are some practical steps people can take right now to start improving gut health through diet or lifestyle. So there's some very basic things that everybody can do and everybody can benefit from whether you knowingly have a gut issue or not. Number one is diet. Diet is can't, I always told my weight loss patients, you cannot out exercise a bad diet. You cannot, it's the same concept with gut. You cannot eat. and have good gut health. So I always tell patients focusing in on looking at lean sources of meats, looking at a whole food plant-based diet, not saying you have to be vegetarian, but really looking at good clean sources, organic sources.

I give all of my patients the clean 15 dirty dozen list when they come in. um Looking at eliminating pesticides, insecticides right off the bat. Also making sure you're getting plenty of healthy fats. making sure that you're consuming nuts are a great source of that, your fatty fishes. Your health is shaped by more than symptoms. Through real stories and expert insights, we explore how your genetics, environment, and daily choices affect your wellbeing.

We uncover root causes and share practical tools to help you find the healing you need. Welcome to the Forum Health Integrative Medicine Podcast. Welcome back to the Forum Health Integrative Medicine podcast. I'm your host Amanda and I'm here with Amanda Dyer-Moss, our nurse practitioner in our Greenville location. And today we are going to be talking about gut health and a root cause approach because your gut isn't just about digestion. It's connected to your immune system, hormones, mood, and even your energy. Today we're going to talk about why gut health is central to the whole body approach. and why testing matters and what you can do to get to the root cause of symptoms. Amanda, thank you so much for being here today. I'm so excited to talk. Just want to start, tell us a little bit about yourself and how did you get into functional medicine? So I have been a nurse practitioner for about five or six years now.

I actually got into functional medicine just because of personal experiences. Looking at more of, I had a lot of medical problems in my 20s. kept going to physicians, never got answers and started treating myself. And so that's kind of what led me to functional medicine.

I have been a nurse for over 20 years and worked in ICU primarily. saw a lot of heart patients, a of cardiovascular patients. And again, a lot of times it was, we were putting bandages on patients, never treating root causes. Yeah. Hear that a lot in integrative and functional medicine that there's a lot of times just like that personal journey that kind of opens up.

Pandora's box and there's really no going back. There's not here, right? Okay. So let's dive into our topic. Let's talk a little bit about gut health and why gut health is central to the whole body approach. A lot of patients, a lot of people think that gut health just means like, oh, I'm digesting my food or my poop in, or, you know, all that. So what does gut health really mean from a root cause approach and from a provider's perspective? So from a provider's perspective, know, my philosophy is, and I've done a lot of reading on this topic in particular, and I educate a lot of patients, it's not just the digestive system.

I have a lot of patients come in, I don't have any GI problems, but then their micronutrient levels are in the toilet, and they also are experiencing a lot of anxiety, depression-type symptoms. That doesn't sound like gut health. No, it doesn't. But there is a huge correlation between what takes place in the gut and what affects the overall body. Yeah. You know, there's the link between, we call it the gut-brain axis. That's a term that's been thrown around a lot, increasingly, over the last 10 or 15 years, where you have some of your neurotransmitters manufactured in your gut itself, which is going to affect anxiety, depression. There's even been some studies showing links between Parkinson's disease as well as autism, a link back to gut microbiome. But we also know that there is uh an interplay between hormone production, not just sex hormones, but also thyroid hormones. There's a huge link between that. Yeah. mean, these micronutrient deficiencies, it makes sense, but you know, it's the male absorption, right?

Like if you're eating food, you have to digest that and you have to absorb it. So we talk about micronutrients like, oh, but how does that deal with the gut? Well, you have to absorb them into your system. The anxiety, the depression you mentioned. serotonin is made in the gut.

So of course it's going to impact your mood and anxiety and depression and things like that. that's so interesting. I think it's really important for patients and listeners to understand that like the gut. Affects every system. So the gut, it's connected to the immune system, hormones and brain health. We know that now and a lot of times people ask the question when they're sitting in the chair, I know I've asked it before even as a patient is, do I really need the test? Why is gut testing so important and what can it reveal? So, you know, a lot of patients do ask that. You start getting into testing, you you open up Pandora's box with that. But I always tell patients the importance of gut testing is we're looking at identifying specific issues. So, you know, we're looking at is there a problem with your stomach acid?

