Conquering Arthritis With Functional Medicine - Dr. Michael Ruscio, DNM, DC

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Conquering Arthritis With Functional Medicine

How Susie Used Anti-Inflammatory Foods, Triple Therapy Probiotics, Elemental Heal, and Fasting To Relieve Joint Pain and Stiffness

On the search for answers about joint pain and stiffness in her hands, Susie came across functional medicine and our clinic. While she was aware of anti-inflammatory diets and other evidence-based interventions, she was struggling to find the right combination that worked best for her. By treating her—not her labs—we were able to provide her with answers to her initial questions, an actionable and effective plan, and get her symptoms under control. Listen in to hear how Susie used Elemental Heal, Triple Therapy Probiotics, fasting, and the autoimmune paleo diet to feel better.

In This Episode

Introducing Susie, her joint pain, and her path to the clinic … 00:08
What actually started making the difference for Susie … 05:13
A signal of improvement … 12:53
A small setback … 20:20
Expanding Susie’s diet … 23:30
Healing isn’t an overnight thing … 30:26
Finding the right support for your health journey … 32:07
Outro … 37:02

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➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Susie:

I can’t really pinpoint one specific thing that really made a huge difference. It really seemed like it was everything in combination.

Dr Ruscio:

Hey everyone, this is Dr. Ruscio. I’m here with Susie and she has had some good results. And per the usual, I think it’s helpful to try to share some of Susie’s background and what she’s been going through so that we can all learn and really try to take as much away from these circumstances that we can. So Susie, maybe start us off with a little bit of your background in terms of what symptoms you were experiencing, maybe some of what you had tried prior, and then we can kind of go from there.

Susie:

Okay. About a year and a half ago, I started experiencing some fairly severe symptoms in my hands of joint pain and stiffness. And not only inflammation of the joints, but like the tendons in the palm of my hand, triggering, finger triggering. And it was at the point where in the morning it was really hard to move my hands or make a fist or close my hands. And it didn’t resolve during the morning. It would persist through the day. And I’d had some symptoms shortly prior to that that were less. But then it just escalated to that. And those were the most current symptoms. In hindsight, I think this actually started 10 years ago but didn’t get its roots in really. But it definitely manifested a year and a half ago and stayed.

Susie:

So it was very concerning to me. So I did reading about it and it was seeming to me, rather than it being… just by the nature of the symptoms, it was seeming to me not to be something like osteoarthritis. I was thinking it was some kind of inflammatory arthritis more. So, I read up on that. I got a book out of the library from Susan Blum or Bloom—I’m not sure how you say her name—who’s a functional medicine MD who is well versed in autoimmune. And the book I got was “Healing Arthritis.”

Dr Ruscio:

Yeah. She’s been on the podcast. We’ve had a few conversations, so yeah. She’s had some good work out there for arthritis.

Susie:

Right, right. And so, I’d already known about functional medicine, but that got me just further into some specifics about arthritis. And so I was trying to follow some of the protocol in her book, but it was not as easy to bring it together on my own. I was making some progress. I was doing things like doing an anti-inflammatory diet. I was doing some probiotics, but that was basically like going to the health food store and getting some recommendations there. I was eating fermented foods. Let’s see, what else was I doing? Oh, things sort of mechanically, like contrast baths for my hands and compression sleeves or gloves. All that helped, but it wasn’t tamping things down as much as I wanted.

Susie:

And that’s when I did more research. I came across your information. I got your book. I really liked how it laid out very logical sort of sequence of a protocol. And also that, if need be, I would be able to get supplements through you rather than having to get them through a lot of different sources. So I thought that was beneficial. But even with that, I started with doing the paleo autoimmune diet. And that was before I started working with you directly.

Dr Ruscio:

So you started from more of a vegetarian-based diet—high food quality, antiflammatory—then you pivoted over to autoimmune paleo. And, maybe there, anything you want to juxtapose in terms of how that felt on the joints and overall?

