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The truth about SIBO with Dr. Will Bulsiewicz

By ZOE

Dive into the intricacies of gut health with the "ZOE Science & Nutrition" podcast, where Jonathan Wolf and guest speaker Dr. Will Bulsiewicz unpack the complexities of Small Intestine Bacterial Overgrowth (SIBO). Dr. Bulsiewicz, an authority on the human microbiome, sheds light on the nuanced condition of SIBO, emphasizing that it is not an infection but a bacterial imbalance, suggesting a misplaced migration of bacteria within the gut.

The conversation delves into the wide-ranging symptoms of SIBO, from gastro-intestinal disturbances to far-reaching neurological effects like brain fog, illustrating the systemic impact of this condition. Additionally, common misconceptions regarding SIBO diagnosis are addressed, overturning the reliability of conventional stool and breath tests. Discussion points also cover conventional and alternative treatment approaches, highlighting the critical role of understanding SIBO's root causes and the importance of supporting a robust gut microbiome, both in managing SIBO and ensuring overall health.

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The truth about SIBO with Dr. Will Bulsiewicz

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The truth about SIBO with Dr. Will Bulsiewicz

1-Page Summary

SIBO Definitions and Causes

Small Intestine Bacterial Overgrowth (SIBO) signifies a bacterial imbalance in the small intestine, often described by Will Bulsiewicz, a gut health expert, as an overshoot of bacteria from the large intestine into the small intestine. This condition is not an infection but a disruption in the symbiotic relationship of the body with its gut bacteria.

Symptoms of SIBO

SIBO's symptoms, as outlined by Dr. Bulsiewicz, range from bloating and gas to nutritional deficiencies due to malabsorption. These symptoms stem from the metabolization of nutrients by the overabundant bacteria, leading to discomfort. SIBO may also affect neurological functions, with individuals experiencing brain fog, showcasing the systemic reach of the condition.

Myths around Diagnosing SIBO

Contrary to popular belief, stool tests do not accurately diagnose SIBO, as they reflect the microbial state of the large intestine, not the small one. Moreover, breath tests used for diagnosis are not foolproof, suffering from a lack of standardization and potential for false readings.

Finding the Root Cause of SIBO

Bulsiewicz places importance on identifying the root causes of SIBO, such as abnormal bowel motility, anatomical issues, and certain medications that reduce stomach acid, like proton pump inhibitors. These causes create an environment conducive to bacterial overgrowth in the small intestine.

Conventional SIBO Treatments

Conventional treatment for SIBO includes short-term use of antibiotics followed by a low FODMAP diet, which is later diversified through careful reintroduction of foods. This strategy aims to abate bacterial overgrowth while identifying dietary triggers and maintaining a healthier gut microbiome balance.

Importance of Nurturing the Gut Microbiome

The health of the gut microbiome is vital for overall well-being; repeated antibiotics and a low-fiber diet can be detrimental. Increasing fiber intake and carefully selecting probiotics are suggested approaches to support and rebuild the microbiome for better health outcomes and the management of SIBO.

