Friday, January 6, 2012

A Balanced Diet - Why is it so complicated?

With the new year upon us, many of us are looking to shed some weight and so I thought I would write about how you can lose weight both safely and effectively.

Confusion abounds when it comes to dieting. Fad diets are very lucrative (for selling books), but many may be very unhealthy or even dangerous. The options presented to people who want to lose weight come in many forms that are drastically different. They can include low-fat, high-fat, low-carbohydrate, vegetarian, vegan, low-calorie, and on and on, each claiming to be the “holy grail” of dieting (i.e. lose weight and stay healthy while doing so). Unfortunately, very little in the way of scientific fact seems to make it into many of these diet recommendations and so I thought I would undertake to make this less confusing.

So let’s take a look at what constitutes “healthy eating” and on the way, I will explain how you might lose weight safely in case you “indulged” a little too much over the holidays.


Unfortunately, there are a lot of confusing myths surrounding food and dieting that many people firmly believe. Let’s look at these first.


Contrary to popular belief, calories are NOT what you need to concern yourself with when it comes to losing weight. The often quoted idea that calories in and calories out account for all weight changes is just wrong. Even though it has been repeated so many times that it has become ingrained in almost everyone’s mind, just ignore it and we can move on to explain how things actually work.

Research over the last 10 - 20 years has made remarkable progress in understanding adipose tissue (body fat cells) and how we gain and lose weight. Calories have essentially nothing to do with this process. The reason for this is that different sources of dietary calories are processed completely differently by the body. Some calories can turn straight to excess body fat and some simply cannot. The three important sources of dietary calories we need to understand are protein, fat, and carbohydrates.

These different sources of calories break down using very different methods in your digestive system, each needing a different amount of energy in your gut to do the digesting. Protein takes a lot more energy (both heat and chemical energy) to break down and a relatively large amount of time to absorb in the gut than does sugar. Sugar (in this case, glucose) is absorbed pretty much “as is”, providing a large amount of energy at almost no digestive cost (since almost every cell can use glucose directly for energy). Fats take even longer to digest than protein or sugar. If you want to lose weight, you want to make the body work for its calories. Fat and protein are the best choices, while carbs are not.

Furthermore, calories from fat, protein, and carbohydrates are also metabolized completely differently by the body and then have ultimately have completely different effects once they are metabolized.  


We’ve probably all heard the saying “you are what you eat,” but that doesn’t mean that when we eat fat, we get fat. This is perhaps one of the biggest and most misunderstood aspects of diet. In fact, we need fat for a variety of crucial systems in our bodies. If we eat too much fat then our bodies simply flush out the extra fat into our intestines where it ends up in our stool.

Fat is critical to everyone’s health. When we eat fat, it breaks down into fatty acids which are then absorbed into our body. Some of these fatty acids are “essential”, meaning that we can only get them from our diet and our body cannot make them in any other way. Essential fatty acids are used throughout our bodies for many purposes. In the absence of glucose in our bloodstream, fatty acids are used to create energy for muscles and many other body systems. Low fat or non fat diets are not only virtually meaningless for weight loss, but they can also be dangerous in the long term.

A diet that is high in fat simply CANNOT make you gain weight from the fat you eat.


No matter how many times I talk about sugar, it cannot be emphasized enough how incredibly bad sugar is for everyone. If you eat too much sugar or carbohydrates, your body stores the energy quickly and efficiently by creating fat. High insulin levels (caused by eating carbohydrates) cause you to store more fat in your fat cells. Lower insulin levels (through lower carbohydrate intake) cause fat to be released from the fat cells (and muscle and other lean tissues if necessary) and you can burn it for fuel. While your body runs relatively easily on sugars, you do not specifically need to eat any sugar in your diet.

Fructose (half of ordinary table sugar and the sugar found in fruit) is not used by your body for energy and so your liver essentially processes it like a toxin. As your body tries to process this toxic substance, it creates free radicals which cause cellular damage (and even DNA damage) in the process. As your body tries to deal with fructose, it creates triglycerides, which are part of the bad kind of cholesterol (LDL). High levels of LDL and the associated levels of oxidation (from free radicals) cause damage to the walls of your arteries can directly lead to heart disease.

For more detailed information on why sugar, particularly the fructose portion of sugar, is so bad for your health, and for your waistline, the following video does an excellent job of explaining the topic in detail.