Susie:

Within about two weeks, I did see improvement, just through diet alone. It wasn’t a hundred percent but I definitely saw marked improvement over two weeks. But then I did have a little bit, it was maybe coincidental, but I started getting twitches in my legs at the end of those two weeks. And it was like, “wow, is the transition of not doing as much carbs causing this?” With that, and that I had seen improvement, I thought, “there is a lot of power in diet alone.” And at that point I thought, “I don’t want to work just on my own anymore. I want to work with a coach.” And that’s when I sought you out because, for one thing, I didn’t want these symptoms to last for a long time because my understanding was if the inflammation stayed for quite a while that I could actually have permanent joint damage. So I didn’t want to mess around with that. So that’s when I sought you out. And we started on a more methodical regimen.

Dr Ruscio:

Yeah. And I’m glad you use the term methodically. Because one of the things that Susan [Blum] and I think we have a slight difference of opinion. I think the core essence of food quality we agree upon. There’s a decent body of evidence showing that a vegetarian diet can help with various joint conditions, including RA. But when you really look at the literature, there’s actually not many studies at all looking at other types of diets, like a paleo diet. And so this is what can be tricky where you can say, “the evidence indicates this is the best diet,” let’s say vegetarian of high food quality for some type of Arthritity. And that’s partially true. But if we haven’t examined other diets that we know help other inflammatory ignitions, like a paleo diet is one example, then it’s not fully accurate to say that’s the best diet.

Dr Ruscio:

It’s one on a menu of diets to methodically try. And that’s where just making that flip over to the autoimmune paleo seemed to move the needle. And then even further, when we did some fasting or modified fasting, that seemed to give you another big improvement. And fasting really isn’t a dietary intervention, but I mean it kind of is because we use some sort of caloric solution. But yeah, to your point, I think again, it’s just worth reiterating this methodical approach that takes a broad view on the evidence and looks at […] different dietary directions we can trial for something like joint pain. And let’s try to move you through these, not taking months on each one, but going at a decent clip, listening for a positive signal from your system, and then continuing to move forward in these sort of iterative updates that we make periodically.

Susie:

Right. […] And I did hear that inter-discussion between you and Susan Blum. And I thought it was a good discussion. Anyway, I respect both of you and think you both have a lot of good information and a lot to offer.

Dr Ruscio:

We all have different perspectives and that’s why it’s good having the ability to bandy different concepts back and forth on the podcast like that.

Susie:

Right. And I know in your book you had mentioned—and this really came true for me—that you want to set the environment first. And to me, the diet was probably the largest foundation. And also the fasting and the intermittent fasting. And by the intermittent fasting, for me, that is keeping the food intake within just a certain time window. Just so I can get my gut a rest. So I think the things that I see as a foundation for myself are the diet, fasting (periodically, not too often, and I’ve done it maybe once every three months where I’ll do like a hybrid type of fast and then intermittent fasting), and then on top of that the probiotics. And when I did the hybrid fasting, some of it was with the, I forget, the master cleanse where it’s the lemon…

Dr Ruscio:

Lemonade with cayenne.

Susie:

Right. Right. So I did a combination of that, Elemental Heal, and then also bone broth. I never exclusively did one thing. And sort of how I used it was maybe the master cleanse in the morning, as almost like a tonic, and then Elemental Heal midday, and then later in the day the broth. And that combination worked well for me and helped me get through what can be challenging when you’re not eating solid food.

Dr Ruscio:

It can be challenging to use periodic fasting interventions if they’re a true fast. Some people do it and some people have success. There’s a decent number of people (myself included) that doing too much fasting starts to cause problems with fatigue, brain fog, insomnia. So that’s what’s nice about things like the master’s cleanse or bone broth or an elemental diet—it does give you, from a gut perspective, a rest but you’re not going really low calorie and hitting some of that metabolic stress that can be challenging for some people.

Susie:

Right. Right. Yeah. I don’t feel like I can go really low calorie because I don’t really want to lose muscle mass at this point. And at other times earlier in my life where I did a little bit of fasting, I just saw where it hit my muscles and started taking those away. And I can’t afford that. But, yeah, I see those things as the foundation. And then the other supplements that I used like the gut rebuild, the turmeric, fish oil, those were all things that were supportive. But I feel like those other things really laid the foundation and the environment.

