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Reversing Autism with The Nemechek Protocol – Update 2017

Reversing Autism with The Nemechek Protocol – Update 2017
March 20, 2017 Dr. Patrick Nemechek and Jean Nemechek

Nemechek Autonomic Medicine Autism 2017There is growing scientific evidence that an imbalance of intestinal bacteria called SIBO (Small Intestinal Bacterial Overgrowth) along with excessive inflammation within the brain are responsible for the features associated with Autism as well as ADD/ADHD, mood disorders, and developmental delay in children.

Bacterial overgrowth occurs when large numbers of bacterial that predominantly live in the colon migrate upwards, and increase the number of bacteria within the small intestine by 10,000 to 100,000-fold. This added bacterial load in the small intestine has two consequences that contribute to Autism.

First, the bacteria often tend to be of a clostridium species which can produce propionic acid in massive amounts. Propionic acid is a short chain fatty acid that is normally produced in small amounts within the intestine but the higher concentrations are being linked to some of the behavioral aspects of autism.

In animal studies, high propionic acid leads to the development of antisocial behaviors, increased sensitivity to sound, light, and touch, as well as gait abnormalities. In human studies, children with autism have very high concentrations of propionic acid within their tissues.

Secondly, the increased concentration of bacteria within the small intestine causes leakage of pieces of bacteria into the large concentration of immune cells that surround the small intestine and triggers the inflammatory reaction referred to as leaky gut.

A TESTIMONIAL

Hello! Just wanted to share that I started my Autistic/Apraxic 3 year old son on your protocol almost a month ago. He had about 10 words before this, averaging 1 new word a month prior. He has since, in that short time had an explosion of speech. He has been saying now about 1 new word a day, said 3 new words just yesterday, and has even spoken a few 3 word sentences. I felt hopeless before trying your protocol and cannot believe the large gains we are seeing so quickly! Thank you thank you thank you!!!!!!!   –   A Mom on Facebook

Leaky gut causes an increase in peripheral pro-inflammatory cytokine levels and allows for the inflammatory priming of a specialized form of white blood cell known as microglia within the central nervous system.

The combined production of inflammatory cytokines and activated microglia are primarily responsible for the developmental issues, seizures, sensory issues, mood and attention disorders commonly associated with autism.

A child is born with approximately 100 billion neurons and over the ensuing 18 years, needs to prune these neurons down to 50 billion in a process referred to a synaptic pruning. Excess inflammation from leaky gut, microglia priming and omega 3:6 imbalances prevents otherwise healthy microglia from pruning fast enough, and results in developmental delay.

The priming effect from the bacterial overgrowth causes many microglia to shift into the M1-phenotype, and results in the brain being less able to fully repair itself from commonplace physical (falls and bumps to the head), emotional (fear, abuse, neglect) and inflammatory (surgery, infections, vaccines) brain injuries.

A small residual amount of damage will remain after each injury, and each new injury leaves residual damage upon the prior injury in a process referred to as cumulative brain injury. The abnormal neurological functioning from cumulative brain injury can occur slowly over time and or rapidly depending on the intensity of the brain injury. Damage to different portions of the brain will result in different outward symptoms such as ADHD, chronic anxiety or gait abnormalities.

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The elevated inflammatory cytokines are also able to turn on certain genes that are linked with autism and may be responsible for certain features or more severe forms of Autism.

And finally, the excessive inflammatory environment in the brain reduces the seizure threshold and make seizures more likely to occur. The drop in the seizure threshold from inflammation is seen when young children without Autism develop febrile seizures with the fever and inflammatory reaction that occurs with simple upper respiratory viral infections or middle ear infections.

My understanding of the bacterial and inflammatory features in Autism have opened the door for me to provide groundbreaking treatment. The bacterial overgrowth increases propionic acid levels that cause kid’s brains to function differently, almost like a chemical impairment or slight intoxication, and at the same time the inflammation prevents normal neuron pruning and development as well as inhibits normal brain injury repair.

