It shouldn't just be that you get assigned a doctor by your insurance company, you go there and you check the box, but be involved in it. Ask the right questions. Are they ordering the right tests for you? Do you have to find another practitioner that's out of network and pay out of pocket if health is a priority for you? There's so many options now, but it really is in the patient's hand.
Jeff: Right, so let's walk through like a... let's do some play... some role-playing here. I'm the nervous Nelly patient, not a stretch, I'm going into see my primary care physician and, before I actually see him, I'm filling out a bunch of paperwork, then I go and undergo a whole series of tests. What are these tests and why are they important, and I never really hear about them again, so why am I doing it, and what do I need to know when I'm doing that?
Mary Pardee: Yeah, and this is really what sets apart conventional medicine from functional and naturopathic medicine, so, when you go in, most likely thing is exactly what you said. You get the tests. You might get a phone call. Hey, everything is normal, like "normal."
Jeff: Yeah, whatever normal is. Yeah.
Mary Pardee What normal means is you don't have a disease, but, in functional medicine, we don't wait for somebody to have a disease process to do something. We're really looking at things with a much more narrow lens, so we're saying, "Okay, you don't have a disease, but are you in optimal health?" and, to do that, we have more narrow ranges for the actual values. These are our functional medicine lab ranges, so we want to see, for instance, HbA1c is a screening marker for diabetes, so, normal, 5.7, 5.6, but in functional medicine, I want to see people at a 5.5 or lower, and that's because I don't want to have to diagnose somebody with prediab:etes and then treat them for that. I'd rather wait. I'd rather do something before we ever get there.
Mary Pardee: We're also looking at markers that normal doctors won't even run until there's a disease process in the works, so I do a fasting insulin on all my patients, and fasting insulin tells you way before HbA1c even or fasting blood sugar whether somebody's becoming resistant to insulin, and so we're diving much deeper into the blood work. Even if you're in the conventional model, you want to ask your doctor, "Hey, can you explain the lab work for me? What's going on?" and your doctor should be able to go through and see.
Mary Pardee: A normal blood test is always going to include something like a CBC, a complete blood count. Every doctor is going to run that, and that has a lot of information on it. It's not just normal. You don't have leukemia or something. There's a lot of information that you can get there. For instance, MCV. That's your mean corpuscular volume. That's how big are your red blood cells, and that tells us about your B vitamin status, B12, folate. It also tells us about iron status, so, from just that one marker, you can get a good amount of information from it.
Jeff: What would you say are the very essential battery of tests that one would... that you would administer to me if I actually had the gumption to come to your office?
Mary Pardee: Okay. My essential list is much longer than most doctors' essential lists, so I'll give that disclaimer.
Jeff: Fair enough.
Mary Pardee: Your basic ones that almost every doctor is going to run are going to be your CBC, your complete blood count, your complete metabolic panel, your CMP that's looking at liver kidney function. I'm also going to run hormone, so I think every man and woman should know where their hormones are even if they're not in menopause, even if they don't have erectile dysfunction. You should know what your testosterone level is, and women need to know how is your estrogen progesterone, so I'm always going to run sex hormones.
Mary Pardee: I'm also going to run the fasting insulin like I said. HbA1c is a really important one for diabetes screening. I'm running things like a C-reactive protein to look at inflammation in the body, omega 3 to omega 6 status. That's never run by a conventional doctor, but I think it's really important. You want to make sure that your inflammatory pathways are in balance, full thyroid panel, so not just a TSH. TSH is the hormone that comes from your brain, tells your thyroid to make thyroid hormone, but then, from there, is your thyroid producing enough active thyroid hormone, so I run free T3, free T4. I'm looking at thyroid antibodies as well and reverse T3, which we can see elevated in instances of stress, so I'm doing that full thyroid panel.
Mary Pardee: I'm running some genetic markers like APOE. APOE looks at possible risks for Alzheimer's, but also tells us a lot about whether you do well with a high fat diet, which is really trending right now, so I like to tell people, "This might not be good for you. Let's stay away from the high fat and go more moderate." I'm looking at advanced cardiac markers as well as a standard lipid panel, so your total cholesterol is one number, but you really want to know more. You want to know about how many particles are there, so I look at LDL-P, how dense is your LDL, small density LDL that you can measure.
Mary Pardee: The other ones I'm going to look at are some cortisol measurements, which we do in saliva. I don't do that for everybody though, but that's where we get into the functional testing, so that's my basic panel. For women, I'm always going to do a ferritin level to look at iron stores, and I think we hit all the other ones.