So do you have hypochloradria? Then we need to treat that from a different approach. We also need to look at what is causing that issue. If we look at pancreatic function, we have to look at is there a pancreatic insufficiency? We need to treat that pancreatic enzymes. But also again, what is causing that pancreatic insufficiency? Sometimes heavy metal toxicity can be linked back to that. oh Um, you know, that's where I talk about Pandora's box. You do a gut test. That's foundational. You're looking at what you can identify upfront. Um, and I always tell patients we look for the elephant in the room, the biggest thing we can find first, which is going to be gut. And then we start looking out at what is causing the issues in the gut. Then we may go down the road of heavy metal testing. Things of that nature.

Thyroid testing. It's uncovering one piece of the puzzle at a time. And I love that it's, you know, maybe we do this first and it's. It's not all at once. That's so much information for you as a provider. So much information is for a patient also. But also when you get one test and you start working and correcting that, it's gonna affect the next test and the next test and the next test. So then you'll never know what came first, the chicken or the egg.

Exactly. So I love that approach. love not necessarily jump all in, but let's take the mindful approach of let's… What's your symptom? What's the most appropriate test for that symptom for us to start? And taking it one step at a time. And I think that's really important. And the other thing too is that like we're talking about gut health here, right? But it's not just like the gut. It's not just the stomach. It's the pancreas. It's the liver. It's the gallbladder.

So it's, you you think gut health, but there's a lot of other organs and a lot of other things that's that gut health is about. Yes. And I get a lot of patients who say, can I just do a treatment protocol? You know, they'll come in and they'll say, can I just forgo testing?

Just put me on what you would put every patient on. You know, and always tell patients. funny. It is. I always tell them, I'm like, it's not a one size fits all. It's kind of like if you walk in your bathroom and there's water on the floor, are you just going to mop it up every time you go in there or are you going to fix the leaky part? There's things that you can do if you are not able to do testing that is just going to be helpful. You're not going to have. some of the same guidance from information perspective as a provider with the patient provider relationship, but doing a detox, cleaning up your food, like even doing small things at a time, right? Elimination diet, understanding what your potential triggers could do. And I would almost argue too that sometimes doing some of those foundational things upfront before the testing too, so that you have a, I wouldn't say a clean bill of health because that's not what it is, but you're removing some of the noise from the body so that when the testing is done and comes back, you don't have all the extra noise in there. And I will say, I see a lot of patients who come in specifically just for gut testing upfront. They're usually on 45 different supplements. They're trying, they've done a lot of research, a lot of Googling, Dr. Google. And they are taking a lot of things that I sit down and I look at them and I go, some of this may be unnecessary. Right. And that's where testing again comes back into play. They may be on things that they don't really need. They're wasting their money, but they're also putting things in their body that are not necessary that they're just basically eliminating. That's a uh good point that just came to my mind is when you're testing and people are already coming on a protocol that they found or was prescribed, anything like that. Should they stop taking supplements? It depends on the situation. So like I had one particular patient came in one time. She had a diagnosis from GI for pancreatic insufficiency.

She was on Creon. I did not take her off of Creon because we had a diagnosis to support the use of that. But we did go ahead and do stool testing to see was she on enough Creon?

Did we need to alter dosages? Did we need to support and other mechanisms? Did she also have SIBO or gut dysbiosis going on in addition to the pancreatic insufficiency? So that particular patient, we left on her protocol. I've had other patients come in and they're on probiotics, but they're still experiencing lots of issues. And I'm like, well, you know, it's kind of best if we stop this probiotic. It's not helping anything. Let's start back over. And generally I tell patients, you know, in those situations, let's stop everything for about 14 days and then let's proceed with testing. I think that's valuable. And don't stop telling anybody to stop any protocols. Yes, maybe the provider first. Meet with providers first. So we know that the gut impacts a lot, a lot more than we think, right? We know testing can be really valuable in a treatment plan when you're working with your provider. But what are some of the hidden causes of symptoms like fatigue, brain fog, or hormone issues that actually start in the gut? So, you know, a lot of times we have to think about the immune system as being part of the gut. Like 75 or 70 % of your immune system lies within the gut. That's a lot of our immune system. a lot of our immune system. And if we think back to what happens in the immune system with we end up with inflammation in there from either an acute infection or long term. then we end up with gut permeability increases. so what is permeability? What is gut permeability? So that's where you have tight junctions in the gut and they should be allowing certain things through certain things not through. And then when you get leaky gut, those junctions open up and now they're allowing things to pass through that membrane that may be necessarily should be through to the bloodstream. And then we're now stimulating. chronic low-grade inflammation.