Dr Ruscio:

And it’s a key concept. And that’s one of the posits I try to develop in “Healthy Gut, Health You,” which is really developing this internal environment or ecosystem that has all these healthy inputs that really encourage it to be healthy, rather than saying, “well, we’re going to use harsh antibiotics,” which are needed in some cases, or just really pound on one intervention, depending on what’s in Vogue. But rather, take that holistic gardener approach (which may sound a little bit hippy dippy) but actually if you read in between the lines and the evidence, I think that’s the approach that you come away with. And probiotics is a good example of that.

Dr Ruscio:

From the notes I have here in your chart, we were able to see a signal of improvement. I wouldn’t say it was massive, but a signal of improvement from using the Probiotic Triple Therapy as compared to a health-food store probiotic X, Y, Z. But I also don’t want to overrepresent that. Can you give us your overview on the difference in those two different approaches to probiotics?

Susie:

Well, I think I felt good about using, a broad spectrum of probiotics. And I think I wasn’t getting as good of results earlier because I don’t really think it was as consistent for me but I did definitely notice a difference, as I said, when I did the paleo-autoimmune with the full spectrums of probiotics. And prior I was doing more an anti-inflammatory, maybe not really leaning more paleo, with the single probiotic. And it was the more like the Lacto/Bifido type. So those were the two things that were different. And the second definitely pushed me forward. So—and this is something I’ve discussed with you before—I can’t really pinpoint one specific thing that really made a huge difference. It really seemed like it was everything in combination. In that regard, that’s why I can’t necessarily give a very exact answer.

Dr Ruscio:

Sure. But this is also a really important, I think, lesson for any individual. It’s great when someone goes on probiotics and there’s this 0-60 change in like two weeks and that does happen, but that’s probably more so the minority of cases. What we see more often is you’ll pick up 15 or 20% here and another 20% there. And it’s when you weave together a few of those correctly that now you aggregate this 60 or 80% improvement. And I think that’s so important to echo because I see so many people who come in who are well-read and they’ve been doing a lot of the right stuff, but the execution has been off. And I think in part it’s because people are looking for this huge change from one thing rather than thinking more, as you were saying, in this kind of methodical iterative process where we evaluate one therapy, we see what this signal is, and then we respond accordingly. And in some cases we need the right diet plus some fasting plus some probiotics. And now we’ve finally hit that threshold where we’re feeling that 60, 70, 80% everyday improvement.

Susie:

Right. I think that’s what it took for me.

Sponsor:

Hi, this is Erin Ryan from the Dr. Ruscio team. We get lots of questions about Elemental Heal, our gut supporting meal replacement shake, so I thought it would be helpful to answer a couple of those questions. Now let’s talk about the investment. Some people wonder, is it worth the cost? What if it doesn’t agree with me? What then? Well, there’s a lot of different ways to think about it in terms of offsetting costs. You’re using this shake as a meal replacement. So you’re not paying for food while you’re using it as a meal replacement. So that helps with the cost. It could also offset future costs for ongoing therapies. So if Elemental Heal is really helping you, and you only need to use it in combination with one or two other therapies, you’re offsetting costs of more doctor’s appointments and more testing. And so on in terms of the sourcing, every ingredient is impeccably sourced by Dr. Ruscio himself. There is nothing in this product that he wouldn’t put in his own body in terms of the taste. It tastes great. I love the chocolate, but there’s also peach and vanilla. We also have a money back guarantee in case you order too much, or if it doesn’t agree with you; just let us know and we’ll help you out. There’s a lot more info on the website DrRuscio.com. There’s customer reviews, research and scientific evidence, all about Elemental Heal.

Susie:

Let’s see…For about four or five months I did that full spectrum of things consistently. And it was a challenge at times and, as I mentioned, I think it was a little easier when it was during lockdown time.

Dr Ruscio:

Yeah.