1-Page Summary

Additional Materials

Clarifications

  • SIBO, or Small Intestine Bacterial Overgrowth, is a condition where there is an excessive amount of bacteria in the small intestine, disrupting the normal balance of gut flora. This imbalance can lead to various symptoms like bloating, gas, and malabsorption of nutrients, impacting overall health. Identifying the root causes of SIBO, such as abnormal bowel motility or certain medications, is crucial for effective treatment and management. Conventional treatments often involve a combination of antibiotics, dietary adjustments like the low FODMAP diet, and strategies to support a healthier gut microbiome.
  • Stool tests are not ideal for diagnosing SIBO because they primarily reflect the microbial composition of the large intestine, not the small intestine where SIBO occurs. Breath tests, commonly used for SIBO diagnosis, can lack standardization and may produce false results, making them less reliable for definitive diagnosis. These limitations highlight the challenges in accurately pinpointing SIBO through traditional testing methods. It's important to consider these factors when evaluating diagnostic approaches for SIBO.
  • Abnormal bowel motility as a root cause of SIBO means that the contractions and movements of the small intestine are not functioning properly. This can lead to a slowdown in the transit of food and bacteria through the digestive system, creating an environment where bacteria can overgrow in the small intestine. Factors like slow transit time or ineffective clearing mechanisms can contribute to this issue, allowing bacteria to accumulate where they shouldn't be, causing symptoms associated with SIBO.
  • Certain medications like proton pump inhibitors (PPIs) can contribute to SIBO by reducing stomach acid levels. Low stomach acid can allow bacteria to thrive in the small intestine, leading to bacterial overgrowth. This disruption in the stomach's acid balance can create an environment conducive to SIBO development. Medications that alter stomach acid levels can impact the gut's bacterial balance and potentially contribute to conditions like SIBO.
  • A low FODMAP diet is often used in treating SIBO because it restricts certain types of carbohydrates that can ferment in the gut, leading to gas and bloating, exacerbating SIBO symptoms. By reducing these fermentable substrates, the diet aims to alleviate the discomfort caused by bacterial overgrowth in the small intestine. This dietary approach can help manage symptoms and support the effectiveness of other treatments like antibiotics in addressing SIBO. Following a low FODMAP diet under the guidance of a healthcare provider can be beneficial in identifying trigger foods and improving gut health in individuals with SIBO.
  • Maintaining a healthy gut microbiome is crucial for overall health as it influences digestion, nutrient absorption, and immune function. A balanced gut microbiome can help prevent conditions like Small Intestine Bacterial Overgrowth (SIBO) and promote mental well-being. Factors like diet, antibiotics, and stress can impact the gut microbiome's balance, emphasizing the need for proactive care. Supporting a diverse gut microbiome through fiber-rich foods and probiotics can enhance gut health and overall wellness.
  • Antibiotics can disrupt the balance of beneficial bacteria in the gut microbiome, potentially leading to overgrowth of harmful bacteria. A low-fiber diet lacks the necessary nutrients to support a diverse and healthy gut microbiome, impacting its overall function and diversity. Both factors can contribute to conditions like SIBO by creating an environment where harmful bacteria can thrive in the gut. Rebuilding the gut microbiome after antibiotic use or poor dietary choices involves strategies like increasing fiber intake and incorporating beneficial probiotics to restore balance.

Counterarguments

  • While SIBO is characterized by bacterial imbalance, some experts argue that it can also involve fungi or other microorganisms, suggesting a broader dysbiosis beyond bacteria.
  • The symptoms of SIBO are non-specific and can overlap with other gastrointestinal disorders, which can lead to misdiagnosis or oversimplification of the patient's condition.
  • The connection between SIBO and neurological functions like brain fog is an area of ongoing research, and the causal relationship is not fully established.
  • Some practitioners believe that breath tests, when performed and interpreted correctly, can be a useful tool in diagnosing SIBO, despite their limitations.
  • There is debate over the efficacy and safety of long-term antibiotic use for SIBO, with some experts advocating for alternative treatments or more conservative use of antibiotics.
  • The low FODMAP diet is sometimes criticized for being overly restrictive and potentially leading to unnecessary avoidance of healthy foods and nutrients.
  • The role of probiotics in managing SIBO is controversial, with some studies showing benefits while others indicate they may exacerbate the condition.
  • There is ongoing debate about the best dietary approach to managing SIBO, with some experts suggesting that a diet tailored to the individual's specific needs may be more effective than a one-size-fits-all approach like the low FODMAP diet.
  • The emphasis on increasing fiber intake for gut health may not be suitable for all individuals with SIBO, as some may experience worsening symptoms with certain types of fiber.
  • The concept of "nurturing the gut microbiome" is complex, and there is no consensus on the best approach, as the gut microbiome is influenced by a wide range of factors, including genetics, environment, and lifestyle.

