The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[43] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[19] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.[9]


One morning, by way of The Dr. Oz Show, I discovered Shaun T, fitness trainer and creator of INSANITY workout (of infomercial fame). His program intrigued me, but what really kept my attention was the way he harped on nutrition. Most exercise programs promise extreme results just by going through the motions. But he was adamant that great results can only be achieved by also overhauling your eating habits. Since exercising like a maniac had scarcely made a dent in my dimples, I decided to give his way a shot. Sayonara, fried and processed food. I was in for a nutritional overhaul.
On the other hand, underweight people can suffer from medical problems, ranging from chronic fatigue and anemia to lowered resistance to infection and clinical depression. Inflammation, certain medications, and depression associated with a chronic illness may lessen your appetite or upset your stomach, making it difficult for some people with spondylitis to maintain a healthy weight. This is especially true for those who have spondylitis with inflammatory bowel disease or Crohn's disease who experience gastrointestinal problems on top of arthritis symptoms. Any severe weight loss to should be reported to your doctor. 
The exercise program included three months of supervised physical activity at the research facility, in which the people exercised to about 70% of their peak heart rates on a treadmill or stationary bike three times a week. For the last three months of the study, people exercised at home using a regimen created by the researchers around convenience, whether it was joining a gym, using their own exercise equipment at home or walking vigorously in their neighborhood. The diet group adhered to the Dietary Approaches to Stop Hypertension (DASH) which emphasizes reducing salt and increasing fiber to control blood pressure and improve heart health.

