Open Future HealthHPCSA v Prof. Tim Noakes - The Verdict and Implications

Copied from the ADSA Website

Statement on the outcome of the HPCSA inquiry into the conduct of Professor Tim Noakes

The Association for Dietetics in South Africa's (ADSA) former president Ms Claire Julsing-Strydom submitted a complaint about Professor Tim Noakes to the Health Professions Council of South Africa (HPCSA) in 2014 on behalf of ADSA regarding, what it considered, unconventional infant nutrition advice.

The complaint

The complaint was lodged after Professor Noakes advised a mom via Twitter to “ween” (sic) her baby on to a low carbohydrate, high fat diet. ADSA believed, at the time, that the advice:

Professor Noakes did not advise the mom to continue with breastfeeding, which undermined its importance. For these reasons, ADSA considered the advice unconventional and requested the HPCSA to investigate further.

Prof. Tim Noakes, was a celebrated academic, Emeritus Professor in the Division of Exercise Science and Sports Medicine at University of Cape Town, and Co-Founder and Executive Co-Director, Sports Science Institute of South Africa. Among his awards in 2013 - nominated as one of 100 World Class South Africans.

Dr Noakes testifies: "This trial has been an ordeal, but it's also been very helpful. It's raised the profile of the Real Meal Revolution, and helped us sell more books and commit more people to Banting. But we are only reaching the upper-middle class population. We need to penetrate the population much deeper. The next task is convince doctors and dietitians. At the moment patients are educating doctors. That should be the task of medical schools and universities, including my own university. I worry about my own medical faculty. They seem very reluctant to change."

"Nothing in my medical education suggested that the choice of the food I ate might be important in preventing future disease conditions." .. "It's taken me 61 years to realise that bread, cereals, rice and pasta in my diet, may be toxic to my body." ... "Today my goal is to show that better nutrition is the key way we can keep ourselves healthy."

Noakes says, "We can't go on ignoring what we know;" and pretending that we are doing evidence-based science. "Industry wants us to believe we don't know the cause of obesity, since that lets them keep driving the sales of their addictive foods."

"The public deserve the truth. South Africa deserves to know the truth we've been denied for 50 years. We don't need to be dominated by other interests. (The WHO Guidelines, or the US Dietary Guidelines) If we want medicine to move forward we need to change what we teach young doctors. They need to know that type two diabetes can be reversed, by simple dietary changes."

"Weston Price, in the 1930's, identified the benefits of a healthy diet: no diabetes, on dental caries, no heart disease and no strokes. Cancers, auto-immune diseases and neurological diseases were very rare. Price considered these were all the "diseases of civilization" caused by our poor diet. If we read the literature this information is all obvious. But in our "educated" modern world, we refuse to acknowledge the people we call "primitive" were more healthy than we are today. We live in a toxic food environment, that we need to change, if large numbers of us are to get well again. We begin by telling each other the truth about the food we eat."

Faulty Nutritional Advice

"I believe that the current Dietary Guidelines for South Africa are incomplete and is some cases incorrect. I would be failing in my responsibility if I have specialist knowledge and experience that better informs the public of their health options and I didn't try to communicate what I believe."

Professionals are expected to work within protocols that are intended to "protect the public" and standardize the care people are given.

"My father was given the wrong dietary advice, when he got type two diabetes. Thirty six years later the same wrong dietary advice is still being offered to type two diabetics."

"My father was told to eat a moderate balanced diet. That carbohydrates were an important source of energy for the brain. That glucose was an essential source of energy for the brain, and it was critical that he eat carbohydrate foods at each meal."

"Diabetes was described as a problem of blood glucose control, and the remediation was to increase the supply of insulin. Today we know that this advice is scientifically wrong, but it's still the advice given around the world. The protocol has changed little in 40 years. People with type two diabetes, are condemned to a lifetime of medication, and to the certain knowledge that their disease will get worse and eventually kill them." ... "That's not what modern science says. We know that on a very low carbohydrate diet, most people can be completely symptom free. Why don't our doctors know that?"

"Most doctors and health professionals only have a superficial knowledge about nutrition. What they "know" is the protocol or the convention, and largely that's the only basis for what they say and recommend to patients."