And we know there's multiple studies that show that chronic low-grade inflammation is the root of all diseases. You can pinpoint back to everything from cancer to heart disease, to a lot of your neurodegenerative diseases. Yeah, absolutely. I think that's really important.

Thank you for explaining that to me. So how can the gut… how can gut health influence autoimmune conditions like Hashimoto's or rheumatoid arthritis or psoriasis? Because those are autoimmune conditions that really are very different from each other. Very different, but they're very common. one thing I always explain to new patients when they come into our office is I explain to them epigenetics. Epigenetics is a term that some people are familiar with and some are not. And epigenetics is the… very complex um interplay between what genes you have, things you were born with, maybe genes that turn things off, turn things on, but also environments.

So how do those two work together to either improve things or to make things worse? So for instance, we know that there are some genetic components to some of these autoimmune diseases, but something in the environment turns them on or off. And that thing from the environment got into that person's body through intestinal permeability. Very likely. into the bloodstream.

Likely. And triggering something. Very likely. And so when we have increased gut permeability, we have dysbiosis, we have infections, we have environmental toxins, things that are not able to be detoxed through the body through the colon, our colon detoxes our body. And so now we can't detox the way that we need to. We can't move things through. So we're increasing autoimmune diseases because of again, chronic low grade inflammation. There is a really interesting statistic that I saw that somebody who has one autoimmune disease is far more likely to have two or three because of with one autoimmune disease, it's almost proven that you have leaky gut or intestinal permeability. And I can't tell you how many patients I've seen who have come to us as they come in and they go, you're my last resort. I've seen rheumatology, I've seen neurology, and they keep telling me I have an autoimmune disease, but they don't know which one. And then I tell the patient, I'm like, we may never tell you what autoimmune disease you have, but that's not the point. Let's fix what the problem is. Let's go back to gut. We actually don't need to know what it is because we already know what the trigger, well, we don't know exactly what the trigger is that your body responded to, but we do know where it's coming from. And if we correct that, clean up the gut and remove the trigger, then the response goes away. Right. You know, and I always tell patients the degree that you may benefit from with your autoimmune process that you have going on varies by lifestyle, again, genes, other toxins in your body, metals, microtox, that sort of thing. But you also have to think about the… We may not get rid of things, but we can at least help control them and improve quality of life. Yes, absolutely. I know some common triggers and things like we'll do a lot of elimination diets and stuff like that. Very common things that one, it might not be your trigger, but we do know that it has an uh impact on intestinal permeability, but like things like gluten and sugar and processed foods and additives and like all of those things that really our body wasn't designed to be, the additives and preservatives um weren't designed to be exposed to that way. Yes, and so a lot of times when I have patients come in when they initially report gut symptoms, a lot of patients come in and immediately think it's because I have a food allergy. That's what the problem is. And I always tell patients, food allergies are only a piece of the puzzle and may not be the initial problem. If you have gut dysbiosis, you have SIBO, you have increased intestinal permeability. That may be the problem and may be causing food sensitivities. So I'll have a lot of patients who immediately come in and say, I want food testing. And I discourage them from immediately doing food testing. like, let's again, let's look at gut. Let's treat gut three to six months down the road. Then we can look at food sensitivity. You need to remove that. I've seen so many times people jump into food testing a little bit too soon where they haven't done any of the work where everything becomes a red flag. Yeah. Instead of what's supposed to be like.

Yes. Your body's overreacting right now. You have to calm down. Otherwise, you're going to get this report and it's going be like, oh. It's lit up like a Christmas tree. Yeah. Everything's positive. can't do anything. Yes, you can. But we got to clean up first. And so it's a very basic Timing and testing sounds important. Yes. It's a very basic concept that I explain to patients when it comes to that is I always tell them, if you eat a food and you have a response, you have bloating, you have acid reflux, you don't feel good, you have fatigue, brain fog.

then stop eating it. It's pretty simple. Yeah. I'll be the first to admit sometimes it's just a little bit harder than it sounds. Okay. That's great. In your practice, what nutritional deficiencies do you often uncover when the gut is impaired? I like this question. Yes. So this is a very important question and this is chicken and egg again. it's, did your gut issues cause a nutritional deficiency? or did your nutritional deficiency contribute to a gut problem? And sometimes we don't have an answer for that, but you have to treat from both aspects. So what we do on all new patients in our clinic is what we call our, it's basically a mini micronutrient test.

