Salt and cardio-vascular disease: Policy and Science clash

The recent video we posted of Dr SalimYusuf’s PURE study had a section on sodium intake, where he showed that the lowest risk of cardiovascular events, cardiovascular deaths and all-cause mortality was associated with an intake between 3000 and 6000 mg of sodium per day (equivalent to 7 to 15g salt per day). The current US average sodium intake is 3800 mg placing the general population nicely within this sweet spot, although towards the lower end.

Current US and UK dietary recommendations recommend an upper limit at 2300mg of sodium (6g of salt) whilst cardiovascular recommendations by bodies such as the American Heart Association aim to reduce sodium intake to 1500 mg per day (approx 3.75 g salt). If the PURE study is right (and it is not alone in questioning the current guidelines), then these aspirations would do more harm than good.

How did such discrepancy arise? The problem may be the use of surrogate markers. The thinking goes like this: Salt raises blood pressure. Raised blood pressure increases CVD risk, so salt increases CVD risk. This kind of thinking was evident in 2011 when the American Heart Association (AHA) called for salt targets to be reduced to 1500mg per day.At the time MedPage Today explained:

The evidence linking salt intake with blood pressure — and the major adverse outcomes of heart disease, stroke, and kidney disease — is “impressive,”…

That evidence includes more than 50 trials assessing the blood pressure effects of salt, as well as a meta-analysis showing that cutting salt intake by about 1,800 mg per day lowered blood pressure by 5 mm Hg systolic and 2.7 mm Hg diastolic.

This is a “critically important public health issue,” according to Appel and colleagues, and this AHA advisory must be considered “a call to action.”

On the basis of this ‘A leads to B leads to C, therefore A leads to C’ thinking initiatives were instigated all round the world to reduce public consumption of salt. A task force of concerned scientists even formed a lobby group to put pressure on food manufacturers, which successfully led to reductions in added salt in manufactured foods.

However, within a short time of the AHA call to action reports started coming in contradicting this advice.

Over this period it is clear that scientists were becoming more and more irritated with the dogmatic approach of the AHA and government bodies, and by the last article were publicly calling the AHA anti-scientific!

Despite all of the research questioning the validity of further salt reduction US and UK policy remains stubbornly wedded to the ‘less is best trajectory’. In their 2016 survey the UK government reported proudly that average sodium consumption fell from 3500mg in 2005 to 3200 mg in 2014.

Their report claimed “Too much salt in the diet can raise blood pressure which increases the risk of heart disease and stroke. A reduction in average salt intake from 8g to 6g per day is estimated to prevent over 8000 premature deaths each year and save the NHS over £570million annually.”

Yet contrary evidence from studies including PURE would suggest that this is not simply futile but probably harmful. You would think that with the swathe of research challenging the low salt dogma that public policy would be questioning the wisdom of further reductions. Not a bit of it. Dr Alison Tedstone, chief nutritionist at Public Health England, makes no bones about it:

Our analysis makes clear that there is a steady downward trend in salt consumption. While people are having less salt than 10 years ago, we are still eating a third more than we should.

Many manufacturers and retailers have significantly reduced the salt levels in everyday foods. However, more needs to be done, especially by restaurants, cafes and takeaways.

The intransigence of health policy makers leads researchers to exasperation and despair. As one writer put it:

…the ‘salt hypothesis’ is rather like a monster from a 1950s B movie. Every time you attack it with evidence it simply shrugs it off and grows even stronger. – Malcolm Kendrick

In an interview with MedPage today researchers who found that patients with heart failure who ate more salt did better than those who ate less made the following statement which we have published before, but is such a gem it deserves another outing:

“We have had no basis for any of our recommendations regarding sodium restriction during the past 50 years, although these recommendations have changed a great deal (for no good reason). After this report, we still have no basis for any of our recommendations regarding sodium restriction. We were ignorant before; we are not any smarter now. Did we really need this report to tell us that we lack evidence for our recommendations regarding dietary sodium in patients with heart failure?”
Milton Packer, Professor in the Division of Cardiology, UT Southwestern

Further reading:

The three wise herbalists brought… Gold, Frankincense and Myrrh




Everybody knows the story of the three wise men bringing gifts of Gold, Frankincense and Myrrh to the infant Jesus in the Christmas nativity. There is plenty of symbology around these iconic gifts allowing a host of interpretations. What I want to focus on here are some very real medical uses of the herbs Frankincense and Myrrh, and if you allow me a little bit of poetic licence, Saffron (as gold)…