Susie:

So I was at home and not out socializing and such, so it was a little easier. But it was over about a five month time that just bit by bit by bit I saw improvement. And so I was probably at the end of five months, about 80% improvement. And then that’s when we together decided it was time to try antimicrobials because the one test that I had done was SIBO breath test and that showed some low level of hydrogen [sulfide]. So, and it seemed like at that point, there was enough healing and robustness on my part that I could handle that. So I did…

Dr Ruscio:

And also, sorry, just to slip in one thing there, even though we had laboratory evidence of hydrogen sulfide SIBO, we had already seen a lot of benefit in your symptoms from all these therapeutics that were not lab guided—the diet, the fasting, the probiotics. And, I just want to reiterate to people, because I feel like there’s such this strong tailwind of laboratory-guided healthcare. And there is an extent to which we should do that, but I think a lot of this more empiric, personalized care is being left by the wayside even though there’s a lot here that can help people. So just a quick reminder for people that probably the minority of improvements in your case were based upon treating a lab finding.

Susie:

Right. Right. Yeah. We didn’t really even hardly ever discuss that, as far as treating to a lab finding. Oh, and the other interesting point that I want to make in regards to having SIBO (or some level of it), I have had no GI symptoms and no really clear reactions to any particular food. So the thing that was letting me know something was off was joint pain. It was not any symptoms related to my gut. So I know that’s not always the case. A lot of people have gut symptoms. No, not me at all.

Dr Ruscio:

I was the same. I mean, for me, my GI stuff manifested mostly neurologically in terms of brain fog. And I think it’s always good to remind people that you can have an issue being fueled by your gut that isn’t also causing direct digestive symptoms like bloating or abdominal pain or loose stools or what have you.

Susie:

Yeah. Yeah. Well, and when it was seeming like what was going on with me was actually autoimmune—and actually it was diagnosed through a rheumatologist that I was diagnosed with psoriatic arthritis even though I didn’t even know I had psoriasis—all my blood work was negative. Which is something that happens with psoriatic arthritis, as opposed to rheumatoid arthritis; there’ll be positive blood test results with rheumatoid, but with psoriatic, no. So we decided it was time to do antimicrobials. And before that I was, I’d say probably, 80% improved. I did the phase one antimicrobials for one month.

Susie:

All that went fine, I tolerated it all well, I kept seeing improvement, and probably by the end of that first month I was symptom free and I was elated. And then we went to the second phase of antimicrobials and initially all that was going fine. But about two weeks in, I started having nausea and I thought, “Hey, I’m having a die-off reaction.” But then it started really increasing. The nausea started increasing. This was just over a period of a few days. And, like I said, it was after two weeks in taking the next round of compounds. And then my urine started getting dark and I looked up those symptoms and it was like, “oh my God, this is like induced hepatitis or something.”

Susie:

And so I contacted you. You said to stop everything. And also I contacted my general practitioner. Through her I did blood test for liver enzymes and she also had me do an ultrasound on liver. And my liver enzymes were very elevated.

Susie:

So there was something in the compounds that my body was not happy with. But after I stopped everything and later took the blood tests again—and this was over a period of about two months—all my liver enzymes returned to normal. And the ultrasound showed some mild fatty liver but my GP did not seem too concerned about that. And she said that the recommendation for fatty liver was [to] basically stay on a relatively low-carb diet, which I was continuing on.

Susie:

But when that happened, I stopped everything. I stopped all the protocol. I stopped probiotics. And actually, at that time, I had started broadening my diet, which I’ve done. I’m basically eating everything now. Not tons of gluten…I’m eating some dairy, some grain, some beans. And I’ve only recently, maybe the last month or maybe couple of months, started seeing a creeping up of symptoms again. So I’m going to circle back around and basically start the protocol over again.

Dr Ruscio:

And by protocol, just clarify for people, diet, fasting, probiotics, some basic antiinflammatory supports, not the herbal antimicrobials. And I think we’ve gotten what we need to get out of the antimicrobials, at least for right now. But just to kind of build upon that, the fact that you’re able to go off all the supplements and really broaden your diet for months and notice little to no regression is an excellent sign. This is part of how we figure out where someone’s minimal effective dose and plan is.