It's not as extensive as some of your specialty testing, but we look at things like zinc copper balance. We look at vitamin B12 levels. We look at vitamin D levels. We look at ferrets in levels. And even though you're not doing the big comprehensive, even those that small panel just tells you a lot about the whole picture because if those are impacted, you can make an assumption on the rest of the nutrients that you didn't test for yet. Correct. Well, and I don't oftentimes check magnesium in patients because number one, most people are deficient in magnesium. 80%. Yes, and so I don't… So, it's kind of safe to say it takes some magnesium.

Yes, it is safe to take some magnesium. But most patients are walking around deficient. We know that if you are vitamin D deficient, you have to have magnesium on board for the synthesis and processing of vitamin D. So I just put a patient on magnesium if they're vitamin D deficient. And so we can make a lot of inferences from that very small basic panel.

And if I have a patient who they're deficient and all of that, I know whether they say they have a gut problem or not, there is something gut at play. And it can be something as simple as low stomach acid. And it could be something as major as they have chronic diarrhea and they are now also infected maybe with something like a klepsiella or citrobacter that is completely destroying the life. Absolutely. That is so important to know. And I think the connection is important to know. Question for you, what role does the microbiome play in regulating inflammation and metabolism? We know it has an impact, like, can you… go a little bit more. I think that's a big topic for a lot of our patients. One, inflammation, and then two, metabolism. So inflammation kind of goes back to, that immune system lies in that gut. So you're inflaming that mucosal lining. You're breaking it down. You're increasing intestinal permeability. Now you have, again, molecules traveling through that membrane that should not travel through, stimulating low-grade inflammation. So that's the inflammation side of things.

When it comes to the metabolic side of things, there's also a big process there. A lot of your bacteria, your microbiome and your gut, play a role in production of certain bacterias and also hormones. And so we have to kind of think of the correlation back to hormones.

So you actually have production of GLP-1s naturally in your gut. Acromansia is a great bacteria that helps to promote your GLP-1 production naturally. So instead of having to get it from an outside source, a GLP-1 injection, then you can look back at gut health and the correlation to that. So that is an aspect of that. But you also think about the bio acid transformation process that takes place in the body. If you don't have enough adequate bio acids, then you're not going to break down the foods that you're in and you're going to get the right nutrition and absorption. if your gut is also all over the place too, you might even if you are digesting it, you might not even be absorbing it. oh Because you have little sensors on your gut lining that are going to say and pick up what they need to. But when you have intestinal permeability, those sensors are kind of damaged. They're not picking up, oh, I see a vitamin D in there because now it's all open. And I'll say this too, you could have a healthy diet and still have leaky gut. Correct. Right? Because leaky gut doesn't just mean what you're putting in. if you're on medications or medications play a huge role. Even the environment plays a role in it too, right? So you can have a healthy diet and chronic infection. Exactly. That all impact the gut and leaky gut and even a piece of broccoli. If that gets through, right, that can be a trigger. So you can have a great diet and still have all these triggers because of intestinal permeability. And also intestinal permeability doesn't mean you're also absorbing everything either because you don't have the appropriate receptors to pick up the micronutrients that it needs to actually absorb into the cells. Wow, I felt really smart there for a second.

are some practical steps people can take right now to start improving gut health through diet or lifestyle? So there's some very basic things that everybody can do and everybody can benefit from whether you knowingly have a gut issue or not. Number one is diet. Diet is can't…

I always tell my weight loss patients, cannot out exercise a bad diet. You cannot, it's the same concept with gut. You cannot eat poor and have good gut health. So I always tell patients focusing in on looking at lean sources of meats, looking at a whole food plant-based diet, not saying you have to be vegetarian, but really looking at good clean sources, organic sources.