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The truth about SIBO with Dr. Will Bulsiewicz

SIBO Definitions and Causes

Small intestine bacterial overgrowth is a bacterial imbalance in the small intestine

Will Bulsiewicz, an expert on gut health, explains that Small Intestine Bacterial Overgrowth (SIBO) involves a shift from a symbiotic to a dysbiotic relationship with gut bacteria, signifying an imbalance. He clarifies that it is not an infection but a condition where the balance between the human body and its bacteria is disturbed. SIBO occurs when the small intestine has an excess of bacteria that ar ...

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SIBO Definitions and Causes

Additional Materials

Clarifications

  • In a symbiotic relationship, the gut bacteria and the human body coexist harmoniously, providing mutual benefits. On the other hand, a dysbiotic relationship indicates an imbalance or disruption in this harmony, potentially leading to health issues. Symbiosis is like a healthy partnership, while dysbiosis signifies a breakdown in this partnership, causing problems in the gut environment. This shift from symbiosis to dysbiosis is a key aspect of conditions like Small Intestine Bacterial Overgrowth (SIBO).
  • In the context of SIBO, the analogy of "bacteria spilling out of the city (large intestine)" is used to illustrate the abnormal presence of bacteria in the small intestine, where they are not typically found in large numbers. This analogy highlights the disruption in ...

Counterarguments

  • The definition of SIBO as merely a bacterial imbalance might be oversimplified, as it does not account for the complexity of the condition, including the potential involvement of other organisms like archaea or fungi, or the role of the host's immune response and motility issues.
  • While SIBO is characterized by a shift to dysbiosis, it's important to note that the term "dysbiosis" is not well-defined and can vary greatly between individuals, making it difficult to establish a one-size-fits-all description of the condition.
  • The statement that SIBO is not an infection could be misleading, as the overgrowth of bacteria in the small intestine can sometimes lead to infections or be secondary to an existing infection.
  • The idea that SIBO occurs due to an excess of bacteria not typically present in large numbers in the small intestine might be too narrow, as SIBO can also be ...

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The truth about SIBO with Dr. Will Bulsiewicz

Symptoms of SIBO

Dr. Bulsiewicz provides a detailed overview of the symptoms associated with Small Intestinal Bacterial Overgrowth (SIBO), highlighting the complexity and breadth of the condition’s impact on individuals.

Gas, bloating, abdominal discomfort

One of the hallmark symptoms of the classic form of SIBO includes bloating, which can be accompanied by significant flatulence and a general sense of gaseous abdominal discomfort. These symptoms are typically a result of the excess bacteria in the small intestine producing gas as they metabolize nutrients.

Malabsorption and difficulty digesting nutrients from food

SIBO can lead to malabsorption of nutrients due to the interference from excess bacteria in the small intestine. This can make digesting and absorbing nutrients from food quite difficult, leading to a range of nutritional deficiencies and related health issues.

...

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Symptoms of SIBO

Additional Materials

Clarifications

  • SIBO stands for Small Intestinal Bacterial Overgrowth, a condition where there is an abnormal increase in the number of bacteria in the small intestine. This overgrowth can lead to various digestive symptoms and can interfere with the absorption of nutrients from food. SIBO is associated with symptoms like gas, bloating, malabsorption, and even neurological issues like brain fog. It is diagnosed through specific tests and can be managed with dietary changes, antibiotics, and other treatments.
  • The presence of excess bacteria in the small intestine can disrupt the normal process of nutrient absorption, leading to malabsorption issues. This interference can affect the body's ability to properly digest and absorb essential nutrients from food, potentially causing deficiencies and related health problems. The overgrowth of bacteria can compete with the body for nutrients, impairing the absorption process and impacting overall nutritional status. This disruption in nutrient absorption due to SIBO can contribute to various symptoms and complications associated with the cond ...