The fat that forms in your body has very little to do with the fat that you eat, but a lot to do with storing the energy from sugars and other carbohydrates. Adipose (body fat) tissue is simply a way for your body storing excess glucose (a sugar) until you need it later (i.e. when food is scarce). Any excess glucose triggers insulin to be released. Insulin then binds this excess glucose to fatty acids, turning this combination into fat cells.

Fatty acids (from “fat” in food) alone DO NOT get stored as body fat this way. Fatty acids from fat in our food is only used here as part of the mechanism for storing the sugar. An easy way of looking at this is that dietary fat is broken down into fatty acids (to be useful in many parts of the body); carbohydrates (especially glucose) are either used as energy directly or stored as body fat for energy later. A little bit of fat allows us to store some energy for the periods of time where food is scarce (e.g. sleeping). Depending on the amount of carbohydrates you eat, this storage can quickly get out of hand and lead to obesity.

In the time that this myth has been around (50 years or so), dietary fat consumption has been reduced dramatically in the United States while carbohydrate (especially sugar) consumption has skyrocketed. If this myth were true, we should have seen a drop in obesity rates. In fact, we see the exact opposite...a massive unprecedented increase in obesity, insulin resistance, and diabetes. And of course, excess body fat does not exist in a vacuum without causing other problems. Along with obesity comes chronic inflammation, heart disease, insulin resistance, diabetes, the risk of stroke, and a host of other chronic diseases.

It bears repeating again that the amount of fat you eat has absolutely no bearing on the storage of fat in your body. Fat is a healthy part of our diet and provides us with the fatty acids we require to maintain health and vitality. In the absence of carbs, your body uses the sugar stored in fat cells (and then the fatty acids stored with it) as energy and you lose weight by “burning” fat.


The bottom line when it comes to dietary cholesterol is that how much cholesterol you eat typically doesn’t matter very much at all. Contrary to popular belief, dietary cholesterol is fairly insignificant when it comes to raising or lowering our blood cholesterol levels (ratios) in any meaningful way. All forms of cholesterol are so essential to many body processes that your body actually makes the vast majority of it, as needed. However, if you eat cholesterol, then your body simply decreases the amount it produces. If you eat enough cholesterol, then your body simply shuts off it’s own cholesterol production entirely in order to maintain your “natural” level of cholesterol.

In addition, your liver also removes any “excess” cholesterol by turning it into bile, which is then released to help digest food. The cholesterol in bile is either removed through defecation or reabsorbed by the small intestine. The only real ways proven to reliably decrease blood levels of cholesterol (without medication) is to aid in its removal or prevent its reabsorption in the intestines. We will discuss later in this post about additions to your diet (fiber and phytosterols) which help this process along.

So what is cholesterol used for in your body? We use cholesterol to synthesize useful hormones, digest food, make cell membranes, and to manufacture vitamin D, among other things. You simply wouldn’t be able to live without it. But too much cholesterol in your blood can be dangerous as well.

Unfortunately, as you may know, some types of cholesterol (LDL) can be harmful under certain conditions. Excess LDL cholesterol increases the likelihood of heart disease (hardening of the arteries and plaque buildup causing blockages in the arteries). In our inflammation article, we discuss the process by which “bad” cholesterol (LDL) causes hardening of and blockages in the arteries (atherosclerosis). The important thing to remember here is that LDL on it’s own is actually necessary and used by the body, however, under certain conditions it can become dangerous.

Research has found that your level of LDL cholesterol is tied more to genetic factors than to diet. If you eat less cholesterol in your diet, your body will simply make more to maintain your “baseline” level. This means that trying to lower your LDL blood cholesterol level by reducing the cholesterol in your diet can be very difficult, if not impossible. However, since we now know that LDL (the bad cholesterol) levels are only important insofar as the ratio of LDL to HDL (the “good” cholesterol), eating a diet that raises HDL can reduce the overall risks of heart disease. Oddly enough, a diet high in fat and cholesterol increases levels of HDL, making the ratio of HDL and LDL more favorable (less likely to lead to heart disease).

Cholesterol is so essential to life that your body creates it’s own. Eating too much cholesterol does NOT cause a rise in blood cholesterol levels because your body simply down regulates its own production of cholesterol to compensate. Too much LDL circulating in your blood (usually due to genetic factors) in combination with too little HDL cholesterol increases your risk of heart disease and atherosclerosis dramatically.  