The Internet is breaking down the barriers between the people who have knowledge and those who don't. Everyone of us can read scientific papers online, that a few years ago were only available to researchers. Many thousands of diabetics have discovered for themselves that they can minimise of eliminate the use of insulin or any other medication by the simple process of limiting carbohydrate in the diet. They have abandoned the medical model.

"In the same way medical professionals who recognise the new science and have changed their practise to give their patients the best possible care, run the risk of prosecution, and loss of their professional status. My job is to make sure that a different message gets out, so that these people can be protected."

A dietitian for 35 years, Jennifer Elliott in Australia, lost her job in that way. After successfully guiding her daughter to lose weight using the LCHF method, Elliot has increasingly used that method in her practise for 10 years. In 2014, a patient reported her to the Australian Dietitians Society and her license was revoked.

Yet at the same time the Australian CSIRO, publicly launched a new scientifically researched low-carbohydrate diet, that promises improved outcomes for weight loss and diabetes management. CSIRO clinical studies found that following a low-carb diet improved the lives of obese patients with type 2 diabetes.

Local FileMany researchers understand that the current dietary paradigm is wrong. In South Africa, Dr Tim Noakes is hailed by some, as a South African hero. Public knowledge of the issues is increasing, enabled by the Internet. Within the next ten years, I hope everyone will agree that poor diet; too much carbohydrate, caused metabolic syndrome, created inflammation in our blood vessels and caused heart disease. Case closed.

Professionals and Self Defence Strategies

"There are forces working against the pursuit of knowledge. I should have been protected by my university, the University of Cape Town. Instead they chose to attack me. In August, 2014, four professors at the University of Cape Town wrote a letter to the Cape Times. They confirmed that 1 in 3 black South African women were obese. They agreed that the popularity of the Banting Diet proved that people can lose substantial amounts of weight.

Their concern was that I was claiming that the Banting Diet could prevent or even reverse Type 2 Diabetes. Dr Larry Distiller, founder and managing director of the Centre for Diabetes and Endocrinology, said there are 4 million people in South Africa who suffer from Type 2 Diabetes, and they should not be told anything that cannot be supported by sufficient scientific literature.

Dean of the Faculty of Health Sciences, Prof. Wim de Villiers, claimed that the Banting Diet was one dimensional, at the expense of healthy carbohydrates, and that a balanced diet must included food from all food groups."

"I find that utterly unacceptable. I've served them for 51 years. The statements written in their letter to the Cape Times are completely without foundation. There is no basis in science for their criticism. Professional pride and self worth have a great deal to do with one's ability to re-think one's position. I was forced to re-evaluate my position. What were they trying to do, humiliate me?" ... "In my professional life I've often been in a position where my work challenged the conventional view. It's my responsibility to apply the discipline of science and to challenge views that are wrong or harmful."

Professions often act collectively to protect themselves. They control who can and cannot enter the profession, and they try to control the market for their services, they seek to project their image in a manner that keeps the price high.

Their action really hurt. What or who's reputation did they think they were protecting? What income stream was at risk, if they supported my professional integrity?

"I've learned that money drives what happens. Ketones can't be patented, so there is no commercial effort to promote their use. A ketogenic diet is highly anti-inflammatory, much better than any products on the market, but that knowledge is ignored, because there is no profit potential."

"It's easy for a dietitian or a doctor to blame the obese patient for his/her obesity. That allows us to ignore the possibility that the dietary model we are using might be wrong. It's much easier to shoot the messenger, than to re-examine the ideas on which one's professional career is based."

"Maybe it's time to read the literature. Our team has brought the evidence to this court. We have now a unique opportunity to in the history of medicine, to examine the evidence."

Type Two Diabetes

Type Two Diabetes is the most important Public Health problem in South Africa. Type two diabetes, and the many health problems that will cause, threatens to bankrupt the health system.

Type two diabetes is incurable and progressive, only if people continue to eat carbohydrates. In the Western Cape, SA, diabetes is out of control, and diabetes related health problems threaten to consume the entire health budget in a few years. That need not happen.

I suspect that my view that type two diabetes can be reversed by diet alone is a key reason why I'm here today.

The real problem with type two diabetes is insulin control. The best way to control insulin and minimise it's use is to avoid dietary carbohydrates. Treating high blood glucose levels with insulin addresses a symptom but ignores the problem. Patients get progressively worse, not better. Excess insulin, Hyperinsulinaemia is the key driver of disseminated arterial disease, the cause of metabolic syndrome, and later cardio-vascular disease.