Dr Ruscio:

And what I expect we’ll find is you’ll probably be able to continue to be fairly liberal with your diet. And if we have just some basic and reasonable supports in play, that should buffer against maybe some alcohol or processed food or what have you. Which is very similar to what I’ve fallen into, which is [that] I can be okay without any supplements but I can better buffer a bottle of wine with friends and maybe dessert and what have you. And everyone’s different in terms of what kind of stuff they want to take and that’s all good and fine. But I think the key here is allowing you to have that realization of [whether you] feel a little bit better when [you’re] doing X, Y, Z, and then you elect [whether it is] or is it not worth it to modify your diet most of the time as such use X, Y, Z supplement—and really put you in the driver’s seat of being able to identify the risk/reward, pro/con for these decisions and not have this boogieman [of] “someone somewhere said that these foods can be inflammatory for some people with RA or psoriatic arthritis so I’m never going to have those” and I’m not going to qualify what I can and cannot do.

Dr Ruscio:

Because that’s a couple things that I think it’s important for people to realize is that sure, there is a food that can be a problem for people, there’s a supplement that can be helpful for a given person, but it doesn’t mean we have to ardently follow the dietary rules or very fastidiously follow a supplement plan. Those are guideposts. We work through those trials iteratively and then you decide kind of where your sweet spot is in terms of how exactly you follow those things.

Susie:

Right. Right. As far as diet restriction, I think it was very helpful. I’m seeing what I did earlier—as when I was very restricted—as therapeutic. And that helped me during that period of time is it’s probably not going to always be this way. So that helped me sort of stay the course. And with, circling back around, when I did broaden my diet, I wasn’t particularly methodical about reintroducing foods back in. And because I’m not highly reactive to food triggers, I’m not sure what foods…

Dr Ruscio:

Which is kind of a double edge sword, right? If it’s super apparent it’s nice. But then do you want everything to be super apparent? It’s kind of nicer to have such minimal reactivity that’s hard for you to pinpoint. So yeah, there’s kind of a pro and a con to that.

Susie:

Right. I’d like to have a little bit more insight, but I don’t know if I will get that. And I don’t know if, with holidays coming up, it’s the exact time to do it but at the same time, since symptoms have increased some, I don’t want to just ignore them either because I don’t want to backslide.

Dr Ruscio:

Right. Yeah. And for you, it may not be any one particular food. Normally that type of presentation isn’t demonstrative of a solitary food trigger but more so it’s just like a volume of these inflammatory foods, whatever that is for you. And so it’s just being a little more cognizant, almost like someone who let’s say metabolically is really carb-sensitive and they go away for a week and their carb intake goes up by 3X […] It wasn’t necessarily the one type of carbs, it was just a total volume of carbs. So when it careens back down then the metabolic problem, let’s say is weight gain, improves itself. Which is good; that’s a good boat to be in.

Susie:

Yeah. Yeah. So we’ll, we’ll see how it goes. I’ll be connecting with you again in January. So I’ll give a report then of how things have gone.

Dr Ruscio:

Yeah. This has been really insightful. I’m glad we had a chance to connect and share all these lessons with people. And obviously I’m thrilled that you are much, much better than you were at baseline. And, sure, there’s a few maybe finishing touches for us to determine in terms of your longer term maintenance plan. That being said, I think it’s fairly apparent, and now it’s just a little bit of additional granularity.

Sponsor:

Hi, everyone. If you are in need of help, we have a number of resources for you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is the clinic—the Ruscio Institute for Functional Medicine—and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path, health coaching support calls every other week, and also we offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, etc. There’s also the store that has our Elemental Diet line, our probiotics, and other gut health and health-supportive supplements. And for clinicians, there is our FFMR—the Future of Functional Medicine Review—database which contains case studies from our clinic, research reviews, and practice guidelines. Visit DrRuscio.com/resources to learn more.

Dr Ruscio:

Are there any closing thoughts that you want to leave people with?

Susie:

Well, a few things, actually. At least from my perspective with my journey, it may not be quick. […] Healing may not be just an overnight thing. I mean, looking back, I think I actually had some symptoms related to psoriatic arthritis 10 years ago and didn’t know it. So it didn’t take me a few weeks to get in the place where I was, where I was having symptoms, so I look at it [as] it’s not going to take me just a few weeks to get out of it. Although I’m very happy with the progress that I made during the amount of time—we’re talking initially some things within a few weeks of seeing improvement—but just being determined to stay the course and to try to not get discouraged.