If there is only one tip I could give you about making your diet healthier, it would be to eat more unprocessed whole foods (preferably organic) and avoid most carbohydrates (especially sugars and starches) completely. Eating too much food, especially processed and sugar-heavy types, also causes serious problems. If you want to eat carbohydrates, then eat smaller amounts and make sure that you eat sources that contain a lot of fiber to prevent spikes of insulin. Snacking in between meals can also help to increase our metabolism to “burn” more energy (digesting food takes quite a bit of energy).  

Here are some other tips and a few simple concepts that can help you to understand how to lose (or maintain) weight and also prevent disease. As with many things in health and medicine, it appears that moderation is a key concept to keep in mind.

Protein is a key element of a healthy diet. The essential amino acids
that make up protein are present in animal products, grains, legumes, nuts and seeds 

Eating enough protein is absolutely essential to health. We need protein for several important functions. First and foremost, protein is used to rebuild muscles after exercise. But protein can also act as an energy source if sugar is in short supply. It is critically important to have enough protein in your diet so that your body can repair tissues and produce the proteins it needs to survive.

Generally, protein should account for about 20% of the calories in our diet. Eating too much protein can cause kidney problems. If you eat extra protein it is essential to drink enough water because the kidney disposes of the excess proteins through your urine. Without sufficient amounts of water, it can’t all be flushed out properly. Anyone with any type of kidney disease or kidney dysfunction should consult with their physician to determine the safest level of protein intake for their individual condition.

In vegetarian and vegan diets, it can be difficult to get complete protein (all the essential amino acids), so it is important to understand how to combine vegetarian sources of protein to get all the essential amino acids you need. Generally with vegetarian diets, it is critical to eat both some form of grain (rice, corn, oat, rye, etc.) and legumes (beans, lentils, peas, etc.) at meals. Grains and legumes both contain essential amino acids (the building blocks of protein), but neither source usually contains a complete complement of essential amino acids on its own. By combining grains and legumes, you optimize your chances of obtaining enough of the essential amino acids from the protein in each. Nuts and seeds are another great options to obtain healthy vegetarian sources of essential amino acids, and are great snack foods between meals.

Finally, a note about soybeans. While soybeans do contain the most complete essential amino acid content of any legume, excessive intake of soy poses its own health issues. We will discuss this issue in greater detail in a later post, but something to keep in mind if you wish to eat soy is that almost all of the soy now grown in the United States is genetically modified. See our posts on the concerns about Genetically Modified Organisms (GMOs) to learn more.


In a recent article, we discuss the many varied health benefits of dietary fiber. In any diet, fiber will help you to both better absorb nutrients from food or supplements and also help remove waste products and toxins from your body. On top of these benefits, fiber also slows the rate at which you digest food, making you feel full for longer. Decreasing hunger while dieting is often a challenge, so fiber makes a good addition to any diet. Fiber also helps to reduce cholesterol re-absorption in your intestines, thus lowering levels of LDL in the blood stream. Overall, fiber is a necessary and very valuable part of any diet.

A salad with greens, nuts, and berries contains phytosterols,
which can help to lower cholesterol levels.


Phytosterols are a type of oil found in many plants and are very helpful in lowering the levels of the bad type of cholesterol (LDL). They do this because, chemically, they are very similar to cholesterol in your body, but different enough that they are insoluble and biologically inactive (phytosterols don’t really do much of anything once inside your body).

Your body uses a lot of its cholesterol in making bile, which helps you to digest food. The small intestine, where bile is released, typically reabsorbs a fair portion of the cholesterol in bile through “receptors” (on cells lining the small intestine which specifically absorb it). It turns out that phytosterols are chemically preferred by this receptor, so the phytosterols essentially latch on to them and block the re-absorption of the cholesterol in bile. So your body has to pull more cholesterol from your blood stream in order to make more bile so it can digest your next meal. Because phytosterols are biologically inactive, they don’t do much other than trick the cholesterol receptor cells, thus helping you to lower your blood levels of LDL cholesterol.