Whilst the metallic element, gold, does have some medical uses, as a Medical Herbalist I do not use it, so I am going to talk about the golden herb saffron, which can literally be worth its weight in gold. [Daily Mail: How an ounce of saffron is more expensive than gold: Cultivation of exotic spice returns to Essex for the first time in 200 years]

Saffron is made from the stamen of the saffron crocus (Crocus sativus). Each crocus produces just three of these delicate strands per year, and they must be laboriously picked by hand before drying, at the right temperature and duration.

When used in cooking – such as saffron loaf or saffron rice – it adds a strong golden colour and has a distinctive aroma and flavour. I always add half a dozen strands of Kashmiri saffron when making a small pot of special gunpowder green tea. When used medicinally it has serotonergic (mood enhancing) effects, is an antioxidant, anti-inflammatory, anti-convulscent, has anti-timor effects, neuro-endocrine (hormone engaging) influence and has neuro-protective properties [ref].

Here is some evidence of medical efficacy:

  • Depression
    A 2014 review of the scientific literature [ref] identified six high quality studies that demonstrated  a positive effect, similar to that seen with anti-depressants drugs, and without the dependence or side effects.
  • Psychological and behavioural
    An excellent 2015 review paper from an American research team [ref] concluded: “Findings from initial clinical trials suggest that saffron may improve the symptoms and the effects of depression, premenstrual syndrome, sexual dysfunction and infertility, and excessive snacking behaviors.”
  • Cardiovascular
    It is reported that regions of the world that regularly consume saffron have lower levels of heart disease. The anti-atherosclerotic, antioxidant, anti-diabetes, hypotensive, anti-ischemic, anti-platelet aggregation effects of saffron suggest it is cardio protective and animal studies show this to be the case. [ref]
  • Diabetes
    Saffron has a hypoglycaemic effect and has been shown to raise insulin levels in diabetic rats with low insulin, whilst enhancing glucose uptake. Its antioxidant properties may reduce diabetic vascular complications too [ref].
  • Obesity & Weight Loss
    Saffron has been shown to reduce body weight in rats, whilst in humans it has been shown to reduce appetite and increase satiety [ref] “After 2 months, the subjects using the saffron extract reported a decrease in snacking and lost more weight than the control group”

Safety: The widespread use of saffron as a culinary spice suggests it is safe at those doses. This superb paper, published in 2012 by an Italian team of researchers reviews the known biological effects of this amazing herbal medicine [ref] and it concludes: “To date, very few adverse health effects of saffron have been demonstrated. At high doses (more than 5 g per day), it should be avoided in pregnancy owing to its uterine stimulation activity.” Well that’s fine, as it is therapeutic well below that dose. It is a significant antioxidant and anti-inflammatory, and since these processes a known to be the drivers of most major diseases I think it worth revisiting the use of this herb more widely. The problem is just the cost!



As well as being burned for incense in religious ceremonies this gum distinctly medicinal. Chewing on bobbles of frankincense is good for mouth ulcers and gum disease, but tastes like soap or turpentine. Mostly it is therefore used either as an essential oil or powdered and encapsulated. One can also concentrate the 5-Loxin component to optimise the anti-inflammatory properties, as in one of the products I stock.

This traditional medicine of the Middle East has expectorant, antiseptic, and even anxiolytic (i.e. calming) and anti-neurotic effects as well as the well recognised anti-inflammatory ones. Indeed recent studies have shown it has analgesic, tranquilising, anti-bacterial and anti-tumour effects too, which gives it a role in the treatment of quite a range of common conditions. [ref]

The following medicinal effects come from a 2016 review:

