woman buying meat at the grocery store

Dear Mark,
A friend of mine just found out that I’ve been eating a keto diet for the past few months, and they told me I should stop right away and get my selenium levels checked. They said I could be at risk of a heart attack because of keto. Now I’m freaking out a bit. Help?

Don’t freak out. Let’s look at the evidence.

First Off, What is Selenium, and Why Do We Need It?

Selenium is an essential trace element that we get from our diets. Enzymes called selenoproteins play a variety of important roles throughout the body. Notably, selenoproteins in the thyroid gland facilitate the conversion of T4 to T3.https://pubmed.ncbi.nlm.nih.gov/11848134/‘>2 This is the case with Keshan disease, a potentially fatal cardiomyopathy (disease of the heart muscle). Keshan is a region in China where the soil is depleted of selenium. As a result, residents were suffering high rates of heart disease before a supplementation program was introduced. Selenium deficiencies can also lead to male infertility because a selenoprotein known as GPx4 protects spermatozoa from oxidative stress.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829306‘>4 https://pubmed.ncbi.nlm.nih.gov/20031863/‘>6 Selenium supplementation doesn’t appear to prevent heart disease, but clinical trials have mostly been carried out in adult males who already get enough selenium from their diets.https://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/‘>8 So already, your friend’s basic premise seems shaky, but let’s do our due diligence here and ask whether following a keto diet puts you at greater risk.

Is There Any Evidence that Keto Causes Selenium Deficiency?

Yes, specifically among children who were prescribed a therapeutic ketogenic diet to treat intractable epilepsy.

As of 2020, there were at least 66 documented cases of selenium deficiency among children on a therapeutic ketogenic diet.https://www.ncbi.nlm.nih.gov/pubmed/12681013‘>10 https://pubmed.ncbi.nlm.nih.gov/10881264/‘>12 so selenium might not have been the culprit here.

It’s unclear exactly how prevalent selenium deficiency is among pediatric epilepsy patients on keto. One study of 110 kids found that nearly half of them had low selenium. None of them showed evidence of cardiomyopathies as a result.https://pubmed.ncbi.nlm.nih.gov/21615805/‘>14 Selenium levels decreased over time, with some kids falling under the recommended range by the end.

So it’s clear that selenium deficiency is a risk for these kids. However, the current medical opinion is that nutrient deficiencies can be managed with proper monitoring and supplementation and, moreover, the risk of serious adverse events is small.

What about in Healthy Adults?

I haven’t seen any evidence that selenium deficiency is a concern among healthy adults following ketogenic diets, much less heart problems as a result.

Here’s the deal: it’s incredibly easy to get selenium in your diet, keto or otherwise. The RDA for selenium is 55 µg per day. Here is just a sampling of the selenium content of common foods:

  • One 5-ounce can of tuna: 103 µg
  • 4 ounces (113 grams) of coho salmon: 43 µg
  • 4 ounces of skinless chicken breast: 31 µg
  • 4 ounces of 80% lean ground beef: 23 µg
  • 2 ounces of beef liver: 20 µg
  • 1 large egg: 15.4 µg

You can see that most keto dieters will exceed the RDA without even trying. If you’re concerned, eat a Brazil nut. Yep, just one. A single Brazil nut packs 90.6 µg of selenium.

So Why Are Kids with Epilepsy at Risk?

It boils down to the specific type of keto diet they are prescribed. All the kids in the aforementioned studies were following a therapeutic ketogenic diet designed for intractable epilepsy. This diet is wildly different from a Primal keto diet, and this is the crux of the matter.

Therapeutic keto diets usually follow a 4:1 ratio, meaning that for every four grams of fat, the child gets 1 gram of carbohydrate and protein combined. In other words, they have to restrict carbs and protein enough so that together they only comprise 20 percent of their food intake. In fact, the goal is to eat the bare minimum of protein necessary, in order to drive ketone levels as high as possible. As you can imagine, this makes the diet difficult to follow. It also increases the risk of nutrient deficiencies and associated health problems. (Hence the increasing interest in “modified Atkins” diets, which might be just as effective using 2:1 or even 1:1 ratio that allows for more protein.)

The keto diet an average person follows for health, weight-loss, or longevity purposes is probably nowhere near as strict a therapeutic 4:1 diet, nor should it be. The version of keto I recommend in The Keto Reset Diet and Keto for Life contains plenty of protein and embraces a colorful variety of plant foods to cover your nutritional bases.