Counterarguments

  • While gas, bloating, and abdominal discomfort are common symptoms of SIBO, they are also symptoms of many other digestive disorders, such as irritable bowel syndrome (IBS), celiac disease, and food intolerances. Therefore, these symptoms alone are not specific to SIBO and can lead to misdiagnosis if not thoroughly investigated.
  • The presence of excess bacteria in the small intestine is a characteristic of SIBO, but it's important to note that not all individuals with these bacteria will experience symptoms. The relationship between bacterial overgrowth and symptoms is complex and not fully understood.
  • Malabsorption can indeed be a consequence of SIBO, but it can also be caused by other factors such as pancreatic insufficiency, bile acid malabsorption, or damage to the intestinal lining from other diseases. It's crucial to rule out these other causes.
  • Nutritional deficiencies and health issues related to malabsorption in SIBO patients may also be influenced by dietary restrictions that patients often adopt to manage their symptoms, which can inadvertently lead to reduced intake of essential nutrients.
  • The connection between SIBO and neurological symptoms like ...

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The truth about SIBO with Dr. Will Bulsiewicz

Myths around Diagnosing SIBO

Diagnosing Small Intestinal Bacterial Overgrowth (SIBO) is a complex process, and there are myths about the diagnosis methods that should be clarified.

Misconceptions About Stool Tests

Bulsiewicz explains that it is a common misconception that SIBO can be diagnosed with a stool test that measures the gut microbiome. However, these tests are not an accurate measure for SIBO as they assess what is happening in the large intestine and not the small intestine where SIBO occurs.

Limitations of Breath Tests

While ...

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Myths around Diagnosing SIBO

Additional Materials

Clarifications

  • SIBO, or Small Intestinal Bacterial Overgrowth, is a condition where there is an abnormal increase in the number of bacteria in the small intestine. This overgrowth can lead to various digestive symptoms and nutrient malabsorption. Diagnosing SIBO involves specific tests like breath tests that measure the gases produced by bacteria in the small intestine. Stool tests, on the other hand, are not typically used for diagnosing SIBO as they primarily reflect the microbiome of the large intestine.
  • In the context of diagnosing SIBO, the distinction between the large intestine and the small intestine is crucial. SIBO specifically affects the small intestine, where an overgrowth of bacteria occurs. Stool tests primarily reflect the microbiome of the large intestine, not the small intestine where SIBO is located. This is why stool tests are not reliable for diagnosing SIBO.
  • Breath tests for diagnosing SIBO can yield false positive ...

Counterarguments

  • While stool tests primarily assess the large intestine, they can sometimes provide indirect evidence of SIBO by revealing certain inflammatory markers or fat malabsorption that may suggest a problem in the small intestine.
  • Some experts may argue that while breath tests have limitations, they are still a valuable non-invasive tool for diagnosing SIBO when used in conjunction with clinical symptoms and other diagnostic methods.
  • It could be pointed out that efforts are being made to improve the standardization of breath tests, with research ongoing to refine testing protocols and interpretation of results to increase their reliability.
  • There may be advancements in diagnostic technology or methodologi ...

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The truth about SIBO with Dr. Will Bulsiewicz

Finding the Root Cause of SIBO

Dedicated to understanding the underlying reasons for Small Intestinal Bacterial Overgrowth (SIBO), Bulsiewicz delves into common root causes that contribute to its development and emphasizes the importance of identifying them.

Common root causes: abnormal bowel motility, anatomical issues, medications, low stomach acid

Bulsiewicz prioritizes finding out why a person may be suffering from SIBO, as it doesn't occur without an underlying reason. He points out that issues such as stagnant intestinal fluid, or abnormal motility, often due to chronic constipation, diabetes, a low thyroid, gastroparesis, or chronic opiate use, can be conducive to bacterial buildup, leading to SIBO.

Anatomical issues that alter the normal flow of the digestive system—like a stricture from Crohn's disease or past abdominal surgeries—can also contribute to the development of SIBO by causing fluid to stagnate before such blockages.

Moreover, he discusses low stomach acid as a potential cause, explaining that it can result in a loss of bacterial control, which in turn fosters the development of SIBO. Medications like proton pump inhibitors, which reduce stomach acid production, are identified as linked to an increased risk of developing SIBO.

Root causes create situa ...