I give all of my patients the clean 15 dirty dozen list when they come in. looking at eliminating pesticides, insecticides right off the bat. Also making sure you're getting plenty of healthy fats, making sure that you're consuming nuts are a great source of that, your fatty fishes. Also making sure you're getting fiber. I get these patients who come in on these keto carnivore diets. They're eating zero fiber and then they're like, well, I feel good. And I'm like, but your gut is struggling. And if you do this long-term, you're causing more damage than benefit that you're achieving. You need to be pooping every day. You have to poop every day. And that's a question I ask every patient. How often do you go to the bathroom?

They're all like, oh, it's fine. I'm like, well, how often are you going? Yeah. But it might not be here. It might not be. Yeah. The other things you have to think about are the correlation with stress and sleep. we live in a very fast paced world. And we underestimate the importance of sleep. I'm guilty of that myself. I think, well, I've got four hours. I feel OK. I'm fine.

But really we need to, our body resets and it heals and repairs over throughout sleep. And if you are not getting adequate sleep, if you're under a lot of stress, you have elevated stress hormones. We know that. And so those elevated stress hormones can actually disrupt the gut microbiome. Yeah, it's almost like a signal to the gut to increase intestinal permeability.

Yes. I have a question. Yes. Why? If our body, if… this intestinal permeability, this leaky gut where things can get through. Why does the body do it in the first place? Because obviously right now our lifestyle is overreacting this response in the body. But it exists in the body for a reason, more primal reason. Well, you got to think you have to have the transport of your minerals and nutrients things that you want through molecules you want through that gut membrane. But what happens is think of it like a sponge. The sponge gets too many holes in it and things just start flowing through. You do not want that to happen. And so, you know, I was again back to telling all of my patients I'm like the toxic world we live in.

Yeah, it's not the same world our grandparents lived in. Yeah. 40, 50, 60, 70 plus years ago, we're exposed to so many more things. Even viruses, think about COVID pandemic. Look how fast it wrapped around the entire globe. It was very, very rapid. That would not have happened 100 years ago. It would have been a much slower process. You look at the Spanish flu in the early 1900s, took place over the course of a year to travel around the world, whereas COVID traveled around the world in a matter of weeks. And that also kind of parlays into the environmental impacts that are taking place in our bodies. Wow. Great. What are some common myths or misconceptions about gut health that you'd like to clear up? So there are a couple of big things that I look at. uh I'll get patients who come in. The one that always makes me laugh is why I yogurt every day. I like that one. That one I tried not to snicker at, but I'm like, you know, what kind of yogurt are you eating? If you're eating Yoplait off the shelf and it's full of sugar, then you're not getting any benefit from that because the elevation in the sugar is damaging to, again, the gut excess sugar. So you're just not getting the benefit. And the nice thing is though, it's a simple swap with the right tools and resources.

Correct. Right? We had the right idea. let's make it the right step for us. So let's get the like ice land. Make your kefir. Yes, thank you. the kefir. And you know, you need it to be a little sweet or something like that. Add a little bit of raw natural sugars, raw honey, a little bit of berries or something that has a little bit of fiber in it. Correct. and the antioxidants. Correct. All the nice stuff. That's the one that makes me snicker the most. The next is patients will come in. And they'll say, well, I Dr. So-and-so's detox I bought on Amazon. And I'm just like, what you're getting is not what you think you're getting. You're getting a lot of times fillers, you're getting cheap products. The label may not even be accurate for what you think you're getting. And you really shouldn't be pooping your pants all day on a cleanse. Correct. Right? like, it worked. Because it had a laxative in it. Yeah. Thank you. I'm trying to find a way to say it eloquently, but… You pooped your pants all day, that doesn't mean it worked. The way you think it worked. It did actually work. The way they wanted it to work. And then that brings me into probiotics. Patients will say, I bought Dr. So and So's probiotic off of, you know, I saw it on Dr. Oz or wherever. I always tell patients, probiotics are not all created equal. What you're purchasing on some website somewhere may not be, number one, it may not be the strain of bacteria you need. That's very individualized.

Again, back to stool testing, what are you missing? What do you need? But also, is it in the right form? Meaning, can it make it through the digest? There has to be a delayed release capsule that can bypass the gastric acid in the gut so it doesn't get digested. And if it doesn't make it to the colon, it's not doing anything. It's gone. Bye. Yes, it is. so, you know, looking at quality ingredients of the products that you are taking is a big factor in that. And I always tell patients you have to look at quality over your quantity pricing situation. Absolutely.