My approach to reverse the key components in Autism is straightforward. To provide the brain with a healthy, non-inflammatory environment to function more normally and to allow microglia to correctly prune and repair the brain, we need to reverse bacterial overgrowth and suppress the production of inflammation cytokines that are produced from a variety of sources.

By applying a logical understanding of science, I have focused application of The Nemechek Protocol™ medical consultation and treatment services on Autism, and have reversed the key features of Autism in many children.

The Nemechek Protocol for Autism uses a prebiotic fiber called inulin to reverse and control bacterial overgrowth, and high doses of omega-3 fatty acids to normalize microglial function and normalize the inflammatory state within the brain.

Cooking with domestic extra virgin olive oil also helps reduce brain inflammation resulting from linoleic acid, an omega-6 fatty acid found in in high concentration in cooking oils and processed foods.  Inulin is a natural fiber found in onions, garlic, artichokes, agave, chicory root and many other plants.

When buying powdered inulin, I avoid ones that also contain probiotics or digestive enzymes as these ingredients can makes some aspects of Autism worse.  (See my post on probiotics for more info on this topic.)

I find that 2-4 inulin gummies or 1/2 to 1 teaspoon of powdered inulin daily can reverse bacterial overgrowth enough to allow an autistic child (2-8 years of age) to become much more aware and interactive with their environment within a few weeks. And depending on the amount of underlying developmental delay, children will often start speaking within a few weeks to a few months.

Remember this is a simple plant fiber found in foods we eat every day, and is safe in children. If children get a little gassy or bloated, I recommend cutting back on the dose. Inulin is heat-tolerant and can be mixed or sprinkled over any form of liquid or food.

To help reduce the inflammation within the brain and normalize the behavior of microglia, my autistic patients are placed on omega-3 fatty acids (EPA and DHA) from fish. A recommended starting dose for small childrens is about 600 mg of omega-3 (the total of EPA plus DHA) per day.  DHA is particularly important as it is the main omega-3 in the brain.  (Read this post for more information on DHA as brain food.) Omega-3 fatty acids may be given in the forms of simple fish oil mixed in their food or drinks.

I don’t recommend fermented fish oil.  And when dosing I tend to increase the dose of omega-3 is the children are older (specific dose for varying ages of children can be found in The Nemechek Protocol for Autism and Developmental Disorders)  When in doubt, I favor a high dose.

If children have difficulty with diarrhea or prior problems with fish oil causing diarrhea, I have the kids start inulin fiber alone for 2-3 weeks in order to let the gut bacteria balance out, and then slowly increase the dose of fish oil and usually the tolerance is much better.

Whether the parents use Nordic Fishies or or another brand of liquid fish oil, I recommend they buy a high-quality brand as there is a very high level of fraud in the supplement industry.

All families are asked to cook their foods in domestic extra virgin olive oil (EVOO).  EVOO contains 70% oleic acid, and oleic acid reverses the underlying inflammation coming from excessive linoleic acid toxicity.  (Watch my screencast for more information on the benefit of olive oil.)

Linoleic acid is most commonly found in the unnatural vegetable oils added to the foods we purchased.  (See my other post about omega-3/omega-6 rebalancing for more information on this topic.)

The bigger, older children with autism require more effort and higher doses of inulin.  To gain better control of SIBO in older children I often treat with a 10-day course of Rifaximin (Xifaxan in U.S.).  Rifaximin is a non-absorbable antibiotic that is only used for other bacterial overgrowth conditions (hepatic encephalopathy and IBS with diarrhea).

Follow-up use of inulin after Rifaximin is sometimes used if intestinal symptoms are still present.  If inulin does not make any significant difference as a follow-up therapy, I stop it.  I never add probiotics after resetting with Rifaximin because probiotics can easily make things worse even if they helped prior to the use of Rifaximin.

The reversal of bacterial overgrowth with inulin results in a drop of propionic acid and can result in a sudden improvement in function within a few weeks.  But many children do not fully return to normal because they still have underlying developmental delay (some quite severe) as well as ADD, ADHD, sensory issues, seizures, as well as chronic depression, anxiety or aggressive behaviors. ( Watch my screencast about how leakage of LPS from bacterial overgrowth prevents the brain from fully recovering from injuries.)