Jeff: Okay, that's a good battery of tests, and I think I can... I might be able to grapple with that now. Now, there's a lot of discussion these days in the introduction of new products on the market around self-administered testing. What do you think about that? Where is it useful and what can you learn from it, and when is it actually really necessary to come see you?
Mary Pardee: Yeah, and so I think it is wonderful that people have the option of just testing themselves especially when we look at places where they don't have access to functional medicine doctors, so there's going to be some spots around the country that maybe there's not a ton of people around you, so, in those instances, I say wonderful.
Mary Pardee: The thing that I don't like about them, which I've seen, is that people are just doing them and they're treating themselves and they don't really know how to go about it or they get this blood work back and they're like, "Okay. Great. Now what?" and they're not seeing anybody, so there's this blood work that's been done, there's some abnormal values and it's just hanging out there, but I think that they do have value and we can use them accordingly, but if you have something that you don't know what to do with, then you should go bring it to somebody that does know what to do with it.
Jeff: Right, I guess there's only so much analysis that you can treat or teach people because they're not trained doctors. You actually take some of these self-monitoring practices to the next level, so I want to poke at this a little bit. Maybe you can talk a little bit about your own personal monitoring experiences and your glucose monitoring and all that kind of stuff and why you did it and what you learned.
Mary Pardee: Yeah, I'm like a health tech nerd. I really like all the gadgets. I also like using things on myself before I tell somebody else to do them, so I think that that's important, so I've had the experience myself, so the most recent one is the one you're talking about, which is the continuous glucose monitor, which is the CGM device. The one I used was Dexcom was the company, and these are really designed for diabetics, so, if you're going through insurance, you have to have diabetes to get it prescribed to you, but, off label, you can use it for anything you want, so that's the route I went. I don't have diabetes, but I inserted it. It goes onto the abdomen and it gives you a reading of glucose every four minutes so you can actually track your whole glucose cycle throughout the day
Mary Pardee: And so, for me, the biggest things that I found were that, first of all, I react to caffeine, so, if I drank a bunch of coffee, my blood sugar would raise.
Mary Pardee: Yeah, and not everybody reacts to caffeine. It's based on genetics partly and then just the individual and what you eat around the caffeine, too, but I talked to one of the reps and she was saying, "Oh, yeah, that's one of the most common things that people are surprised by. They're either responders to caffeine, and it jacks up their blood sugar, or they don't, and so it's one or the other, but you don't know until you test it.
Mary Pardee: The other one that was super interesting is oatmeal. We always say oatmeal is this amazing health food. Some people, if you're in the anti-green camp, then you're no longer an oatmeal person, but I had a very small cup of oatmeal with about five berries on top, really tiny...
Mary Pardee: ... yeah, very modest portions, and that raised my blood sugar more than ice cream did, almost more than caffeine did, more than any food that I ate throughout the week.
Jeff: Wow, so no more Quaker Oats.
Mary Pardee: Quaker is out for me...
Jeff: Yeah, for you.
Mary Pardee: ... and so there is an individual link to this, which is really, really interesting to me because it has to do with the microbiome, and the microbiome is my baby, it's my favorite, but it's because our microbiomes are going to secrete chemicals called metabolites, then they can go to the liver and can affect our blood sugar regulation, so blood sugar regulation really, the center of it, is the liver. That's where we make blood sugar if we become low based on our diet, and so we know now that the microbiome contents in our gut can affect how we respond to different foods.
Mary Pardee: There's also been studies that show, if you have a certain composition of microbes in your gut, you might harvest more energy, so that means that I could give the same amount of calories to one person that I give to the next person, and one person would gain more weight than the other person.
Jeff: Yeah. Yeah, and are you a big proponent of fermented foods and probiotics, probiotic-oriented foods and-
Mary Pardee: I'm a proponent, but they're not for everybody either, so, because I deal with people with such sensitive gut sometimes, I'm not suggesting them for everybody, so it really is based on the individual, and so that can change, but for people that have a robust gut and they don't have some issues, then maintaining it with fermented foods I think is wonderful.
Jeff: So, let's talk a little bit more about personal monitoring. I know that heart rate, heart rate variability is one of the keys to long life and longevity. I'm not exactly sure I understand why. Just read that. Maybe you can explain to me why that is and then now you can actually monitor that. Is that correct?
Mary Pardee: That is correct, yeah. So heart rate variability, HRV is the short name for it, and that is the beat to beat changes in your heart rate, right? So your heart goes lub dub, lub dub, lub dub. And from one dub to the next lub, there's a millisecond amount of time. And we actually don't want that time between heart beats to be the same each time. So we want it to either contract or get bigger. And that shows us the flexibility in your heart rate variability. And we want a wide range of heart rate variability. We don't want a small one and it reflects a really flexible central nervous system.