The exercise program included three months of supervised physical activity at the research facility, in which the people exercised to about 70% of their peak heart rates on a treadmill or stationary bike three times a week. For the last three months of the study, people exercised at home using a regimen created by the researchers around convenience, whether it was joining a gym, using their own exercise equipment at home or walking vigorously in their neighborhood. The diet group adhered to the Dietary Approaches to Stop Hypertension (DASH) which emphasizes reducing salt and increasing fiber to control blood pressure and improve heart health.
Live It! This phase is a lifelong approach to diet and health. In this phase, you learn more about food choices, portion sizes, menu planning, physical activity, exercise and sticking to healthy habits. You may continue to see a steady weight loss of 1 to 2 pounds (0.5 to 1 kilogram) a week until you reach your goal weight. This phase can also help you maintain your goal weight permanently.
There's no denying it: Getting the fresh air from exercising outdoors is great! But along with it, you also get the harmful UV rays. To keep yourself shielded while still having fun in the sun, opt for a sweat-proof screen with SPF 30 or higher (look out for types that say "water-resistant" or "waterproof" on the bottle, terms regulated by the FDA), a lip balm with SPF 15 or higher, a lightweight hat, and sports shades. Also consider trading in your white tee and instead going for a shirt with built-in UV protection (a rating of 30 UVP is necessary to be awarded the Skin Cancer Foundation's "Seal of Recommendation"; a white T-shirt has a rating of 10). And remember, the rays are at their brightest from 10 a.m. to 4 p.m., so try to plan a before-or post-work sweat-session.
Research shows that exercise alone won’t help you lose weight, and contrary to popular opinion, it’s not the right message for the worldwide obesity epidemic. A recent study reveals why, suggesting that your body adjusts to higher activity levels, so while you may burn extra calories initially, eventually that rate will plateau. And there is some disheartening research, indicating that solely using exercise as a weight loss method can actually lead to weight gain. “Clients always say, ‘I’m doing all of this activity, but I just can’t lose the weight,’” confirms Mangieri. “I even have athletes who are training for 5Ks, 10Ks, and half marathons, and still gaining weight.”
In a recent study in the Journal of Sports Medicine and Physical Fitness, Weiss and his colleagues found that participants performed worse on high-intensity cycling and running tasks after four days on a ketogenic diet, compared to those who’d spent four days on a high-carb diet. Weiss says that the body is in a more acidic state when it’s in ketosis, which may limit its ability to perform at peak levels.
Also, the natural sugar in fruit does affect your carbohydrate intake — especially if you eat a lot of fruit. This may temporarily raise your blood sugar or certain blood fats. However, this effect is lessened if you are losing weight. If you have diabetes or any other health conditions or concerns, work with your doctor to adjust the Mayo Clinic Diet for your situation. For example, people with diabetes should aim for more vegetables than fruits, if possible. It's a good idea to snack on vegetables, rather than snacking only on fruit.
Nuts are a great source of heart-healthy fats and also provide protein and essential nutrients. They can give you a source of sustained energy for your workout. Pair them with fresh or dried fruit for a healthy dose of carbohydrates. However, test these options to see how they settle. High-fat foods can slow digestion, and they may make food sit in your stomach too long if your workout is coming up quickly.
Here are a few of the most common side effects that I come across when people first start keto. Frequently the issues relate to dehydration or lack of micronutrients (vitamins) in the body. Make sure that you’re drinking enough water (close to a gallon a day) and eating foods with good sources of micronutrients. To read more on micronutrients, click here >
Both calcium and alcohol affect the strength of the bones, and it is a well-known fact that people with spondylitis are already at higher risk for osteoporosis, a dangerous thinning of the bones that can lead to fractures. Following a diet with adequate amounts of calcium and vitamin D will help reduce the risk of osteoporosis.  Consuming more than two alcoholic drinks per day increases a person's chances of developing weakened bones. In addition, alcohol mixed with certain medications can cause serious side effects to the gastrointestinal tract and major organs such as the liver and the kidneys.
A love/hate relationship with weight loss emerged in 2018. The most recent Centers for Disease Control survey found that almost 50 percent of Americans tried to lose weight in the past year—a time when anti-diet sentiment was just as strong. As you can see from popular search terms, we’re clearly not ready to ditch dieting just yet, and that’s okay. Though the word “diet” puts some people off, reaching a healthier weight to feel better, manage your health with fewer medications, or to experience more energy, better sleep, and more confidence are worthwhile goals to pursue. Clearly, I discourage restrictive eating, but if you want to follow a plan that’s more inclusive than exclusive, includes generous servings of veggies, and helps you develop a framework for establishing sustainable, healthier eating habits that also encourages weight loss, I’m not going to knock it.
It usually takes three to four days for your body to go into ketosis because you have to use up your body's stores of glucose, i.e., sugar first, Keatley says. Any major diet change can give you some, uh, issues, and Keatley says he often sees patients who complain of IBS-like symptoms and feeling wiped out at the beginning of the diet. (The tiredness happens because you have less access to carbs, which give you quick energy, he explains.)
It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]
Minerals are another component in a healthy diet. There are two categories of minerals: major minerals and trace minerals. The difference between each of these is the amount that is needed each day. The major minerals are calcium, phosphorus, magnesium, sodium, potassium, chloride, and sulfur. The trace minerals are iodine, iron, zinc, selenium, fluoride, chromium, and copper.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
“The alkaline diet often has a focus on eating lots of fresh produce and unprocessed foods, which could be a good thing,” says Hultin. “However, keep in mind that this is not an evidence-based therapeutic diet. When people take it too far — for instance, drinking baking soda — or become too restrictive or obsessive over food choices, it can definitely turn negative.”
Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more

The plan promotes long-lasting, sustainable changes, and undoubtedly a bounty of research backs this up. In fact, one December 2013 study in the American Journal of Medicine shows that people following Weight Watchers were close to nine times more likely to lose 10 percent of their body weight, compared to people following a self-help diet plan. (20)
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
Some athletes swear by the ketogenic diet, not just for weight loss but for improved performance in their sport, as well. But Edward Weiss, PhD, associate professor of nutrition and dietetics at Saint Louis University, doesn’t buy it. “I hear cyclists say all the time that they’re faster and better now that they’re on keto, and my first question is, 'Well, how much weight did you lose?'” he says.
Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, covers the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."[Note 5] Galen believed an "attenuating diet"[Note 6] might afford a cure in mild cases and be helpful in others.[11]

One thing that we all have in common is that we all eat. What, when, why, and how much we eat varies from person to person. We often choose our foods based on taste, familiarity, cost, and/or availability. What we choose to eat is not necessarily what our bodies need us to eat. A diet that is deficient in nutrients is one that can lead to health and weight problems. Fortunately, guidelines have been established to assist each of us in deciding what foods to eat to provide our bodies with the nutrients that we need.


Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[56]

Cyclical keto diet: The Bulletproof Diet falls into this category. You eat high fat, low carb (less than 50 grams of net carbs a day) five to six days of the week. On day seven, you up your carb intake to roughly 150 grams, during what’s called a carb refeed day. Carb cycling this way helps you avoid the negative effects some people experience when they restrict carbs long term, like thyroid issues, fatigue and dry eyes.[9][10]  Learn more here about how carb cycling works.
Take action: Aerobic exercise has always been regarded as critical to improving brain health, but strength training is also key. In fact, the two modes of exercise benefit the brain differently, which is why it’s best to do both. In a 2013 study published in the Journal of Aging Research, the authors found that both cardio exercise and strength training improved spatial memory (for example, remembering where objects were placed in a room) in women ages 70 to 80. Cardio alone improved verbal memory (for example, being able to remember a list of words after a distraction). And in a 2012 study from the Archives of Internal Medicine, women in their 70s who strength-trained improved their associative memory, meaning that they remembered pairs of pictures that they had been shown earlier. This is the kind of memory that allows you to remember two pieces of information at once, like picturing not just your keys but also where you placed them.
Both calcium and alcohol affect the strength of the bones, and it is a well-known fact that people with spondylitis are already at higher risk for osteoporosis, a dangerous thinning of the bones that can lead to fractures. Following a diet with adequate amounts of calcium and vitamin D will help reduce the risk of osteoporosis.  Consuming more than two alcoholic drinks per day increases a person's chances of developing weakened bones. In addition, alcohol mixed with certain medications can cause serious side effects to the gastrointestinal tract and major organs such as the liver and the kidneys.
There’s also some evidence that it might help with type 2 diabetes. “An emerging body of research is finding that a keto plan may have some real benefits thanks to its ability to improve the body’s ability to use insulin and also help control appetite, which can result in easier weight loss,” says Karen Ansel, R.D.N., co-author of Healthy in a Hurry.
There’s no one-size-fits-all plan for nutrition. “You must design a diet you can live with for life, not a quick-fix gimmick that always results in weight regain,” says Somer. “Respect and love yourself to feed your body only foods that will fuel and nurture it, not foods that undermine health.” So, ask around, do some research and find a healthy, doctor-backed plan that appeals to you. Will it be hard? In the beginning, yes. Any major lifestyle change usually is. Is it worth it? Do the work and button-up your old skinny jeans. Then you’ll have your answer.
The information listed below the serving size is listed in grams and percentages. You will learn how to interpret the grams for each nutrient later on in the article. In an attempt to help people determine if the food will reach their nutritional needs, the FDA developed a set of generic standards called Daily Values. You will only find Daily Values listed on food labels. The standard DRIs could not be used because they vary by gender and age, so they are too specific for a food label. The limitation of the Daily Values is that they are based on a 2,000-calorie diet. This means that the percentages are only relevant to someone who is consuming 2,000 calories. For everyone else, these percentages will either be too high or too low. For this reason, it's best to focus on grams and ingredients.
A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31]
These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.
Got a late-night sugar craving that just won't quit? "To satisfy your sweet tooth without pushing yourself over the calorie edge, even in the late night hours, think 'fruit first,'" says Jackie Newgent, RD, author of The Big Green Cookbook. So resist that chocolate cake siren, and instead enjoy a sliced apple with a tablespoon of nut butter (like peanut or almond) or fresh fig halves spread with ricotta. Then sleep sweet, knowing you're still on the right, healthy track.