  • Gastro-Intestinal
    Its anti-inflammatory effect gives it a place in inflammatory bowel disease (i.e. ulcerative colitis and Crohn’s disease), irritable bowel syndrome, bronchitis and sinusitis. In human studies of colitis patients, the resin was far more effective than the standard drug: “Out of the patients treated with Boswellia gum resin, 70% went into remission while in the case of sulfasalazine [the standard drug it was compared to] the remission ratio was 40%”
  • Anti-fungal
    Frankincense is strongly anti-fungal towards candida species. As well as many other moulds including food borne moulds. (One wonders if it would be effective burned as incense to reduce mould spores in houses… )
  • Asthma
    Severity and risk of asthma attacks is reduced by consumption of Frankincense gum, or by inhalation of the smoke when burned.
  • Rheumatoid arthritis Multiple lines of evidence suggest that frankinscence could help via anti-oxidant and potent anti-inflammatory effects. One researcher noted that “at a dose of 200 mg/kg, B. serrata extracts shift the balance of cytokines towards a bone-protecting pattern”

Memory, Dementia, Alzheimer’s
There is considerable interest in the role of Frankincense gum in cognitive impairment as it has been shown to improve memory in animal models of Alzheimer’s [ref]. In fact recent studies have shown that it increases neurone formation in the hippocampus [ref], i.e. that part of the brain that is essential for new memory formation. A recent human study of cognitive impairment in multiple sclerosis found that it “showed significant improvement in visuospatial memory, but had no effect on verbal memory and information processing speed.” [ref]. I would not be using simply frankincense for dementia, as there are other very valuable measures that should be employed, but this resin, depending on the case, could play a significant role in a rounded treatment approach.

In my clinical practice I find Boswellia particularly useful in autoimmune disorders, and when inflammation suddenly occurs, such as polymyalgia rheumatica, for example, which can come on over night and cause severe joint pain, disability and exhaustion. The usual drugs used by doctors have real problems associated with them, as they are aimed at suppression of the immune system, which you cannot do without negative consequences, whereas taking a deeper look at what may have triggered the condition, and treating in a more thoughtful way with medicinal herbs, including frankincense, has been very successful to date with no long term adverse effects.



Another aromatic resinmyrrh, (Commiphora mol mol) also comes from the Middle East, in fact Yemen originally and it has been used in the Western Herbal Medicine tradition for hundreds of years. I prefer the alcoholic extract (tincture) to the resin itself for ease of use, and offer it as part of my Home Herbal set in a dropper bottle as shown above. It is part of the Home Herbal range of medicines that I encourage my patients to keep in their medicine cupboard at all times because it is so reliable, effective and practical to use.

Ten to twenty drops added to a glass of water makes an excellent gargle for sore throats, gingivitis (inflamed gums), receding gums, loose teeth, mouth ulcers, and as a general antiseptic mouth wash which can be swished between the teeth where toothbrush bristles may not reach. A few drops can be put onto the toothbrush along with toothpaste (or my favourite alternative – salt and sodium bicarbonate). Tincture of myrrh can be dabbed neat onto small cuts or bites as it is strongly antimicrobial, antiseptic and astringent, thus helping to defend against any nasty bugs that can get in when bitten by a mosquito or whenever the skin barrier is breached, and as an astringent it helps bring swelling down [ref]. It has been used successfully in the treatment of intestinal worms, as have certain other herbs, most of which, like myrrh, taste bad (to humans and to worms, clearly)!

Myrrh has many similar properties to Frankinscence, including analgesia (pain relief), anti-inflammatory and anti-obesity properties [ref]. I find it has a vital place in the treatment of most infections, including gastroenteritis, ‘flu, colds, sore throats, bronchitis, pneumonia etc, as well as ulcers in any tissue (incl legs, stomach and mouth) and in arthritis. As an anti-inflammatory it has a role in cancer [ref] along with other herbs and dietary measures.

Apart from the above uses, myrrh has also been used in leprosy and syphilis too, which, though it may sound far fetched is quite reasonable. It is a powerful antimicrobial herb, so any bacterial infections can sensibly be treated with this age old defender of health, including common candida albicans and staphylococcal infections. They didn’t give it to the Messiah for nothing! In fact midwives used to dab myrrh onto the cut umbilical cord of new born babes in the less hygienic environment of the past [ref].