Susie:

And then I did have a setback, when I had the reaction to the antimicrobials, and that was sort of discouraging. But then I just sort of picked myself back up and kept going and knew that I could keep moving forward and healing in a good way. So I guess what I want to say [is] healing is not necessarily a quick and linear path, or at least it hasn’t been for me. And I imagine it’ll continue to be that way for a certain amount.

Susie:

And then also, I fortunately had good support at home. My spouse was on this food journey with me, not so much the supplements and everything, but that was really helpful. And also I had support from my general practitioner and also the rheumatologist that I am currently working with. And I told them that I was going to use the gut approach with dealing with this and my GP was all for it. And she said, “if you can avoid taking the drugs, that’s great,” because basically they’re immune-suppressing drugs, which I do not want to take if at all possible. And the same with the rheumatologist. He saw the results that I was getting and he said, “just keep doing what you’re doing.” He couldn’t speak to necessarily agreeing with everything that I was doing, or not agreeing but being knowledgeable, but he was not discounting it. And he knew enough from seeing in rheumatology journals and that type of thing that gut research is going on, but he did and continues to say, “just keep doing what you’re doing.” So fortunately I have good support. And I think that has made a big difference or been a part of helping me in this journey.

Dr Ruscio:

Which I think is another great point worth kind of echoing in the sense that if someone is working with a conventional provider or a natural provider who seems dogmatic and anti-the-other-side, I recommend getting a second opinion. Because it’s an admonition of, I think, a bit of hubris in that whatever camp you’re in has all the answers and therefore you shouldn’t bother with the other camp. And that’s a very untenable hypothesis, just thinking that anyone has everything figured out. And sometimes I think people are a little bit slow maybe to get a second opinion, but if you’re having that feeling that you’re being put in a box or confined, I mean, there are other rheumatologists and GPS out there, of course, that are going to be open minded and able to work collaboratively. And I think for you, it’s so reassuring, so you don’t feel like you’re in this tug of war having to contend with totally polarized opinions.

Susie:

Right. And in this case, because I did have some reaction or whatever to the antimicrobial, I needed the GP on my side. I needed her support. And she wasn’t condescending or anything about that I had some issues coming up. And in fact, the rheumatologist, when I saw him, he said, “yeah, it’s just like any other medicine. Sometimes you have a reaction…”

Dr Ruscio:

I was just going to say that. And that’s fair. And that’s a fair way of looking at a therapeutic. And it’s not, “well that therapeutic is in a camp of philosophy that I don’t like, so anything I can pick at I’m going to use to discredit it,” but rather, “yeah, people have reactions to drugs, to herbs, to vitamins, to diets, and we should just try to work through that rather than trying to throw the the baby out with the bath water, so to speak.”

Susie:

Yeah.

Dr Ruscio:

Fantastic. Well, I think this provides people with a lot of guideposts as they’re trying to improve their health and navigate conventional/alternative medicine, how [to] weave in between the two and how [to] be patient and have the long view, and just all these things and many, many great lessons. As I knew you would have, Susie, because you are, if people can’t tell, very well-read very well-researched, very logical in your thinking. So thank you for being such a pleasure to work with and for being so committed to your health, certainly making my job easier, and for sharing your story with us.

Susie:

Great. Great. Well, It’s been a pleasure working with you. We still have some work to do. But I really appreciate the support and I really like your approach and the information that you’re bringing forward and that you’re making functional medicine accessible to people in an attainable way.

Dr Ruscio:

Yeah. Well, thank you. Thank you, Susie. And, yeah, I guess we will be talking post-holiday and we can debrief more then.

Susie:

Okay, great. Great.

Dr Ruscio:

Okay. Thank you again, Susie.

Susie:

Alrighty. Bye.

Dr Ruscio:

Bye. Bye.

Outro:

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates. That’s DRRUSCIO.com.

 

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