Can you share a success story where gut focused care transformed a patient's health? Yes. So I have one particular patient who she's an older lady. see both her and her husband. She's been seeing GI for 20 years and They just kept telling her, let's do a colonoscopy. So she's had like 20 colonoscopies and they can never. does not sound fun. No, it's not at all. And she kept saying that they just kept telling her she had IBS and just stop, do a low FODMAP diet and you know, your symptoms. And so they wanted to keep putting her on an Imodium and some things like that. So she came to see me and she was almost in tears at her first appointment for GI. She said, I can't even go out to eat with my family anymore because I have to go to the bathroom before I can even get to the car. Which for someone who's an older patient, she's retired. She's very centered around her grandchildren and that sort of things. This was detrimental for this lady. 100%. Absolutely. We did stool testing on her. found out she also had… A husband at Chilz. Yes. She was post-menopausal, she had a thyroid condition.

So a lot of other things in the background you have to think about with gut health. And we found out she had terrible pancreatic insufficiency. She had low stomach acid and she had SIBO.

So we were able. What's SIBO? Small intestinal bacterial overgrowth. The basic way I explain it to patients is a lot of times it's regurgitation from the large intestines into the small intestines.

Small intestines should be sterile. Perfect. Now it's not. Okay. Um, and so we were able to put her on a protocol to treat the SIBO, but also to help normalize her stomach acid, help with pancreatic function. for a follow up at six months, not long ago. And again, she was almost in tears, but this time for the opposite. She said, I can go to a restaurant with my family and then I can go to Hamrick's afterwards. She said, I don't have to rush home anymore. And she said, I cannot tell you how life changing this last year. When I was doing more health coaching, I was doing that for more like complex chronic illness and things like that. And it was amazing. The volume of women I saw who were post retirement and trying to live their best life after giving so, so much to their families and everything like that. And it's their time to shine. And they were running so hard for so long that like you said, the last resort, right? And being able to give that back to people, give them so much of a better quality of life where they can enjoy what they worked so hard for is so incredibly rewarding. It is, it is. And that's the reason I do what I do. Absolutely. That was a beautiful story. And I hope that she does not have any more colonoscopies. Yes. at least maybe a maintenance or an alien, whatever she needs for like She told me she was firing her GI doctor after I was done with her. And the thing is, is that you partner really well with collaborating practitioners because we don't do primary care. Right. Right. But this is an opportunity for patients to, one, understand themselves a lot better, have somebody listen to them and not just look at the labs, but then also become an advocate. Yes. For themselves.

Right, and I always, you know, not to downplay any other primary care specialty or anything like that, but this is what I always tell patients. I approach that as a collaborative arrangement.

It has to I refer patients, you know, if I find something calprotectin is elevated on a GI stool, they've got to see GI. They've got to have a scope because we have to look for big things first. It takes a village. It does. And so, you know, if I have a patient come in and they're having terrible acid reflux, this has been an ongoing issue. They didn't endoscopy an upper. Yeah. So look to make sure there's not any varices, any barotesophagus, things of that nature, anything structurally going on. So there's a time and a place for both sides of things. Yeah. Well, I had such a great time talking to you today. It's really clear that the gut is the foundation of the whole body. It is. Right? If you struggle with fatigue, brain fog, autoimmune issues, or hormone imbalance, the root cause may start in the gut and testing helps uncover hidden problems and with the right plan, healing the gut can transform how you feel every day. Amanda, can you tell our listeners how they're going to find you if they want to connect with you and see you in Greenville? So our office, like I said, is in Greenville. You can look us up online, Forum Health, and then look specifically for the Greenville office location. Thank you so much for joining us today. It was such a pleasure to have you. I can't wait to invite you back to the podcast and talk more with you. Guys, stay tuned for next week's episode. Amanda, it's been real. Thank you. Have a great one. Bye. Thank you for joining us on the Forum Health Integrative Medicine podcast. Each episode, we help you understand your health from every angle and inspire your lifelong wellness journey. Follow the show, share it with someone who needs hope, leave a review, and take the next step toward feeling your best at forumhealth.com.

How Gut Health Shapes Everything: Immunity, Hormones, Mood & More

Amanda Kuehn-Grabot

Amanda Dyar Moss, APRN, FNP-C

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