You only have 4-5 grams of glucose in your blood at any time. If you ate no carbohydrate at all, your liver can easily make all the glucose it requires from protein.

The body is designed to have a constant low level of blood glucose. When we eat a meal, we can easily add an extra 100gm of glucose to the system, creating an emergency, which in healthy people insulin production easily resolves. Insulin drives glucose out of the blood into glycogen reserves and into fat reserves, until the crisis is over.

The way most of us eat, to refuel every 2-3 hours, serves to again recharge the blood with excess glucose, causing another flood of insulin in the system to overcome another self created "glucose emergency." Once insulin resistance develops there is always excess insulin in the system. That over-rides the signal from the hormone leptin. Leptin signals that fat storage has begun, and activates the appestat, to stop you eating. If you are insulin resistant the leptin signal is blocked, because insulin is still trying to store glucose (the emergency comes first), so the appestat doesn't work, and you continue to feel hungry, even though you're overflowing with "energy." Obesity is in this way "caused" by faulty hormone response. But that faulty response is the result of both insulin resistance and eating carbohydrates.

There comes a time when we need to review our "knowledge" and see if it still has value. If a doctor follows the protocol for type two diabetes, his patient will get worse not better over time. In medicine there has never been a case where people reverse their diabetes by following the recommended protocol. The Credit Suisse Research Institute report confirms that the WHO and the American Heart Association recommendations are outdated.

In contrast, if you look online you can see thousands of cases where people have reversed their diabetes by avoiding carbohydrate foods. The profession dismisses those cases as "anecdotes" which have no scientific value. At some stage we should recognise that so many anecdotes are a signal that we should not ignore. Perhaps the protocol we are using has problems.

Insulin Resistance

When doctors follow the recommended protocol they order a blood test and look at both triglycerides and cholesterol levels. If triglycerides are high they recommend a low fat diet. If Cholesterol is high they recommend statins. The protocol doesn't require looking for non-alcoholic fatty liver disease, or for insulin resistance. I believe that more that half the population is likely to have those problems. People with non-alcoholic fatty liver disease, or insulin resistance, have measurable symptoms for many years before they become obviously unhealthy. We don't know the numbers because we don't test for it.

Roslyn Yalow and Solomon Berson in 1965 said: "The release of fatty acids from the fat cells is controlled by the negative stimulus of insulin." So low insulin allows you to lose weight. Fat deposits shrink if glucose is so low that an insulin response is not triggered.

In 2005 in a textbook George Cahill writes: "Carbohydrate in the diet drives insulin. Insulin production drives fattening." Which is what Robert Atkins tried to tell us in 1973, but he was called a quack, and was strongly attacked by the medical establishment.

Today we hardly ever diagnose insulin resistance. We know that type two diabetics are insulin resistant, but they have been insulin resistant for 20 years, unrecognized, and no corrective action taken. We need to act decades earlier than we do. The dietary guidelines assume the everyone is insulin sensitive, and that excess blood glucose is easily controlled by insulin. I believe that's not the case for 60% of the population. Undiagnosed insulin resistance is very common, but we never look for it, so it's an invisible problem, that leads to a cascade of health problems later in life.

I now believe that fatty liver disease is likely to become the best predictor of Heart Disease. Liver specialists may save us from a future epidemic of diabetes and heart attacks.

Obesity is age related only because insulin resistance takes time to develop.

Medical Diets in History

In 1883 Dr Wilheim Ebstein wrote that "dietary fat has the property to produce satiety more rapidly, to diminish the craving for food and to abate the feeling of thirst."

In 1892 Dr William Osler, in the text book "The Principles of Medicine" confirms the diet Dr Ebstein proposed. "All carbohydrates and starchy foods should be reduced to a minimum. Sugar should be entirely prohibited. A moderate amount of fats as recommended by Dr Ebstein should be allowed."

Yet by 1977, among doctors, making carbohydrate the essential part of the diet was entirely accepted, based on the assumption that dietary fat was causing heart disease. Smoking was common at the time and was not considered a health risk by doctors.