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These remaining conditions take longer but week by week things can slowly improve.  If there is no significant improvement within 2 months, I generally increase the dosage of omega-3 fatty acids. If things still do not improve or seem to plateau after a couple months, I now add bioelectric Vagus Nerve stimulation to the Nemechek Protocol with good results.  (See my screencast about vagus nerve stimulation.)

The brains of older kids that have experienced prolonged bacterial overgrowth and inflammation as well as more brain injuries that occur over time, generally take longer to show improvement but I have seen significant progress in older kids as well.

I care for 2 teenage non-verbal autistic boys (14 and 16 years of age), and although they showed signs of continual improvement, they took about 4-5 months to begin speaking.

More recent is a remarkable case of a 23-year-old non-verbal autistic girl with frequent seizures. Within 8 months her seizures had reduced from 5-7 per day to 2-3 per week, and she can now write her name and converse in both Spanish and English (she lives in a dual language family).

For autistic children, the Nemechek Protocol will need to be daily and possibly forever but the benefits are life changing. Inulin fiber, omega-3 fatty acids and olive oil are from natural sources, are commonly consumed by most of us every day, and are available without prescription.

I am a classically trained internal medicine physician (D.O.) from UCLA and my Internal Medicine and Autonomic practice is in the Phoenix area. My research background has been focused on the Autonomic Nervous System, brain metabolism, and metabolic inflammation.

I use all available scientific and medical tools to induce the nervous system and organs to repair themselves by normalizing inflammation control mechanisms, inducing natural stem cell production, and re-activating innate restorative mechanisms.

March 23, 2017 –  An Addendum on Recovery

My Experience with Autism Recovery:

Uniformly all the kids under my care (50-60 to date) seem to be improving in significant ways.

In terms of speech, some younger kids start speaking within a few weeks while kids in the teens might take 4-6 months.  Our 23-year-old patient didn’t start speaking until after 8-9 months of treatment.

Importantly, even the most severe cases have a noticeable improvement in their awareness of their surroundings within a week or 2.  I interpret this as a decline in the toxic effect of the propionic acids on their brains.  Parents report more eye contact, awareness or acknowledgement others have entered the room.  They also seem more tolerant of being touched or held, or are more willing to approach someone and be physically close to them.

After the first few weeks, recovery rates are highly variable, and I believe this is due to the degree of developmental delay underlying the toxic state.  If the inflammatory cytokine process has been going on since birth, there can be so much developmental delay as to be labeled mentally retarded.  But if the developmental delay is simply mild, kids may seem very functional quickly.

The important point to remember is that your child’s brain and an enormous capacity to continue the path of development once the inflammation is controlled.  Neuronal/synaptic pruning will re-initiate, and according to the developmental delay literature, they can catch-up about 2-3 months of development for every 1 calendar month.  In my estimation, it seems to advance this fast if not faster.

The underlying wild card is what gene has been activated by the inflammation and what might it do to the neurological impairment of your child’s brain.  The inflammatory environment that prevents normal synaptic pruning and recovery from brain injury also triggers the litany of genes being found in autism.

Inflammatory cytokines abnormally produced by the mother are affecting the child’s nervous system within the womb, and then the imbalance of intestinal bacteria of the child as well as high omega-6 food sources continue to fuel the inflammatory process within the child after birth.

These inflammatory cytokines are the primary process through which the genes within the DNA that had been dormant for 1,000’s of years in the child’s ancestors are finally activated, begin altering how cells function, and contribute to the overall variety of neurological, behavioral characteristics that manifest in autism.

Here’s the potential for recovery in the autistic brain. A 23-year old non-verbal autistic female (Lennox-Gastaut Syndrome), was having 6-8 seizures per day and had never held her parents gaze for her entire life.  She did not like to be held, could not color or write, and sat curled up in a chair most of the day rocking.