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Finding the Root Cause of SIBO

Additional Materials

Clarifications

  • Small Intestinal Bacterial Overgrowth (SIBO) is a condition where there is an abnormal increase in bacteria in the small intestine, leading to various symptoms like bloating, diarrhea, and malnutrition. The excess bacteria can interfere with normal digestion and nutrient absorption, causing discomfort and health issues. Diagnosis involves detecting high levels of bacteria in the small intestine, typically through specific tests like bacterial aspirates. Treatment often includes dietary changes, antibiotics, and sometimes prokinetic drugs to manage symptoms and prevent recurrence.
  • Gastroparesis is a medical condition characterized by delayed stomach emptying due to weak stomach muscle contractions. This delay can lead to symptoms like nausea, vomiting, and abdominal pain, impacting nutrient absorption and glycemic control. Common causes include autonomic neuropathy, often associated with conditions like diabetes, and diagnosis involves various tests to assess stomach function. Treatment typically involves dietary adjustments, medications to aid digestion, and in some cases, s ...

Counterarguments

  • While abnormal bowel motility, anatomical issues, medications, and low stomach acid are common root causes of SIBO, there may be other factors involved that are not as well understood or have not been mentioned, such as immune system dysfunction or food poisoning.
  • The role of diet and its impact on the microbiome is not addressed, which could be a significant factor in the development and management of SIBO.
  • The text does not consider the complexity of the gut microbiota and how the interplay between different bacterial species might contribute to SIBO beyond simple overgrowth.
  • The emphasis on identifying a single "fundamental cause" of SIBO may oversimplify the condition, as it is often multifactorial and may require a more holistic approach to treatment.
  • The association between proton pump inhibitors and SIBO is still a subject of debate among researchers, and some studies have found conflicting results.
  • The text does not discuss the potential for overdiagnosis of SIBO or the limitations of current diagnostic methods, which could lead to misattribution of ...

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The truth about SIBO with Dr. Will Bulsiewicz

Conventional SIBO Treatments

Conventional treatments for Small Intestinal Bacterial Overgrowth (SIBO) typically involve the measured use of antibiotics and dietary modifications to manage symptoms and reduce bacterial overgrowth.

Short term use of antibiotics

Dr. Will Bulsiewicz acknowledges that antibiotics have a role in the treatment of SIBO, suggesting that their use should be controlled and limited to short-term to prevent potential long-term harm to the gut microbiome. Antibiotics are commonly prescribed to reduce the overgrowth of bacteria in the small intestine, which is the hallmark of SIBO.

Transitioning to low FODMAP diet, then gradually reintroducing FODMAPs

After addressing the overgrowth with antibiotics, a dietary approach is often initiated. Rather than cutting fiber entirely, patients with SIBO are typically advised to transition to a low FODMAP diet. FODMAPs are a group of carbohydrates that can ferment in the gut and potentially contribute to symp ...

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Conventional SIBO Treatments

Additional Materials

Clarifications

  • Small Intestinal Bacterial Overgrowth (SIBO) is a condition characterized by an excessive growth of bacteria in the small intestine, leading to various digestive symptoms. Diagnosis involves detecting an abnormally high bacterial count in the small intestine. Treatment typically includes antibiotics and dietary modifications to manage symptoms and restore a healthier microbial balance in the gut.
  • FODMAPs are short-chain carbohydrates that can ferment in the gut, potentially causing digestive discomfort in some individuals. They include various types of sugars and sugar alcohols found in a range of foods. Limiting FODMAP intake through a low-FODMAP diet can help alleviate symptoms in conditions like irritable bowel syndrome (IBS). Gradually reintroducing high FODMAP foods can help identify specific triggers and manage symptoms effectively.
  • The gut microbiome consists of various microorganisms like bacteria, fungi, and viruses that reside in the digestive system. It plays a crucial role in digestion, immune function, and overall health. The balance of these microorganisms can impact various aspects of well-being, from nutrient absorption to disease prevention. Maintaining a healthy gut microbiome is essential for overall hea ...