The WHO is silent and compliant because it is reliant on external funding. Governments are also compliant to the demands of industry and other contributors to financial objectives. In this way, by official weakness and default, industry controls the nutritional knowledge in the society. Most of the "information" distributed by these official channels is engineered to confuse you, and is not primarily intended to improve your health. The objective is to maintain corporate sales.

The Women's' Health Initiative produced results that made no sense to people who expected that the low-fat low cholesterol diet to be a healthy diet. But that result is entirely what someone on a Banting diet would expect. On reflection the MRFIT trial also had a surprising conclusion, which may be easier to understand with today's LCHF knowledge.

Homeostasis should maintain the body in a healthy state. Your weight, your blood pressure, your blood glucose levels and cholesterol levels should always be tightly controlled. The energy imbalance model is wrong, it's a brainless model that excludes homeostasis and the function of the appestat.

It's not true that the lack of physical activity among adolescent females is the cause of their obesity. You cannot outrun a bad diet. Avoiding fat in the diet, based on faulty understanding of body metabolism, is a likely driver of teenage obesity. We need to educate our young women, but they need quality information, not propaganda from the food industry. Universities and schools have a responsibility here.

The Naudé, Stellenbosch, Cochrane Review

Celeste Naudé

"I first heard about the Naudé Review in 2013. It began a few months before that. I wondered why they made all that effort, because to me the science supporting the very-low-carbohydrate diet was quite clear."

"When the Naudé Review was released, it was used by the study leader and many others to attack the Banting Diet and the Real Meal Revolution. In the report itself neither the Banting Diet or the Real Meal Revolution are mentioned. The HPCSA used the report as a scientific justification for a direct attack on me."

"The Naudé Review was put together to prove a point. Ms Claire Julsing-Strydom wrote that "everyone was waiting for the publication of the review." She went on, leading me to ask what's going on behind the scenes, who is "important," who is "all" and "we" and which "big organisations" can she be referring to? The Naudé Review has nothing to do with using Twitter or with infant complementary feeding."

"When the Naudé Review was released it was used against me and the Banting Diet. Celeste Naudé wrote, "Celebrity professor Tim Noakes' popular low-carbohydrate Banting Diet, is neither healthier nor better for dropping kilos than a balanced weight loss diet." ... "There was no difference for weight loss." There were several articles in the press from the same source. These articles are derogatory of both myself and the Banting Diet."

Stellenbosch Study in the News

Quoting from Health-e News, an article where Wilma Stassen reports on the "Stellenbosch Study": "This study shows that when the amount of energy consumed by people following the low carbohydrate and balanced diets was similar, there was no difference in weight loss," says lead researcher, Dr Celeste Naudé, from the Centre for Evidence-based Health Care at Stellenbosch University Faculty of Medicine and Health Sciences.

The above statements are clearly intended to undermine the success of the Banting programme. As stated elsewhere, they did not put the Banting programme or other programmes like it to the test. Local FileThe Banting Diet works, and the diet Stellenbosch University has been recommending, does not work unless you are insulin sensitive. For Stellenbosch University, and their financial backers, that's a problem.

About now an independent view will be useful. The Credit Suisse Research Institute produced this important document, warning people that the sugar industry is not a good place to have your money invested. (There is a follow-up study on the importance of fats in the diet, here.)

The response from the ivory tower at Stellenbosch University, to the strong critical attack by Zoe Harcombe has been silence. There has been no comment either on the "Not Guilty" verdict for Dr Noakes. That's how the establishment dealt with the success of Local FileVilhjalmur Stefansson, in 1928; and the "failure" of the Local FileWomen's Health Initiative, in 1998. They will pretend it didn't happen.

The Truth Will Set You Free?

"When our beliefs are attacked, we respond by attacking the person who is the messenger. I've been subjected to strong criticism for my scientifically stated positions before. I wrote a book about that; "Challenging Beliefs: Memoirs of a Career."" (Many examples: cricket batting, hydration during training and events, resting players, rugby neck injuries, swimming in cold waters)

Noakes writes: "The search for truth has always kept me focused, in the face of these attacks." ... "If you challenge someone's hallowed beliefs you must expect an aggressive reaction."

"Sometimes people who stand up for the truth pay dearly for their values. I believed that Lance Armstrong was a drug cheat and I wrote an article saying so in 2005. Doping was common in cycling at the time. I refused to share the stage with Armstrong. That stand cost me little."