All in all, this isn’t something I’m worried about. Any version of a Primal keto diet that includes meat will contain plenty of selenium. To ease your mind, you can always ask your doc for a selenium test, but that seems like overkill in my book.

One last note: as with any vitamin or mineral, it’s possible to get too much selenium. Don’t go eating a cup of Brazil nuts per day because your friend has you worried. Just eat your regular, balanced diet, and you should be good to go.

The post Dear Mark: Keto and Selenium Deficiencies – Something to Fear? appeared first on Mark’s Daily Apple.

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Since we first released our collection of mouth-watering paleo/primal recipes, I’ve been getting loads of emails from you guys cooking up recipes from the Fat-Burning Chef eCookbook.

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sleeping man hitting snooze on his phoneHey folks! Erin is here for another round of Ask a Health Coach. If you’re sleep-compromised, stressed out about carbs, or you’re a chronic snooze button pusher, today’s post is for you. Keep your questions coming in the Mark’s Daily Apple Facebook Group or share them down in the comments section.

Alicia asked:

“I’ve been trying to get up early to exercise, but I always end up hitting the snooze button and falling back asleep. Got any tricks to get myself up on time?”

I love that you’re setting goals for yourself. It proves that you don’t have to wait until New Year’s or (another) Monday to make a change in your life.https://www.marksdailyapple.com/sleep-tips-video/‘>4

1. Minimize screen time. If you need to use a computer, tablet, or phone in the evening, wear blue light blocking glasses or set devices to the “night shift” setting. Artificial light can mess with your circadian rhythm and therefore your sleep cycle.

2. Avoid that late-night drink. A glass of wine or cocktail might help you fall asleep faster, but it can disrupt your REM cycle, leaving you drained, groggy, and likely a little hungover the next day. Alcohol also relaxes the muscles, including the ones in your throat, which might cause you to snore more — or snore louder.

3. Keep your phone out of the bedroom. In addition to the aforementioned blue light situation, scrolling right before bed can lead to weird dreams and stressful fits of sleep. Plus, if you’re one of those people who checks email or social media the second you pop open your eyes, it might be worth exploring taking a break from that routine.

And if these don’t move the needle, consider getting in touch with a medical professional or health coach. Some Primal Health Coaches even specialize in sleep.

Marcelle asked:

“I’m stressing out about the carbohydrates I ate over Thanksgiving. I know a lot of people gain weight around the holidays, but I’ve been working so hard to keep it off. What can I do to off-set all those extra carbs?”

The holidays are always stressful, and, as I’m sure you’ve noticed, this year is no exception. But the extra pressure you’re putting on yourself for what you ate? Why do that to yourself? Adding stress on top of stress only makes your adrenals work harder, encourages your body to pump out more cortisol, and forces your body to store more fat, which if my hunch is correct, likely sends you into a spiral of worry, guilt, and shame.https://psychologyofeating.com/mind-over-food/‘>6

Also, since when are carbs a whole food group? I don’t know who needs to hear this, but carbohydrates are a macronutrient found in nearly every food, including, but not limited to almonds, apples, asparagus, broccoli, beans, cauliflower, carrots, mussels, oysters, yams, and yogurt.

Even if you served yourself up a plate loaded with meat and veg, you haven’t actually skipped the carbs. If you decided to skip the pumpkin pie with whipped cream and have fresh berries instead? Still carbs. If you passed on dessert altogether and poured another glass of wine? Still carbs.

We tend to criminalize these large subsections of foods — sweeping them all into one bucket. But not all carbohydrates are created equal and, honestly, not all of them are bad. When you become metabolically flexible, you can partake in any kind of food your heart desires and have the peace-of-mind that your body can handle it.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440529‘>1 Two main causes of leaky gut are imbalanced gut microbiome—having too many bad microbes and/or not enough of the good guys—and harmful compounds in food, such as gluten.

Carnivore eliminates plant foods, which are the source of most of those harmful compounds, and it offers a hard reset for the microbiome. One study showed profound microbial changes in the gut after just a few days of shifting to carnivore.https://www.researchgate.net/publication/323151200_Therapeutic_protocol_of_ICMNI_-_Paleomedicina_Hungary‘>3 However, the precise data is not published anywhere to my knowledge.

Carnivore for Arthritis

Mikhaila Peterson famously overcame debilitating rheumatoid arthritis with her all-meat diet. In his book The Carnivore Diet, carnivore drum-banger Shawn Baker claims that joint pain is frequently alleviated by carnivore, in his experience.