  • Gastro-Intestinal
    The anti-spasmodic and anti-inflammatory effects of myrrh are of great value when treating inflamed gut disorders [ref]. As myrrh raises white blood cell numbers it assists in ulcer and wound healing too [ref]
  • Skin
    Myrrh has been shown to be effective at treating fungal infections of the skin [ref] including ringworm, and systemic fungal problems caused by candida albicans (once treated, maintenance through a low carbohydrate diet would be wise too).
  • Liver
    Myrrh has been shown to protect the liver from lipopolysaccharides (a major gut endotoxin) and “might be sufficient to combat cellular damage caused by various conditions that resemble fulminant hepatitis” according to researchers in Saudi Arabia [ref].
  • Obesity and Type 2 Diabetes
    Myrrh “has the ability to improve insulin sensitivity and delay the development of insulin resistance… and may be used as an adjuvant therapy for patients with insulin resistance.” [ref]
  • Parasites
    Here is an in-depth paper: Myrrh: A Significant Development in the Treatment of Parasites (pdf) by a colleague of mine, the Medical Herbalist Kerry Bone. Two of the most studied areas are for the treatment of schistosomiasis (a flatworm) and fasciola (a liver fluke) – two common parasitic infections in the tropics and subtropics [ref].

So, in wishing all my readers and patients a very Merry Christmas, I also want to encourage you to use your gold, frankincense and myrrh as wisely as those three wise men. Or rather, if you have any sort of medical problem or niggle, book an appointment with me and we will see what how best to approach it using medicinal herbs and nourishing foods. Chances are you will find me to be a wise woman too.

November News Round-Up


  • Fizzy drinks can’t claim to be part of a balanced diet
  • Aged cheese and longevity?
  • Parkinson’s disease may start in the gut (VIDEO)
  • How your calf muscle affects weight loss (!)
  • High-fat diet fuels long distance runner
  • Coffee reduces risk of dementia
  • Aspartame may be to blame for weight gain from sugar-free drinks
  • Vitamin D – do supplements work?
  • How cooking made us human

Read time: 6 minutes (1200 words)

Fizzy drinks cannot be part of a balanced diet

UK children sugar consumption

One of the tricks of purveyors of manufactured foods is to claim that their products can be consumed as ‘part of a balanced diet’, whilst failing to define the word ‘balanced’.

However, The Telegraph (15th November) tells us that researchers are now calling into question the validity of such claims after testing 169 types of fizzy drinks sold by major supermarkets in 2014 and finding that over 55% of exceeded the recommended limit of 30g of sugar per day (based on 330ml can serving size). One of the things that jumped out at me from this article is that of the 1.3 million employees in the NHS, 700,000 are overweight or obese! Yup, I think that’s about right, and yet I remember at some point in my childhood being struck by how slender nurses were and how their belts accentuated their waists. Not any more I fear! And we all know that there is a correlation between being a lower IQ and waist circumference. Just sayin’…

‘Eating cheese could be the key to a longer life’

…So went the headline of an article in that most highbrow of journals The Metro (15th November), who in their typically classy style go on to inform us “That’s right. Cheese is what you need to live forever.”

Behind the silly headline is a very interesting research paper which found that increasing intake of spermidine – a compound originally isolated from sperm, but present in all cells and found in high doses in foods including aged cheeses – extended the lifespan of mice. Please ignore the nonsense towards the end of this short article that crashes into the debunked theory about fat. Clearly cheese, fat content and all, made a positive difference in the study cited, so the fat cannot possibly be doing harm. The article did not consider the presence of vitamin K2 in cheese, but that glorious subject is for another time…

Parkinson’s disease may start in the gut

Read the article here: New Scientist (30 Nov) and remember, the gut has been called ‘the second brain’ for many years. It now looks more and more appropriate to call the gut ‘the first brain’. In other words, mess with your gut at your peril.

Astonishing new insights into what one of your leg muscles does (which will blow your socks off!)

soleus-muscleThe Mail online (25th Nov), has a fascinating article looking at how dieting reduces resting metabolic activity via – get this -the soleus muscles of the calves. (That’s it in the diagram opposite).

Apparently, these muscles are referred to as our ‘secondary hearts’ as they are responsible for pumping fluid back to the heart. ‘Sol‘ means sun, and the solar plexus is where the heart resides, and the sun is the source of life here on earth, so there seems to be a sun/life origin to these organs, recognised by the names the anatomists, in their wisdom, gave them, unless I am mistaken.

Dieting reduces their efficiency, reducing heart output and thus resting metabolic energy expenditure. This must be part of the explanation for the all round positive effects of walking (as opposed to running, which has all sorts of drawbacks).

The author emphasises the importance of keeping these muscles fit through long duration low intensity exercise. Well done Mail Online health reporters for finding this gem!