Mary Pardee: So your ability to switch from parasympathetic, your rest and digest, to sympathetic, your fight or flight. And so if you have a really good nervous system, you should be able to switch back and forth easily and respond to your environment. So heart rate variability gives us a measurement of that and it's a way for us to say, "Okay yes, you have a high heart rate variability or no you don't. And it's a reflection of your nervous system and your ability to deal with stressors in life."
Jeff: And have you done that?
Mary Pardee: Yeah.
Jeff: Yeah. How are you doing on that front?
Mary Pardee: Pretty good. So HeartMath is one of my favorite companies. They've done a lot of the research in HRV as well. And so I use their Inner Balance device. I'm not sponsored by them, but I really like their device just because it's really easy to use. It gives you direct feedback. You basically log in for a biofeedback session and you not only get heart rate variability information, but heart coherence, which is your heart rate over time. And it should look like a nice signwave pattern.
Mary Pardee: And when you get into a state of anger or a negative emotion, what we see is spikes in your heart coherence, like very erratic. And when you're in a place of gratitude and happiness and positive emotions, that heart coherence starts to normalize into that sign wavelike pattern that looks kind of like ocean waves. So it's kind of like a meditation, but you're getting immediate feedback from it, which I love.
Jeff: I mean you seem to integrate I guess mental and psychological health with physiological health, mind body connection, and you're a meditator. So explain to me how you think of that connection.
Mary Pardee: We can't ignore that connection. You know, the fact that not every doctor looks at that connection I think is kind of crazy at this day and age. I believe that the brain really controls a lot of our health and that includes our thoughts and emotions, right? So we can't separate those out from our physical health. Because we know that everything that we're thinking, all of our beliefs, thoughts, emotions are going to affect the internal organ systems. And that's the thing with functional medicine is we don't look at one organ system. Like I'm not going to just look at your gut, I'm going to say, "Okay, maybe cortisol is affecting your gut or maybe your sex hormones are affecting your gut." So we really have to look at everything as one unit. And in doing so that includes your brain and meditation is one of the best ways to get people into a parasympathetic state.
Mary Pardee: And as a gut health expert, parasympathetic state is where digestion occurs. So if I have somebody that has reflux, constipation, that tells me the digestive system is not working properly, things are not moving through it literally. Like you're not going to the bathroom and food's coming up and not going down. So one of my key things that I'm looking at is how do we put this person into a parasympathetic state more often. And that's things like meditation, heart rate variability, training, walking, really simple things.
Jeff: There's a lot of very interesting conversation happening currently around longevity, essentially being able to physically and cognitively thrive into your centenarian, sort of even longer. And I'm wondering, I mean ... And that I've heard more and more that this notion of like inflammaging, that essentially aging doesn't really exist on some level, that it's actually completely tied to living in chronic inflammation or some degree of inflammation. So, maybe you could speak to that a little bit and just what you would outline according to Dr. Mary Pardee is the keys to longevity and thriving into later life.
Mary Pardee: Yeah. Anti-aging, big field now. I love it. I also think aging is great, right? Like in terms of wisdom. But I think that the foundations need to be in place. So sometimes I see people doing these extreme things and they're still not sleeping. They're still eating processed foods. So I really start foundationally and that is eight hours of sleep a night. Quality sleep too. Sleep is more important than almost diet in my mind. It's really at the top of the list there.
Mary Pardee: Diet, whole foods, plant based diet, so just eating a ton of vegetables and I have like a food strategy guide that I give to all my clients but it's basically just mostly eat vegetables, have a good amount of like a palm size of protein there. Some good fats and you don't have to get too crazy on diet. I think that if you're really just focusing on eating normal real food, then you're in a good spot.
Jeff: Animal protein in Mary Pardee's life?
Mary Pardee: There is animal protein in my life but it's a small amount. My palm's not that big, you know.
Jeff: No, it's a very lovely modest palm.
Mary Pardee: Yeah, so and I don't eat animal protein at every meal, so I really do think it's about moderation.
Jeff: Where else are you getting your daily proteins?
Mary Pardee: Legumes, I am not on electing bandwagon, so I eat chickpeas, I eat legumes, organic, non-GMO tofu is now back in my life, which it was out for a while. I don't eat like a lot of the processed meat alternatives, but yeah, just you know, edamame.
Mary Pardee: Plant sources.
Jeff: So no impossible burgers.