The food guides have been separating food into food groups for nearly a century. The current Food Guide Pyramid still emphasizes eating a balanced diet with foods from each of the food groups, but with today's version of the plan, you can get a personalized plan instead of just general recommendations. This is everyone's chance to learn how to eat a well-balanced diet.
When you have a 5- or 10K (you get to eat more with a half or full marathon) on your calendar, it's important to plan out what you're going to eat the morning of the big day—something that will keep you fueled and also go down easy. While everyone is different, "We always have good luck with a high-carbohydrate breakfast such as a small bowl of oatmeal with fruit or a couple of pieces of toast with peanut butter or cream cheese," says Andrew Kastor, who also advises eating around 200 to 250 (primarily carb) calories about 90 minutes before you warm up for your run . And don't worry about nixing your a.m. caffeine fix on race day. "Coffee is great for athletic performances," Kastor adds, because it makes you sharper and may even give you extended energy. Talk about buzz-worthy!
The ketogenic diet has recently become very popular, and many food companies want to cash in by putting a “ketogenic” or “low carb” label on a new product. Be very cautious of special “keto” or “low-carb” products, such as pastas, chocolate bars, energy bars, protein powders, snack foods, cakes, cookies and other “low carb” or “ketogenic” treats. Read all labels carefully for natural low carb ingredients. The fewer ingredients the better.
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The guidelines are extensive, but you do not need to meet every recommendation all at once. To establish a healthy eating plan, the goal is to begin to make gradual changes to your eating and activity. You can select one or two guidelines a week or month to focus on. Over time, you will be able to make most, if not all, of the guidelines a part of your life.
Vitamin D is supplied by our diet and sunlight. Exposure to ultraviolet (UV) rays from the sun can trigger the production of vitamin D in our body. The amount of sun needed will depend on your skin color, age, the time of the day, season, and geographic location. Experts have recommended that you expose your hands, face, and arms two to three times a week for about 10 to 15 minutes without sunscreen.
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[18] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[48] Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.[18]
Whether you're heading off to spin class, boot camp, or any other exercise, it's always important to hydrate so you can stay energized and have your best workout. Electrolyte-loaded athletic drinks, though, can be a source of unnecessary calories, so "drinking water is usually fine until you're exercising for more than one hour," says Newgent. At that point, feel free to go for regular Gatorade-type drinks (and their calories), which can give you a beneficial replenishment boost. But worry not if you like a little flavor during your fitness: There are now lower- cal sports drinks available, adds Newgent, so look out for 'em in your grocery aisles.

If you’re like many resolution setters this time of year, you’ve already mapped out a route to your local gym. Maybe you’re planning to pound the treadmills or sweat it out in crowded studio classes. But if your ultimate goal is to drop extra pounds, you might want to ask how far all those miles and squats will really get you. According to a number of weight loss experts, focusing on your nutrition could give you a lot more bang for your buck. “By far, diet outweighs exercise if you want to lose weight,” says Heather Mangieri, RDN and spokesperson for the Academy of Nutrition and Dietetics. “You have to change your diet to change body composition. You can never out-exercise a bad diet.” So don’t sweat it—at least not quite so much. Here’s where to start with a weight loss resolution.
Because some cancer cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer.[59][60] A 2018 review looked at the evidence from preclinical and clinical studies of ketogenic diets in cancer therapy. The clinical studies in humans are typically very small, with some providing weak evidence for anti-tumour effect, particularly for glioblastoma, but in other cancers and studies, no anti-tumour effect was seen. Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers.[61]

About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether.[18] Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions.[46] This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure-free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.[9]
During the 1920s and 1930s, when the only anticonvulsant drugs were the sedative bromides (discovered 1857) and phenobarbital (1912), the ketogenic diet was widely used and studied. This changed in 1938 when H. Houston Merritt, Jr. and Tracy Putnam discovered phenytoin (Dilantin), and the focus of research shifted to discovering new drugs. With the introduction of sodium valproate in the 1970s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, by this time restricted to difficult cases such as Lennox–Gastaut syndrome, declined further.[10]
“We really stressed to both groups again and again that we wanted them to eat high-quality foods,” Dr. Gardner said. “We told them all that we wanted them to minimize added sugar and refined grains and eat more vegetables and whole foods. We said, ‘Don’t go out and buy a low-fat brownie just because it says low fat. And those low-carb chips — don’t buy them, because they’re still chips and that’s gaming the system.’”

A love/hate relationship with weight loss emerged in 2018. The most recent Centers for Disease Control survey found that almost 50 percent of Americans tried to lose weight in the past year—a time when anti-diet sentiment was just as strong. As you can see from popular search terms, we’re clearly not ready to ditch dieting just yet, and that’s okay. Though the word “diet” puts some people off, reaching a healthier weight to feel better, manage your health with fewer medications, or to experience more energy, better sleep, and more confidence are worthwhile goals to pursue. Clearly, I discourage restrictive eating, but if you want to follow a plan that’s more inclusive than exclusive, includes generous servings of veggies, and helps you develop a framework for establishing sustainable, healthier eating habits that also encourages weight loss, I’m not going to knock it.