On the other hand, David Walsh took on Armstrong six years earlier in 1999, and wrote a book about it. It was thirteen years later that Armstrong was finally exposed. For 13 years Walsh was vilified and publicly attacked. Even people who knew Armstrong well and knew that he was cheating, continued to defend him. The cost to Walsh was immense.

Emma O'Reiley, Betsy Andreu, Stephen Swart and Greg LeMond, all came forward with evidence against Armstrong and suffered for it.

That was made worse by the willingness of the public to close their eyes to the drug use so long as it led to "success". Sometimes we pretend not to know, things that we do know.

As David Walsh says, "How can you reveal the truth if those to whom you are speaking don't want to hear?"

In her book "Galileo's Middle Finger:" Alice Dreger concludes that ethical science is essential for justice to prevail in any society. Scholars must not act like cattle. "The pursuit of evidence is perhaps the most pressing imperative of our time" she says.

Evidence Based Dietary Advice?

With diets, smoking, exercise, or drug use; it's not possible to do randomised double blind studies. So when John Yudkin produced data showing an association between sugar and the incidence of cardio-vascular disease (1970), it was easy for the sugar industry to attack him with the claim, "that there is no clear evidence." You can see everywhere, that the food industry is very active in protecting it's interests.

The Framingham Heart Study, is highly respected, and has been running since 1948. William Costelli, was for some time the leader of that research. He said: "Most of what we know about diet, saturated fats, cholesterol, blood lipids and other measures comes for ward-type studies. Alas the findings have been disappointing. The evidence we have has been contradictory."

For instance the Framingham Heart Study shows that the more saturated fat people ate, and the more cholesterol and the more calories they ate, the lower was their serum cholesterol and their body weight. The original finding that total cholesterol was a good measure of cardio-vascular risk, has been totally reversed. Total cholesterol, on it's own at least, is useless for predicting CVD risk. Besides, after the age of 50 there is no increased mortality with either high or low serum cholesterol levels. For people over 65 higher cholesterol seems to be protective, reducing the incidence of both CVD and cancer.(Maybe cholesterol is irrelevant, perhaps it was always a false CVD marker.)

Almost all of the "evidence-based" nutritional science we have is based on observational studies or associative studies. The Harvard School of Public Health has been very active in producing these papers, producing more than 2000 over the last 20 years. The hazard ration of these studies is very high, meaning that any "findings" are very unreliable. But it's become acceptable to put 15 or 20 of these studies together, and if there is a pattern to them, that's considered a measure of "proof."

In January 2015 Harvard Medical School lifted the "ban" on dietary fat. "There is on apparent limit on the amount of dietary fat people should be eating." In a similar way with no fanfare, the Dietary Guidelines for Americans 2015, no longer recommend a limit on dietary fat, although whole-grains still get full approval.

A Study prepared for South African Insurance companies show that there is no relationship in South Africa between deaths and cholesterol levels. That study also shows that of the seven markers tested, only diabetes (Very strong), age and smoking, were good predictors of CVD. "I believe that if they were measured, insulin resistance and fatty liver disease are common and would also be good markers of future illness including CVD."

The Lyon Diet Heart Study, took 430 people who had already had a heart attack, and put them on two different diets. Something very unexpected happened, and after 27 months the trial was stopped. If you believe that CVD is caused by a slow build-up of fats or plaque in the vascular system over many years, the study outcome isn't understandable. People on the American Heart Association's Prudent Diet, showed no improvement. People on the Mediterranean Diet, which had much more omega-3 fats and reduced omega-6 fats showed a distinct advantage in less than six months and that advantage increased the longer the trial went on. The researchers behind this study were very disappointed, because the result's didn't confirm the expectations they had.

The Women's Health Initiative proved that a low-fat diet does not improve health. Once people get their diet right, the whole health outlook begins to change.

Challenging the Nutrition Paradigm

Prof. Tim Noakes says that we deny what we know, if it's inconvenient for us. With regard to fats and weight loss diets nutrition science has been denying what we know for a long time. In the 1950's we knew that carbohydrates made people fat and that dietary fat was healthy.

"We've allowed the food industry to tell our children what's good to eat. We've facilitated the take over of our dietary advice by industry in two stages. First we mandate that only registered members of a profession can give dietary advice. Then we allow the food industry to become the key funding source for the society that administers the profession. We create a monopoly industry to give dietary advice, and give financial control of that industry to firms like Coca-Cola, and we call it a "partnership.""