Mary Pardee: No, no. I like, if I'm going to eat meat, I want it like actual meat and not fake meat.
Jeff: Yeah. Gotcha. Sorry to cut you off. So other Pardee sanctioned keys to longevity.
Mary Pardee: For sure. A little bit about what we talked today. We know what your tests look like, your blood tests. You want to make sure that insulin is good because that's not going to do well with aging. If your insulin levels are high, low testosterone, you're not going to age very gracefully either. So we get to know your biochemistry.
Jeff: Vitamin D?
Mary Pardee: Yeah, I do mention that. That's an essential test that's on my list.
Jeff: That's what I'm here for.
Mary Pardee: Okay, thank you.
Jeff: Okay. It's to help you out.
Mary Pardee: Yeah. I need it. Increased brain-derived neurotrophic factors on my anti-aging list and that can come from a variety of sources.
Jeff: You're going to have to repeat that.
Mary Pardee: Yup. Brain-derived neurotrophic factor. BDNF is the short, which we'll use from now on, so I don't have to say that a million times. BDNF is the basically growth factor that helps your brain create new neuronal connections. So we can't necessarily create new neurons in the brain, maybe, maybe not, but we know we can create new synapses, which is all that matters.
Mary Pardee: So you want as many different roads to get to the same location in the brain, because inevitably some of the roads are going to close at some time. And that's okay if we have multiple routes to get there backed up. And so we know that degeneration of the brain is likely going to happen. But if we have all these different avenues, then it's not that big of a deal. And so BDNF is that chemical that helps you create those things.
Mary Pardee: And we can create more BDNF in the brain by things like establishing a flow state, which I talked about. And that's really doing anything that gets your juices flowing. So it might be painting for somebody, it might be working on a business project. People that love what they're doing for a living. It might be surfing. Exercises is an amazing way to increase BDNF, especially exercise that really requires some level of cognitive function. So whether it's balanced coordination. I just started doing Taekwondo and part of the reason was brain health. You know, you have to figure out how to use all your limbs all of a sudden, and you haven't done that since you played sports, so.
Jeff: Also, we couldn't have a conversation without talking about fecal transplant. I'm sorry, but it was in the fine print of my email that I sent you when I invited you over.
Jeff: But it was at like a 0.0002 font so that you didn't really probably read it.
Jeff: We hear about this and it's titillating to talk about because of course what your mind is imagining is like you're taking someone else's poop and putting it inside of you. Can you just demystify this for us?
Mary Pardee: Sure.
Jeff: Why is it important and what is your experience with it?
Mary Pardee: Yes. So fecal microbiota transplantation, FMT, is the acronym for that one, and it's an amazing, amazing therapy. And it's got its laughs and things like that, but it's really actually saving people. It's life saving. And what it's most known for is the treatment of C. diff, C. difficile infections.
Mary Pardee: I'll go what it actually is first and then I'll kind of talk about. Basically what FMT is is you're taking a donor's stool. So you want to make sure that that donor's healthy. There's donor banks now that screen the donor so you know that they don't have any infections. You take that healthy person's stool and then you implant it either by capsule, so you can actually take it orally in a capsule, or more commonly by enema, which is rectally. And you're infusing that person's stool into the sick person's colon. And the idea is to reinoculate the gut with a healthy microbiome.
Jeff: Right. So your microbiome is depleted, that's leading to all sorts of illness. You're having trouble essentially reestablishing a plethora of healthy bacteria yourself. So one of the potential treatments for that is ...
Mary Pardee: FMT. Fecal transplants.
Mary Pardee: Yeah. And so right now that the FDA has decided that it is putting the kibosh on some of it. And so, right now you can only do FMT in office, like administered by a doctor, for the treatment of C. difficile. You can't treat IBD or IBS, and some of those we're getting really great results when that was allowed.
Jeff: So why is that? Why have they kiboshed it?
Mary Pardee: I think it has to do with politics. They want to keep people safe and there have been deaths from FMT, and the deaths mostly have been due to either the specimen being infected, so it wasn't properly screened, wasn't screened at all. Or the person being immunodeficient, that they didn't have the immune system to fight off very simple infections. So they're trying to keep people safe. But-
Jeff: And with the advent of these banks that you're talking about, it might probably be safer. Let's just play this out. Let's say I wanted to try to do this and you could administer it. You would then go to like an ATM or whatever. Not not that kind of bank, but you know what I mean. You would go procure a safe sample from a bank.