Phytosterols are commonly found in significant quantities in nuts, vegetables (and vegetable oils), fruits, and berries. The cholesterol lowering effect appears to be slightly stronger when phytosterol containing foods are eaten multiple times a day. This fits in nicely with the metabolism boost from snacking on foods regularly, as nuts make a pretty healthy snack food. Phytosterols are also available in supplement form. Ask your doctor if taking phytosterols as a supplement may be a good idea for you.


You don’t really want to be getting a side of pesticides with your dinner. Pesticides are a poison and not a condiment. The easiest way to avoid dangerous synthetic pesticides is to eat organic produce. For more information on the dangers of pesticides in health and for the environment, see our article on pesticides.


Eating foods rich in omega-3 fatty acids can help to reduce inflammation, which benefits overall health. Oily fish, grass fed meats (particularly beef), and many plants are good sources of omega-3 fatty acids. For vegans or vegetarians, algae and flaxseed oil are both sources that are acceptable. Why algae? Algae are where the omega-3 fatty acids are produced in the first place (during photosynthesis). The only reason fish have such high levels of omega-3 fatty acids is because their food chain starts with algae. For land animals, grass (again through photosynthesis) is where they get their omega-3 fatty acids. Animals raised on a 100% grass diet throughout their entire lives have the healthiest levels of omega-3 fatty acids. Omega-3 fatty acids are critical for reducing chronic inflammation and helping prevent diseases linked to inflammation, such as obesity, heart disease, stroke, insulin resistance, and diabetes.

Whole grains are a great source of fiber, nutrients, and

Since insulin is the primary hormone responsible for storing fat in fat cells, it should come as no surprise that for weight control, decreasing carbohydrate intake is extremely important. Glucose (a carbohydrate) directly triggers insulin release, which goes to work storing any excess glucose as fat. But in the absence of glucose, insulin levels get low enough that your body starts to pull fat from fat cells and chemically rip them apart to get at the (previously) stored sugar energy inside. You can also trigger this mechanism by exercising enough to burn through the glucose in your bloodstream and the sugar stored in your liver as glycogen, but it is significantly easier to do this through changing your diet to avoid carbohydrates in the first place.

Insulin has another key effect which is tied into cholesterol production. Since eating carbs makes your blood sugar rise, your body produces insulin in response to the higher blood sugar. As levels of insulin rise, cholesterol production is also stimulated (through a specific enzyme). Well, high levels of body fat cause a condition known as insulin resistance, where insulin is less effective at reducing blood sugar levels, so it effectively makes more insulin more often in order to try to compensate. This means that the higher and longer sustained levels of insulin keep telling your body to make more cholesterol. One of the most effective ways of countering this effect is to eliminate carbs from your diet and to eat more protein. Eating protein causes the level of a chemical called glucagon to rise, which suppresses that specific cholesterol producing enzyme. Insulin and glucagon are inversely related, so high levels of insulin means lower levels of glucagon. Eating fewer carbs means that insulin does not rise as sharply or as high, so cholesterol production is less stimulated in this way.

Carbohydrate and starch heavy foods are
stored as fat in your body. Eliminating
these types of foods is key for weight loss
and maintenance.
How low is “low carb”? That’s a hard question to answer because every person has a different level of carbohydrate intake that maintains or loses weight. The easiest way to find out is to eliminate almost all carbs from your diet and then slowly add them back until you start to gain weight again.

As we discussed in our article on the dangers of sugar, excess carbohydrates leading to excess body fat can lead to problems like heart disease, diabetes, insulin resistance, and a host of other serious problems.

When it comes to carbs, it is important to remember that not all carbs behave exactly the same way in the body. Vegetables, fruit, and grains each have different ratios of fiber to glucose. The higher the fiber and the less naturally sweet the food, the healthier the carbohydrate. Also, how a grain is prepared may have a vast difference in how much insulin is released. For example, eating whole grains of oats is different than eating a bowl of instant oatmeal. The harder your body has to work for the glucose inside (getting past the fiber) the slower it will be absorbed causing insulin to be released more slowly, which is a very good thing. The hard outer fibrous layer of grains (e.g. bran) are essential to this process.


Believe it or not, drinking enough clean, pure water is one of the most important parts of a healthy diet. Water is crucial for digesting food and absorbing nutrients, as well as maintaining a good “flow” through your digestive system. Water is crucial for your kidneys to clear out toxins and metabolic waste. Any excess protein you eat can’t be properly cleared by your kidneys.
Also, if you don’t drink enough water, the fiber in your diet can lead to constipation.