Within 2 months’ of starting our protocol (rifaximin, high dose omega-3 fatty acids, and mother cooking with California olive oil), her seizures had dropped to 1-2 a day, she would sit upright in a chair and she slept through the night.

At month 4 she started looking her parents in the eyes and holding their gaze, and was more able to be touched and hugged.

At her month 6 office visit, she started smile at me, her seizures had reduced to 1-2 per week, she could now write her name (although she had never been shown previously) and could draw objects that were recognizable.

At 8 months, she began speaking rudimentary Spanish and English (dual language household) but emotionally is behaving as if she is 3 years old.

At 18 months, she speaks very clearly in full sentences, her seizures have declined to 1-2 per month (despite discontinuation of 2 seizure medications), and her emotional maturity has risen to about that of a 4-5-year-old.

But don’t despair. No matter how badly the developmental delay has slowed brain maturation, the potential for an unbelievable recovery is present.  We are beginning to understand that once human genes are turned on by inflammation, they can ultimately be shut back off again once the inflammatory environment within the body is significantly reduced.

Do your best to be patient and give this approach a chance.  Because the path to recovery over all things medical is 3 steps forward, and 1-2 back, compare today’s behavior to last month’s, not yesterday’s. The neurons within the human brain, like your hair, can only grow and change only so fast.

Every month, your child’s brain has the ability to “catch-up” 2-3 months in development.  That means every calendar year, they may catch-up 2-3 years.  I believe once the inflammation is suppressed, all that is required for recovery is a good solid inflammation suppressing regimen and patience.

May 26, 2017 – Addendum on The Misconception of Feeding Bad Bacteria and Yeast

The conclusion that increased stemming, less sleeping or increased anxiety is from inulin feeding “bad” bacteria such as Klebsiella has been a concern of several commenters.

I’m not saying this is impossible but I do not believe that to be the case, and have never seen such a reaction in the many children I’ve worked with. There are several reasons for this.

First, inulin’s main effect is within the lumen of the small intestine where bacteria digest inulin through a process referred to as fermentation. The primary effect is the production of the healthy short chain fatty acid known as butyric acid. Only small amounts pass through to the colon.

Secondly, a significant increase in pathogenic bacteria, or overgrowth bacteria would almost certainly cause an increase in diarrhea, stool frequency, abdominal cramping, reflux and eczema. We do not see this, and in fact there in general a reversal of these symptoms with the use of symptoms with the use of inulin.  If the intestinal ( not neurological or behavioral) symptoms were to worsen on inulin, I would suggest the inulin be discontinued and would suggest using Rifaximin.

The development of constipation with the use of inulin is a sign of underlying autonomic dysfunction from developmental and cumulative injury that eventually reverse after a few months of fish oil.

Thirdly, propionic acid has a sedating effect on children, almost as if the children had been taking Valium or Xanax. Therefore, once inulin reverses the bacterial overgrowth and the propionic acid levels decline, the children will come out of their stupor. There behavior at this point is predicated but their pre-existing developmental abnormalities and cumulative brain injuries and not some toxic effect of inulin.

A fourth point is that the detection of pathogenic bacteria such as Klebsiella in the stool by no means suggests these bacteria are present within the small intestine where inulin has it’s main effect. Detection of pathogenic bacteria such as <em>Klebsiella pneuomiae</em> or <em>Clostridium difficle</em> are commonly in asymptomatic patients and are essentially harmless. Their growth is kept in check by a healthy balance of other bacteria which is further bolstered with inulin.

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And finally, some parents are worried about overgrowth of candida. I agree that candida and other yeasts/fungi inhabit the intestinal tract but more detailed studies demonstrate yeast/fungal overgrowth does not occur in autism. And while the observations of clinical improvement about reduction of sugars and etc. are correct (think GF/CF, FODMAPS, GAPS), they were misattributed to yeast instead of the bacterial overgrowth for which we have mounting evidence.

Because of this, I believe the use of potent anti-fungal drugs is unwarranted in the specific treatment of autism.