Mary Pardee: Yeah. Ideally, that's what would happen. Right now you can only get banked stool if you have C. diff. So unfortunately for the people that have IBS, IBD, that are trying to treat themselves with FMT, you have to do it as like a DIY, do-it-yourself at home kind of thing. But you must make sure that your donor is healthy. That needs to go through a whole screening process or else you are putting yourself at risk. Because there's things that we don't even know if they're going to get transmitted fecally.
Mary Pardee: But what's interesting is that it's super effective. It's effective. The research I've seen for both IBD, especially ulcerative colitis as well as ... I mean for C. diff, the FDA even realizes it's saving lives over Vancomycin. Vanco is the standard of care treatment. It eradicates C. diff in about 60 to 90% of cases, but then there's a 25% recurrence rate.
Mary Pardee: FMT, 90% are totally cured by FMT who have C. Diff, and only a 5.5% recurrence rate. In my mind, I don't understand why FMT is not standard of care first line before the antibiotics because you're actually reinoculating the gut with the stuff that you want instead of trying to strip it away of things that you don't.
Jeff: Right. Yeah.
Mary Pardee: It doesn't make much sense to me.
Jeff: Yeah. Yeah. I mean, what's your general viewpoint towards broad spectrum antibiotics? I mean, in general. I mean, I can guess. But, yeah.
Mary Pardee: Yeah. I'm not a fan of them, but they're life saving. Right?
Mary Pardee: So if I have somebody that for some reason we can't do an FMT, I'm always going to ... there's a lot of things behind that, but if you can't do FMT, then you Vanco and all these big heavy hitter drugs can save your life. But they should only be used in the instances where you need them to save your life. So I don't like ... sinus infections. It's like most of them are viral. Same with pharyngitis. You rule out strep throat, maybe you have a viral pharyngitis, which is sore throat. So if it's not bacterial, why are we giving an antibiotic?
Jeff: Yeah. It doesn't make any sense.
Mary Pardee: Doesn’t make any sense.
Jeff: And how long do you think it takes to sort of repopulate the gut with a plethora of healthy bacteria post-antibiotics?
Mary Pardee: Yeah. I don't know if I know exact answer for that, but what I do know is that there have been studies, and your microbiome does bounce back after antibiotics. So some people will come and say, "Hey, I think I need FMT because I just took one round of antibiotics." I'm like, "Do you have any gut symptoms at all?" They're like, "No, I feel phenomenal." I'm like, "Um, you probably don't."
Mary Pardee: It's when we have recurrent use, especially in the early years of life, that we see an issue. So people that have been on 15, 20 rounds of antibiotics or they were put on Doxycycline or Minocycline for two years for acne.
Mary Pardee: Those are the people or maybe it did create a dysbiosis in the gut and FMT might be able to help them.
Jeff: Yeah. So for you, in closing, when you're looking at society at large, what's the big salient problem and what is this big solution?
Mary Pardee: Yeah. I think that there needs to be a dramatic shift in our thinking about health care. And that's why I opened up saying that I think that functional medicine, naturopathic medicine is really the future of healthcare when it comes to preventable chronic diseases. I think we really need to focus on that.
Mary Pardee: And I was talking to a doctor the other day and he was conventional medical doctor, very intelligent guy. And he said, "You know, not many people, not many doctors want to focus on health like you do. Most want to practice medicine." And I thought to myself, that's so interesting that there's now a separation between promoting health and practicing medicine. Because I view them as the same, and I think that that's where we're going wrong. You know? Yeah, I don't write a ton of prescriptions every day. I write some when I really need to, but I love the fact that I can ... I dropped a guy's HbA1c from 6.5 to 5.6. And I consider that practicing medicine or creating health. I don't care what you label it, but that's what we need to be doing as doctors.
Mary Pardee: And so, I really think that it just has to be this shift in thinking of not doing sick care, but really promoting wellness optimization and health care.
Jeff: And I love the metaphor of functional medicine, honestly. Of essentially getting to the root cause of the problem because I think you could take that and apply that to other fields. Environmentalism. I mean, we just had a conversation with Finian Makepeace talking about essentially how industrial farming has contributed greatly to global warming. Well, once you start to actually unpack and look at the root cause of the issue, then you can start to address it and create a more healthy symbiosis in the environment. And, in this case, in the environment of your body.
Mary Pardee: I love that.
Jeff: So let's make a bunch of metaphors together.
Mary Pardee: Okay.
Jeff: Thanks for coming to my office.
Mary Pardee: Yeah. Thank you.
Jeff: I feel more secure and more confident about coming to your office if you'd have me.
Mary Pardee: Oh, thank you. I appreciate that. Thank you for having me.
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