A good rule of thumb is to drink plenty of water when you eat a meal. Then, drink when you feel thirsty and also regularly throughout the day. I carry a reusable bottle of water with me wherever I go, so I never have to go looking for clean, purified water. I strictly avoid buying water in disposable plastic bottles that eventually can make their way into the large trash gyres in our oceans.

Also, remember that not all drinks are equivalent to water. Coffee, soda, and fruit juice are in no way the same as drinking water, and they may actually lead to dehydration, obesity, or other problems due to their sugar, caffeine, and chemical content. Clean, purified water is your best choice for your health and waistline.


Getting the right ratios of protein, fat, and carbohydrates in your diet goes a long way toward reaching and maintaining weight goals. Since the levels of carbohydrates necessary for weight control vary between individuals, there is no real blanket recommendation I can make other than to “eat fewer grams of carbs for weight loss” and “increase slowly to find a level of weight maintenance”. Don’t be afraid of eating fat; remember, it won’t make you gain weight.


As we discussed before, carbohydrates (a.k.a. sugar) get turned into fat pretty easily when eaten in excess. So, regulating carbohydrate intake is the best way you can control levels of body fat. If you were to eat almost no carbohydrates, your body would use up its stores of sugar (glucose and glycogen) pretty quickly and start to dip into its fat reserves for energy. Fat is then “burned” (split apart) for the sugar locked inside and used as the primary source of energy. The brain uses glucose when it is available, but once that runs out, it switches to using protein for energy by making and using molecules called “ketones”. So, in the absence of carbohydrates (and sugar), your body will simply use fat and protein for energy. There is nothing wrong with this, and our ancestors ate diets rich in protein and fat (from animals) before (and after) the invention of agriculture.

Finally, if you suffer from cravings for carbohydrates and sweet things, the best way to end the cravings is to eliminate all carbs from your diet for about two weeks. Your body will switch it’s metabolism over to using ketones and fat, and your carb cravings will start to resolve.

It is also very important to also have yourself checked out for dysbiosis, because excess fungal growth in your intestines can actually lead to sugar cravings. Think of it as the fungi (like Candida) “begging” you for their favorite food. Research has found that many fungus species can produce chemical messengers that trick your body and trigger a craving for something sweet. We must get rid of the excess fungus or we unknowingly become a slave to their desires; a diet low in carbohydrates, if followed for long enough, should help to eliminate unhealthy levels of fungus and bacteria in the gut.


It would be naive to suggest that a single diet, and therefore only certain foods, would be of benefit for everyone. For example, if you wish to avoid animal proteins (meat, chicken, fish, dairy and/or eggs) because of ethical or other reasons, you can still get enough protein and fat from plant sources to be healthy, but it will take more careful planning of food choices overall.

Another thing to keep in mind is that some people may be sensitive to certain foods. Certain proteins in foods, such as gluten and casein (a milk protein), can cause you to become sensitive or mildly allergic to them when you eat them. Still other foods may have toxic elements (e.g. solanine in nightshade foods, methylxanthines in coffee, tea, and cocoa) which may be problematic for different segments of the population who are sensitive to them (see our post Food Sensitivities and Allergies for more information).

The guidelines discussed here are more about the ratios of protein, fat, and carbohydrates than about specific foods (which we will discuss in later posts). It is important to tailor the specific foods that you eat around what makes the most sense for you. Obviously, if you are sensitive or allergic to a certain grain, vegetable, or other food then that would not make for a good choice in your diet.

The specific details of what foods you eat are important, but less so than the general makeup of your diet. You should try to keep your diet diverse, but focused on the goal of lowering carbohydrate intake (especially refined carbs and sugar) while making sure to get enough protein, fiber, fat, and nutrients.


If you have high cholesterol (and the associated risks of heart disease, stroke, etc.), it is critically important to make dietary changes. However, the changes most often suggested to people (e.g. eat less cholesterol, eat less fat, etc.) don’t make a lot of sense from a biochemistry standpoint and don’t typically do much to help lower levels of cholesterol in the blood. Without going into too much detail about the biological mechanisms involved, there are a few specific dietary changes that can help.