However, most research has focused on vegetarian diets. A few studies have demonstrated the benefits of a Mediterranean diet,https://www.ncbi.nlm.nih.gov/books/NBK74220/‘>5 for decreasing inflammation and pain among rheumatoid and psoriatic arthritis patients. One small, short-term study found no significant benefit of a ketogenic diet.https://www.cabdirect.org/cabdirect/abstract/19651402878‘>7 Check out the author’s commentary from the discussion:

“When man changed from food-gatherer (nomadic hunter) to food-producer, epochal changes in his ecology (to village community, urbanization and eventually to civilization) were paralleled by similar changes in his diet. The two or three millennia in prehistory during which the transition to agriculture took place is a relatively short period in the biological history of man. In terms of human evolution, this transition could be too sudden for the development of an adequate adaptive response to the drastic changes in his dietetic habits. The idea advanced here is that the challenge to man’s metabolism by the protein-complex of wheat (and rye) could lead to obscure syndromes;…”

Prescient indeed.

Hypothyroidism and the Carnivore Diet

Individuals with hypothyroidism, including autoimmune Hashimoto’s thyroiditis, frequently rely on dietary interventions like the autoimmune protocol (AIP), paleo, Primal, keto, and now carnivore. Despite abundant anecdotal evidence that they help, there have been few confirmatory studies to date.

Two recent papers confirm that AIPhttps://www.ncbi.nlm.nih.gov/pubmed/30060266‘>9 are feasible and can reduce symptoms and improve quality of life for people with Hashimoto’s. The Paleomedicina team has also reported that they can successfully treat hypothyroidism with the PKD, but those data are not available in journal articles.

Carnivore Diet for Psoriasis

On the one hand, calorie-restrictedhttps://pubmed.ncbi.nlm.nih.gov/29926091/‘>11 and gluten-freehttps://www.ncbi.nlm.nih.gov/pubmed/8219661‘>13 https://www.cabdirect.org/cabdirect/abstract/19671407267‘>15 https://jamanetwork.com/journals/jamadermatology/article-abstract/528773‘>17 A recent controlled study in mice found the same.https://pubmed.ncbi.nlm.nih.gov/26559897/‘>19 Still, I think it’s likely that some of those lucky folks experienced relief because they removed triggers like gluten, eggs, or dairy. They may not have needed to go full carnivore.

Carnivore Diet for IBS

If a carnivore diet can potentially reduce intestinal permeability, favorably shift the microbiome, and reduce systemic inflammation, it should help with gastrointestinal problems like IBS.

Clinicians often recommend low-fiber and low-residue diets for their IBS patients.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966170/‘>21 In studies, up to three-quarters of patients find relief.http://www.academia.edu/download/54060434/Crohn_disease__2016.pdf‘>23

What about Using Carnivore to Treat Gastritis?

Gastritis is inflammation of the stomach lining. Generally, it’s treated with medications like antibiotics, proton pump inhibitors, or antacids, depending on what’s causing the inflammation. There’s very little research looking at dietary interventions to treat gastritis—in humans anyway. You’re in luck if you’re interested in cheetah or ferret gastritis, though.

If you have gastritis caused by H. pylori bacteria, I’d recommend you tackle that directly with the help of a medical practitioner. Otherwise, it’s certainly worth exploring what foods, if any, exacerbate your symptoms. Starting with a carnivore diet as a baseline and then reintroducing foods slowly is one way to do so.

Could a Carnivore Diet Ease Depression?

Converging evidence suggests a link between diet and depression, and a role for dietary modification in treating depression. First, it’s increasingly clear that there is a strong connection between gut health and depression, thanks to the gut-brain axis.https://www.ncbi.nlm.nih.gov/pubmed/25415497‘>25 Many experts also consider systemic inflammation to be a root cause of depression.https://www.psychologytoday.com/us/blog/diagnosis-diet/201904/the-carnivore-diet-mental-health‘>27

A 2015 review of dietary interventions for depression and anxiety found that they frequently include recommendations to reduce red meat intake, but that makes them less likely to be effective.https://www.jstor.org/stable/48515238‘>29

Carnivore Diet to Reverse Gum Disease?