Hope this helps.

© 2017. Dr. Patrick M. Nemechek and Jean R. Nemechek. All Rights Reserved. Patent Pending.

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Dr. Nemechek
Dr. Nemechek

Please use the search feature on this blog to find answers to your questions. Many of the questions that are being asked have been answered repeated by me (Dr. N) in the past.

Thank you.

Anonymous
Anonymous

Hello Doctor,
Thank you for the protocol. My son is 7 year old moderate ASD. We are following the protocol since
8 months. Gains are very slow better in certain skills but his stimming and anxious behaviour increased than before. We are following gfcf diet along with protocol.The dietician is suggesting Magnesium L-Threonate and Taurine to improve his cognition and reduce his anxious behaviour. Can I use them along with the protocol.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

You’ll know my response if you’ve read the protocol.

Chetna
Chetna

Hello Dr. Nemechek, I started protocol for my son age 2 years and 5 months old on July 1st 2019. Have not notice any gains (not that I expect this soon) but he had few random nights where he woke up in the middle of the night. Some of his behavior also got worse (not too much worse but like we can say 20% increase) like not using speech for requesting things rather crying, more tantrums, more vocal stimming (repeating nursery rhymes over and over) I am using all approved brands and I started Inulin with 1/8 tsp and after… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes you are on the right track. Continue the protocol and be patient.

Improvements will come.

Kirthi
Kirthi

Hi sir ,Thank you so much for your protocol iam doing it for my 4years old daughter with speech delay for past one month I read your book and slowly increase it the inulin dosage my current dosage is 1/3 tsp in the morning and evoo 5ml and fish oil all recommended brand by you and recently I met a doctor for her and he confirmed she got mild autism and he prescribed l-carnosine 100 mg morning and evening 100mg in liquid form 5ml each . I told that doctor about ur protocol and he said it’s ok to give… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Try stopping the l-carnosine. If the sleep improves, notify your physician.

Marianne Keith
Marianne Keith

Do you ever recommend Rifaximin for children under the age of 10? Our son is 6. On Protocol for a year – huge overall gains. Constipation still an issue. We’ve noticed over the past month that he’s more anxious (daily) and down than usual. He also seems to be back in his own world after many months of alertness and more interest in his little sister and some peers. Prior to switching from gummies to powder inulin, he was on a WAY high dosage (4 gummies) bc he had been taking them for a long time before beginning Protocol for… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Occasionally the inulin seems to quit working.

The child will have several months of continued improvement and then lapse for weeks or months back to no eye contact and no further gains.

Yes I use Rifaximin in kids younger that 10

LESKITA
LESKITA

Hello Doctor Nemechek, my 24 month old son is in protocol 5 months ago with many advances Inulina Now 1/8 + 1/16, when he had 4 months of protocol started with liquid diarrheas 2 or 3 frequencies and a lot of mucus, we suspend fish oil As recommended in his book and we went to the gastroenterologist indicating for my child stool culture and the result has been negative, but my son does not improve, continues with diarrhea with mocus and all his earnings with his protocol are going, I have read his book and suggests stopping inulin for 1… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Since the source is not obvious, I would try stopping everything just to see if the diarrhea stops and then add them back one-by-one to find out which might be bothering your child.

Gaur
Gaur

Hello Dr N, thank you so much for the protocol. My son just turned 7 yesterday, he has ASD , adhd we started the modified protocol in January with 1 now DHA cap and 1/2 tbs of evoo he was also taking guanfacine and within a months we saw major gains he was non verbal and he started talking so we stopped his guanfacine. he behavior was worse after a month he started hitting his head he was hyperactive and became aggressive and was not focusing at all like he became a difficult kid. We did not start the inulin… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

You need to start either inulin or treat with rifaximin if you are afraid to use inulin.