The American Dietary Guidelines are also driven by commercial necessity, leading to four fundamental statements; That starchy foods should be the basis of the diet, that you should eat at least four servings of fruit and vegetables every day, that fats should be eaten sparingly, and that dietary cholesterol should be limited. There is no scientific evidence to support any of those recommendations. They exist for political and commercial reasons. The idea that we should eat five plus servings of fruit and vegetables a day has no basis in science, it's entirely a commercial proposal.

The global food and agricultural corporation Cargill, advertise in the National Geographic Magazine, promoting the sale of white bread. "Thrive" is the headline. The sub-heading is "How can we use nutrition to help kids thrive?" The advertisement goes on to explain how whole grain wheat flour is 100% natural, and is essential for brain development, healthy bones and energy. This is propaganda. Children need protein and fat, for the best development of their brains. The current South African guideline for complimentary feeding states that fats are essential for optimal growth, and that those foods should be eaten every day. (It's acknowledged that in many South African homes, poverty makes regular supply of high density nutritional foods difficult.)

In South Africa those who live in the country often eat superior food to those who have moved into the city. In the country some high quality food, meat, fish and eggs for instance, might sometimes be free. In the city you need to buy all your food, and carbohydrate foods always appear to be the cheapest. The human metabolism doesn't change when you change your address.

Prof Nancy F Kerbs at the University of Colorado School of Medicine, has shown that children almost exclusively breast-fed and given meat and dairy as supplementary foods, grow taller and develop bigger brains.

When a child is exclusively breast-fed, the child is in mild nutritional ketosis. Complimentary feeding with meat and dairy foods, including eggs, continue that metabolism. Introducing infant formulas or cereal foods stops ketosis, and isn't desirable.

"Dairy foods and meats are complimentary foods to breast milk in the diet of infants. Dairy foods provide fat and keep the baby in ketosis for maximal brain growth. Meats supply essential iron and zinc to the diet. Chicken, offal meats and egg yoke are true complimentary foods. Unfortunately, chicken, fish, meats, dairy foods and eggs are seen to be expensive compared with corn and wheat based foods."

Like-wise the idea that whole-grains are important to our health has no basis in science, although Harvard University seem to be keen on the idea. Whole grains contain a lot of energy and not much nutriment.

If commercial product promotion is causing a health problem, it's not in the interest of future business sales to solve it. They will try to complicate the message and confuse the situation. The tobacco industry provides an easy example of how companies will respond. So we keep getting the message that the causes of obesity are complex, and that the problem needs more study. That's completely wrong. Obesity is simple, we've known how to avoid obesity for more than 100 years. The real problem is that there is a great deal of profit to be made by selling foods that make people fat. Nobody wants explain that problem, strongly, demanding action. Which political party is game to limit commercial activities and the sales of the food industry?

Many "Diseases" have a Dietary Root.

In 1998 Gerald Reaven identified that a high carbohydrate diet caused excess insulin in the blood, and that caused future health problems. This was not the view of Stanford University at the time. Stanford University had a very large investment in heart disease research, with many specialities. Reaven's focus on diet was not well received. Reaven goes silent on this matter.

The six very common "diseases" we call metabolic syndrome are all resolved by the right diet. That may not be the end of the health advantages of eating a low-carbohydrate high-fat diet. Several more health improvements are being claimed, but without good evidence yet.

Final Thoughts - Implications.

The result of this hearing will have severe consequences for the HPCSA. They are likely to face a future claim for damages and costs. They already have a substantial bill for legal costs. Questions about governance and competence will be asked.

The ADSA has already begun a process of substantial reform. The adverse public reaction to their position statement after the hearing, will force them to continue the process of re-evaluation and change.

The Real Meal Revolution will continue. But the LCHF movement is largely talking to itself. Deep penetration into science, health care and the public mind has not yet happened.

Stellenbosch University and the University of Cape Town are silent. They will pretend that the judgment was just about twitter, and that the Naudé Review wasn't exposed as incompetent, perhaps even as fraudulent. Certainly the publicity on the release of the Naudé Review, was a direct attack on the Banting Diet, Dr Noakes and the Real Meal Revolution. That attack has backfired. Damage has been done.

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