Your glycogen stores can still be refilled while on a ketogenic diet. A keto diet is an excellent way to build muscle, but protein intake is crucial here. It’s suggested that if you are looking to gain mass, you should be taking in about 1.0 – 1.2g protein per lean pound of body mass. Putting muscle on may be slower on a ketogenic diet, but that’s because your total body fat is not increasing as much.5Note that in the beginning of a ketogenic diet, both endurance athletes and obese individuals see a physical performance for the first week of transition.
While some fats can harm your health, there are fats that are essential for optimal health. The essential fatty acids are the polyunsaturated fats omega-3 and omega-6 fatty acids. You need to consume these because your body cannot produce them. We need an equal amount of each of these fats. The typical American diet has an abundance of omega-6 fatty acids with a limited amount of omega-3 fatty acids. On average, Americans consume 11 to 30 times more omega-6 fatty acids than omega-3 fatty acids. Research has shown that omega-3 fatty acids can reduce blood triglyceride levels, reduce blood pressure, improve morning stiffness and joint tenderness in rheumatoid arthritis, protect the heart in people who have had a heart attack, decrease the risk of stroke, reduce the risk of atherosclerosis, and possibly have an impact on depression. The dietary sources of omega-3 fatty acids are mackerel, lake trout, herring, sardines, albacore tuna, and salmon.
The Mayo Clinic Diet is designed to help you lose up to 6 to 10 pounds (2.7 to 4.5 kilograms) during the initial two-week phase. After that, you transition into the second phase, where you continue to lose 1 to 2 pounds (0.5 to 1 kilogram) a week until you reach your goal weight. By continuing the lifelong habits that you've learned, you can then maintain your goal weight for the rest of your life.
Because people with type 2 diabetes are at an increased risk for cardiovascular disease, there’s a specific concern that the saturated fat in the diet may drive up LDL, or “bad,” cholesterol levels, and further increase the odds of heart problems. If you have type 2 diabetes, talk to your doctor before attempting a ketogenic diet. They may recommend a different weight-loss diet for you, like a reduced-calorie diet, to manage diabetes. Those with epilepsy should also consult their doctor before using this as part of their treatment plan.
The researchers agree that the diet itself isn’t inherently dangerous. But, cautions Weiss, “If you have any medical condition, if you take any medicine at all – there are lots of things that change how medicines work in our bodies, and nutrition is definitely one of them. If you’re making a real change in your nutrition, you really should talk to your doctor.”
Along with protein and good-for-you fat, fiber is one of those nutrition elements that keeps you full and fueled all day long. And if you’re trying to get fit and shed pounds, fiber is your best friend. In fact, in one an American Heart Association study, participants who consuming 30 grams of fiber a day ended up losing weight and improving their heart health. So when it comes to staying healthy and slim, aim for that 30 gram fiber goal!
Folate: This vitamin became a mandatory addition to certain foods due to its role in producing and maintaining new cells. The folate fortification project was implemented for the protection of developing fetuses. A folate deficiency in a woman who is pregnant can cause neural tube defects that result in malformations of the spine (spina bifida), skull, and brain (anencephaly). Since the fortification of foods with folate began, the incidence of these defects has declined. Dietary sources of folate are fortified cereals, beef liver, pinto beans, lentils, spinach, asparagus, avocados, and broccoli.
“Keto diets should only be used under clinical supervision and only for brief periods,” Francine Blinten, R.D., a certified clinical nutritionist and public health consultant in Old Greenwich, Connecticut, told Healthline. “They have worked successfully on some cancer patients in conjunction with chemotherapy to shrink tumors and to reduce seizures among people suffering from epilepsy.”

“A lot of people think the foundation of a paleo diet is high-fat meat, but I suggest that it’s vegetables,” says Hultin. The concept is to eat only foods — including meat, fish, poultry, eggs, fruits, and vegetables — that would have been available to our Paleolithic ancestors. This means grains, dairy, legumes, added sugar, and salt are all no-no’s.
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