There are two huge ways of improving levels of cholesterol in your body; you can lower LDL (the “bad” cholesterol) or raise HDL (the “good” cholesterol), but doing both at the same time is much better. If you eat more vegetables and legumes, particularly those high in fiber and phytosterols, the levels of LDL in your blood will go down for the reasons we discussed earlier. HDL, the good cholesterol, moves through your bloodstream and actually removes damaging cholesterol from arteries and brings it back to the liver for reuse, preventing and in some cases reversing the damage to the walls of arteries. Raising HDL can be done in a number of ways including aerobic exercise, weight loss, and eating omega-3 fatty acids. However, one of the best ways of boosting HDL through your diet is actually eating more cholesterol and fat in your diet. This also raises LDL levels slightly, but the bigger increase of HDL as a result reduces the overall risk of heart disease.

Another huge dietary benefit can be gained by avoiding sugar and carbohydrates. The fructose portion of ordinary “sugar” (which makes up half of it) is processed in the liver in a very similar way to the way toxins are. As a result of this process, many free radicals are produced which, if they come into contact with LDL, directly cause damage to the cells lining the arteries leading to atherosclerosis (plaque buildup and hardening of the arteries) and heart disease. Another byproduct of sugar (and carbohydrate) consumption is the production of triglycerides. Triglycerides are a major component of LDL and the increased levels of triglycerides is closely associated with increased levels of LDL. Cutting out sugar and carbohydrates from your diet can make a huge difference in both levels of triglycerides and LDL.

So the combination of eating more vegetables, less sugar, more cholesterol, and more dietary fat (all elements of this overall diet anyway) helps to both raise levels of HDL and lower levels of LDL and triglycerides. This is a pretty simplified explanation, but there will be some upcoming posts specifically about cholesterol, free radicals (and oxidative stress/damage), and anti-oxidants which discuss the topics in greater detail in order to give a better overall understanding of these topics and how they relate to each other.

A great resource for determining the content of many types of nuts an seeds.
You can see a larger version by clicking on the image above.


  • Eat whole, unprocessed foods, especially a plant based diet with lots of vegetables, legumes, nuts and seeds.
  • Choose lots of vegetables and fruits as well as legumes, nuts, and seeds in order to get the necessary essential nutrients, fiber and antioxidants in your diet.
  • Ensure adequate intake of omega-3 fatty acids to prevent and decrease inflammation and it’s dangers, including making obesity worse.
  • Decrease or eliminate carbohydrates for weight loss and maintenance - except for most legumes and vegetables (some vegetables like potatoes, yams, sweet potatoes, carrots, winter squash and onions have a fair amount of carbs. Limit these vegetables for weight loss).
Other important concepts:

  • Choose certified organic or certified biodynamic food grown without synthetic pesticides as this is healthier for you and for our planet.
  • Avoid Genetically Modified Organisms (most corn and soybeans grown are GMO unless they are certified organic or biodynamic).
  • For animal products - ruminants (cattle, sheep, goat etc.) need to be grass fed for their entire life span to ensure the proper ratio of omega-3 to omega-6 fatty acids. Be aware that all wild caught fish has elevated mercury levels (especially large fish like tuna) and yet factory farmed fish have much lower levels of omega-3 fatty acids.
  • If you choose to eat animal products (meat, fowl, fish, dairy, eggs) as part of your diet, ensure that the animals are raised humanely. Animals raised in cruel conditions (as exist on factory farms) are not healthy physically, emotionally or spiritually. Eating animals raised in this manner should not be considered healthy or even safe to eat.
  • Ensure that you get enough essential minerals from seaweed or other sources.
  • Avoid unnecessary and unhealthy food additives including artificial dyes, coloring agents, or other “junk” that is usually added to processed foods. We don’t fully understand how these chemicals work in our bodies, but the evidence suggests that some of them are simply not safe and can even increase your appetite, making losing weight almost impossible.
  • Instead of artificial dyes and colors, choose a wide variety of natural
  • color in your diet (yellow, orange, red, green, purple, white). Natural colors are a sign of phytonutrients, a sign of powerful antioxidants that are naturally produced in the food.
I hope that this article will help you to make any new years resolutions about your diet just a little easier to accomplish. Happy New Year.

Researched and written by Dr. Rebecca Malamed, M.D. with assistance from Mr. Malcolm Potter.

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