Carra
Carra

I have been reading about higher polyphenol evoo’s and that they have more medicinal qualities than the one recommended for the protocol. However, with such a huge market I understand that it would be impossible to screen every single evoo and approve them for the protocol. I know that in your video you stated that for people unable to access the COOC they would need to do their own research as to what is the best choice in the region where they are from and even encourage them to press their own.. Would pressing their own evoo’s be of a… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Please re-read the EVOO post.

Afsheen
Afsheen

Hello thank you so much for wonderful protocol my son is 3 year and 6 month old on the protocol since November 2018. Inulin 1/4+1/8 teaspoons now brand.
Evoo coco cooking with it . And ultimate omega NN 1/4 teaspoons. He is making good gain. He is not talking but his vocabulary is amazing. He look little hyper some time and still not listening to his name he is also grinding his teeth is been more then one month. He also eating things from the floor. Plz give me some suggestions.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

You’re on a good path, just don’t change anything.

Give him more time to fully recover.

Afsheen
Afsheen

Ok thank you so much your words are everything for us….. we will keep everything same

Robert
Robert

Hi Dr. N., have you seen older children (12 and over ) recover with inulin? Or would you automatically go right to Rifaximin and not experiment with inulin?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Occasionally but I generally start with rifaximin at this age if it is available.

Rozanne Van Jaarsveld
Rozanne Van Jaarsveld

Hi, we’ve been following the protocol for 2 months and I’ve recently moved my daughters onto lactose free milk (cows milk with lactase enzyme added into it). Is this allowed? Will the enzyme affect the protocol? Stools have improved but stimming has increased and eczema for the other daughter but both have also had a slight cold so it’s hard to tell. My main worry or question is will the enzyme lactase that’s in the lactose free milk affect the protocol. Thank you and thank you so much for this incredible protocol!

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Lactose-free milk is allowed.

Rozanne Van Jaarsveld
Rozanne Van Jaarsveld

Thank you that’s great!

Heather
Heather

Hello!
Our doctor, who is not wholly familiar with your protocol, was kind enough to give my 18-year-old a 10-day prescription for Rifaximin. Should the rest of the protocol be implemented while taking the Rifaximin or afterwards?
Thanks a lot!

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

You can start them together or one-by-one. Shouldn’t make any difference..

Jenn J Remick
Jenn J Remick

Hi Dr. N – Do you ever use (or recommend) cranial osteopathic manipulation on your (younger) patients to help correct vagus nerve damage or do you mostly just recommend the tVNS treatment? Thanks so much.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I just recommend tVNS since the treatment is required daily to get a sustained, maximal response

Martha
Martha

Hi Dr. Nemechek, We ‘ve been following strictly your protocol for 17 months now…. but my son (9 years) continues to have hives every time we try to reduce XOZAL. There are no allergies, food intolerances, nothing that can explain this.. All I know for a fact, is that he has MTHFR mutation and that he has high levels of heavy metals (especially lead = 38 μg/g / Method: ICP-MS / Provocative agent: CAEDTA). I know what is your opinion about heavy metals, but what if in his case, there is some need for heavy metal detox i.e. zeolite? In… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Just leave him on the Xozal

Nat
Nat

Dr Nemechek. Hope you are having a lovely day. I just wanted to ask. You said that there might not be a chance of recovery for a child who has been autistic from birth. So can this protocol help them at least have a better chance at independence and speech. Have you witnessed it?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes, the protocol can help them a great deal.

Holly
Holly

Hi Dr Nemecheck,
I am going to be starting my 8 year old daughter on the protocol in a couple of weeks. Is it okay for her to be on the protocol while also taking risperidone & laxido??

Many Thanks

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes, the protocol is compatible with these medications.

Ambika Pant
Ambika Pant

Dear Dr Nemecheck, if my child (17 year, non verbal, on full protocol for 13 months) has firm stools but 3-4 times a day, would that indicate that SIBo is resolved? He has never suffered from constipation. We have done 3 rounds of rifaximin over the last year. I am wondering if constipation is an essential part in the progress of recovery? Thanks!

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

If the child is improving in many respects, then the gut is adequately balance and you do not need to worry about SIBO.

The constipation will ultimately take care of itself.

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