High-fat diet fuels long distance runner

The Business Insider UK (29th Nov) has a nice personal story “Why a guy who runs 100-mile races eats a high fat diet while training”

Anyone still doubtful of the work of Volek and Phinney, or Prof Tim Noakes, or even good old Robert Atkins, or any of the others who have been demonstrating the superiority of fuelling the body with fat, rather than carbohydrates, will appreciate this article.

Coffee reduces risk of dementia

The Express (30th Nov) reports on a study indicating that regularly drinking three cups of coffee per day reduces the relative risk of dementia by 27%.

“Moderate coffee consumption could play a significant role in reducing cognitive decline which would impact health outcomes and healthcare spending across Europe.“

The findings were presented at the European Union Geriatric Medicine Society’s 2016 Congress in Lisbon.

Aspartame may be to blame for weight gain from sugar-free drinks

New Scientist (24th Nov) reports on studies indicating that the artificial sweetener aspartame can lead to higher blood sugar levels and weight gain in mice by changing gut microbe composition and suppressing intestinal alkaline phosphatase which works by neutralising lipopolysaccharides, bacterial toxins that can irritate the gut lining.

Note in this article the voices of those in the soft drinks industry. Not too good on the actual science huh; more weighted to the emotional argument eh? Typical.

Vitamin D – do supplements work?

Low levels of vitamin D have now been associated with hundreds of different diseases. This month, for example, Science Daily reports on a study that found low levels of vitamin D in newborns is linked to a higher risk of multiple sclerosis later in life. What is not clear in many such associations is whether vitamin D plays a causative or contributory role, or whether is is just a marker for some other factor.

Trials using supplements have many times failed to show benefits, leading many to question the value of vitamin D supplementation. A headline in The Express (24th Nov) says it all: “Are YOU taking Vitamin D? It’s a waste of time and doesn’t prevent disease, scientists say”. If you are interested in the research behind this headline I would recommend NHS choices (24th Nov) who bring some clarity to the story!

There are however, many examples of where vitamin D supplementation has shown benefit, including reduction in asthma severity (see our October News roundup last month) and this month News Medical (21st Nov) report on a trial that found improvement of autism symptoms.

“Autism symptoms—such as hyperactivity, social withdrawal, and others—improved significantly following vitamin D3 supplementation but not after receiving placebo,” said Dr. Khaled Saad, lead author of the Journal of Child Psychology and Psychiatry study.


Vitamin D blood levels are largely a marker of sun exposure, rising in the summer and falling in winter. A recent paper looking at the benefits of sunlight shows that these extend well beyond vitamin D production, News Medical (21 November) reports: “Vitamin D supplements have not been shown to be an adequate substitute for sun exposure. Risks of insufficient sun exposure include increased risk of many types of cancer, cardiovascular disease, Alzheimer’s disease/dementia, diabetes, multiple sclerosis, myopia and macular degeneration.”

The importance of cooking in human evolution

New Scientist (2nd Nov) – A really nice article about the importance of cooking in human evolution and it’s health implications. I am sure you will enjoy reading it.


August News Round-Up

Breast feeding may protect babies from meningitis, blood poisoning and pneumonia.

The Mail (26th August) reports on a study by Imperial College London, which found that a sugar present in the breast milk of roughly half of women (it depends on blood type!) reduces rotavirus and group B streptococcus, as well as boosting a child’s ‘friendly’ gut bacteria, effectively protecting them from these infections. (Also covered in Medical News Today)

Childhood antibiotics increase risk of T1Diabetes

Whilst on the subject of infant gut health… MedPageToday (24th August) reports on a mouse study mimicking typical early childhood antibiotic exposure, which induced altered gut microbiota, T-cell populations, and gene expression which doubled the incidence of type 1 diabetes compared with mice on a low level of antibiotics.

Mediterranean diet more effective than statins

Many newspapers, including The Telegraph (28th August), reported on a study that looked at the impact of the Med diet on survival of heart patients. It found that it cut the chances of early death by 37 per cent (relative risk). Previous research has found just taking statins cuts mortality by 18 per cent, making the Med diet twice as effective… and at least four times as tasty. OK, I made that last bit up.