Counterarguments

  • Antibiotics may not be effective for all types of SIBO, as some cases may be caused by non-bacterial overgrowth or may be resistant to certain antibiotics.
  • The use of antibiotics can sometimes lead to antibiotic resistance, which is a significant public health concern.
  • Some patients may not respond well to a low FODMAP diet or may find it too restrictive and difficult to adhere to long-term.
  • The low FODMAP diet may not address the underlying cause of SIBO and could potentially lead to nutritional deficiencies if not properly managed.
  • The process of reintroducing high FODMAP foods can be complex and may require the guidance of a healthcare professional to avoid misinterpretation of symptoms.
  • There is a lack of long-term studies on the effectiveness of the low FODMAP diet and the reintroduction phase in the management of SIBO.
  • ...

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The truth about SIBO with Dr. Will Bulsiewicz

Importance of Nurturing the Gut Microbiome

The gut microbiome plays a crucial role in health, and recent studies suggest that nurturing rather than destroying it is key to both treating small intestine bacterial overgrowth (SIBO) and improving overall well-being.

Destroying the microbiome with repeated antibiotics and low fiber diet has risks

A study in "Nature Communications" identified that reducing fiber intake and recent antibiotic treatment are significant risk factors for developing dysbiosis in the small intestine, a condition similar to SIBO. The high relapse rates observed in SIBO may be attributable to conventional therapies that further disturb the gut microbiota balance. Bulsiewicz warns against approaches that destroy the microbiome and advises nurturing the beneficial bacteria as the correct method to counteract dysbiosis and enhance health. He notes that one does not fix the microbiome by destroying it but rather by building it back up, suggesting that repeated antibiotic use and low fiber diets can be harmful.

Eating more fiber protects the microbiome and improves outcomes

Eating fiber has been shown to protect the gut microbiome. A healthy diet rich in fiber can improve gut health, although increasing fiber intake should be done gradually to avoid discomfort for individuals with SIBO or other gut issues. Bulsiewicz suggests starting with a low FODMAP diet as it includes fiber sources that produce less gas and then gradually reintroducing FODMAP foods over time.

...

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Importance of Nurturing the Gut Microbiome

Additional Materials

Clarifications

  • Small intestine bacterial overgrowth (SIBO) is a condition characterized by an excessive growth of bacteria in the small intestine, leading to various digestive symptoms like bloating, diarrhea, and malnutrition. The diagnosis is typically confirmed by detecting an abnormally high level of bacteria in the small intestine. Treatment often involves dietary changes, antibiotics, and sometimes prokinetic drugs to manage symptoms and prevent recurrence.
  • Dysbiosis is a condition characterized by an imbalance in the microbiota, leading to changes in their composition and activities. It commonly affects the gastrointestinal tract and can disrupt the normal functions of the microbiome. This imbalance can result in overgrowth of certain harmful microbes, impacting overall health and potentially leading to various health issues. Dysbiosis can be addressed by restoring balance through targeted interventions like dietary changes and probiotics.
  • A low-FODMAP diet restricts fermentable carbohydrates to manage digestive issues like IBS. It involves avoiding certain foods high in FODMAPs to reduce symptoms like bloating and gas. This diet is typically recommended for a short period under the guidance of a healthcare provider. It's ...

Counterarguments

  • While nurturing the gut microbiome is important, it's also necessary to recognize that antibiotics are a critical tool in treating certain bacterial infections, and their use should be balanced rather than completely avoided.
  • The relationship between fiber intake and gut health is complex, and some individuals with specific conditions may not tolerate high-fiber diets well, even when increased gradually.
  • The low FODMAP diet is designed to reduce symptoms of irritable bowel syndrome (IBS) and may not be suitable or necessary for everyone looking to improve their gut health.
  • The efficacy of probiotics in treating SIBO and other gut-related issues is still a subject of ongoing research, and their benefits may not be as significant or universal as suggested.
  • The recommendation to use targeted probiotics like Saccharomyces boulardii is based on limited studies, and more research is needed to confirm their effectiveness and safety for a broader population.
  • The idea that nurturing beneficial bacteria is the correct method to counteract dysbiosis may oversimplify the complexity of the gut microbiome and its interactions with the host's immune system and overall health.
  • Some individuals may have conditions, such as small intestinal fungal overgrowth (SIFO), that require different treatment approache ...

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