...and protects against Alzheimer’s and Dementia

Medical Daily (10th Aug) reports on a study published in the journal Frontiers in Nutrition which found that elderly people who eat a Med diet pattern benefit from better brain health.

Paleo diet in healthy people may improve cardiovascular health

A small preliminary trial found that after just 8 weeks there was an increase in the molecule IL10 (interlukin-10) indicating reduced arterial inflammation. For the exagerated headlines head over to the Mail (29th August), or for a more sober reflection try Medical News Today.

Fish oils in brief:


The lab rats get their own back!

Ketones improve cognitive function and endurance

Medical Daily (18th Aug) report on a study which found that lab rats made ‘ketogenic’ through calorie restriction and supplementing with ketones had improved cognitive function and exercise endurance. It’s an odd approach, but seems to lend credence to the performance athletes that are using high fat diets for endurance sports. What is remarkable in this study is that the rats were not only ran for longer, but faster too!

This Month’s Guest Publication: NEW SCIENTIST

New Scientist Aug 2016

In our household New Scientist is the only magazine we have a subscription for, and have received the print edition every week for over a decade. We are often struck by how often it covers topics we have just posted about or covered in a talk (i.e. We got there first – high fives!) This month’s editions have had several articles that I think might be of interest to my readers. If you don’t want to buy the print edition their website has some content that is free, although some requires a sign up or subscription, likewise with some of the links below.

1. Sleep disruption and infections  (FREE ACCESS)

I am seeing more and more evidence on the importance of sleep (see our post on Sleep and Health). Here is another bit: a study in which mice were shown to be more susceptible to viral (herpes) infections towards the end of the day, suggesting that late nights, sleep disruption and shift work may make us more vulnerable to infections.

2. Migraines and Salt  (FREE ACCESS)

What is so great about science is that it is always throwing up unexpected results. Here is one of those. It had previously been observed that sodium levels in the cerebrospinal fluid rise during a migraine. High sodium levels make neurons more excitable. So it seemed reasonable to assume that high levels of salt in the diet might be associated with increased, or worse migraines amongst sufferers.

So researchers were surprised, as was I, when they checked the surveys of 8819 adults and discovered the exact opposite – those with the highest levels of sodium in their diet reported the fewest severe headaches and migraines

3. More doubt on vitamin pills  (FREE SIGN UP

Many vitamin pills – taken as an ‘insurance policy’ when there is no evidence of deficiency – may do more harm than good. The latest bit of research is that calcium supplements appear to increase the risk of dementia. One study found a seven fold increase in risk!

4. Archaeology – food for thought

Otzi and Teotihuacan

LEFT: Analysis of Otzi  the 5300 year old, copper age iceman discovered in the Alps twenty years ago, has shown that he was clothed in the skins of many animals: His quiver was made from roe deer, his hat from brown bear. His coat from goat and sheep, leggings from goat leather, and his loin cloth from sheep leather. (FREE ACCESS)

RIGHT: Studies of the ancient Mexican city of Teotihuacan (1st to 4th century) has revealed that they farmed rabbits in large quantities for food. (FREE ACCESS)

5. BAD MEDICINE: Why so much health advice turns out to be wrong (SUBSCRIPTION REQUIRED)

A great article documenting ten major areas of medicine where the conventional thinking turned out to be wrong. I’ll just give you three of my favourites:

    Rationale: they work in cases of heart attack, so have been assumed to benefit those with stable heart disease, so became common practice from 2004.
    Reversal: Shown not to reduce future heart attacks or death, and may cause harm
    Rationale: Early detection will help intercept the disease before it progresses too far. So Mammograms and PSA testing have been routine since 1980’s
    Reversal: Many false positives lead to unnecessary procedures. PSA testing no longer recommended in the US.
    Rationale: Removing damaged cartilage will (obviously) reduce pain and increase mobility. By 2002 their were over half a million procedures being carried out each year in the US.
    Reversal: Several trials have found no benefit over physical therapy alone.

I hope you have enjoyed these items. If so, leave a comment to let me know. (Or hit the like button if you’re in a hurry!)

Why we pass on the semi-skimmed and low-fat dairy


If you take a look at the recipes, articles and health issues discussed on this site you will see that we love full-fat dairy products, (see here, here and here). Of course, not everyone can tolerate cow’s milk (or sheep’s or goat’s for that matter), but for those that can full-fat is the way to go.

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