You probably learned as a child that sugar is public enemy number one when it comes to dental health. In part, that’s because it disrupts the oral microbiome. That’s only part of the story, though. Gum health also goes hand-in-hand with gut health and systemic inflammation. That’s why gingivitis and periodontitis are common among diabetic folks—because of the hyperglycemia and chronic inflammation characteristic of poorly controlled diabetes.https://www.ncbi.nlm.nih.gov/pubmed/19958441‘>31

Carnivore advocate Jordan Peterson, Mikhaila’s father, claims to have reversed his own gum problems once he went all-meat. Some indirect evidence backs his experience:

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how to eat more organ meatUnless you’re regularly including organ meat in your diet already, you probably have a nagging voice in the back of your head telling you that you really should be eating more.

That voice is correct. Organ meats are economical and dollar for dollar, pound for pound, the most nutrient-packed food you can get. Okay, yes, organs aren’t always the most pleasant to eat. Allow me to apologize on behalf of moms everywhere if you were forced to eat overcooked liver and onions as a kid. However, organ dishes can range from totally innocuous to downright delicious when prepared correctly. If you’ve been reluctant to venture into the world of organ meat till now, it’s time to suck it up, buttercup. We’re doing it.

Why You Should Eat More Organ Meat

Besides the fact that they are incredibly nutritious, there are good reasons to be putting more organs on your plate. For one, they are usually cheaper than meat, often by a lot. (I’m going to use “meat” to refer to muscle meat throughout the post.) I used to be able to get a three-pound beef heart for five dollars from the rancher at my local farmer’s market. A similarly sized roast would have cost over thirty dollars if I picked the cheapest cut. Unfortunately, I talked up heart so much that I created demand among my friends in town. Now he charges $3 a pound—still a great price.

If you’re buying a whole cow, pig, goat, or sheep directly from a farmer, they may be willing to sell you the organs for a steal since most customers don’t want them. While you’re at it, ask for the head, though they’ll probably say no.

There’s also the principle of nose-to-tail eating. If you aren’t eating the organs, you are missing much of the edible portion of the animal. Sometimes organs go to make pet food, but other times they are simply discarded by meat processors. It’s wasteful. Ranchers and farmers have to raise more animals to feed the same number of people, making it hard to do sustainably.

There’s also something to be said for expanding your palate and trying new foods. Gutsy eaters (no pun intended) have a world of options open to them. And let’s be honest, when you eat organs in front of your kids and friends, they will either think you’re cool or totally disgusting. Either way, you win.

Is Organ Meat the Same as Offal?

Organs are offal, and often the two terms are used interchangeably. Offal can also refer more generally to any edible parts of the animal that are neither muscle meat nor internal organs, such as skin, feet, and cheeks. Still other times, offal refers to any part of the animal that gets discarded during standard animal processing. For the most part, though, when you hear people talking about eating offal, they mean organ meat.

Which Organs Can You Eat?

Historically, humans around the world created dishes out of any and every available part of the animal. Today, you are limited by what you can find at your local butcher shop or by bargaining with a local farmer.

Adventurous travelers know that every culture has traditional dishes featuring all manner of offal. Sausages and stews made with blood and organs are widespread. Scottish haggis—assorted organs and oats mashed together and stuffed in a sheep’s stomach—gets a bad rap, but you’d be surprised how many regional versions there are: Swedish lungmos (literally “lung mash”), Russian nyanya, or Romanian drob, to name a few. Look for Mexican menudo made with tripe (stomach lining), Indonesian limpa (spleen), or Rocky Mountain oysters (bull testicles) in the U.S. and Canada.

The availability of specific organs varies widely based on where you live. In the U.S., you’d be lucky to find spleen or brain in your local market, and it’s illegal to sell lungs for human consumption here. It’s easiest to find beef, pork, and chicken organs in my experience, but don’t limit yourself to those options. Bison, deer, sheep, goat, duck, and goose organs are also fantastic. If you’re a hunter, I hope you’re taking advantage of your access to a variety of organ meats!

For now, I’m going to focus on organs that are easiest to source, but if you’re lucky enough to find a farmer who will sell you a pancreas, by all means, grab it!



I always suggest that people who are squeamish about organ meat start with heart. It’s comparable to muscle meat in flavor and texture, and it’s easy to prepare.

Nutritional highlights:

Heart is rich in CoQ10, a vitamin-like compound that acts as an antioxidant and helps cells produce energy. It also provides B vitamins (especially B2 and B12), selenium, copper, zinc, iron, and phosphorous.

Preparation tips:

Heart takes a bit of prep, which is easiest to do when partially frozen. If you’re working with a thawed heart, throw it in the freezer for an hour before getting to work. Remove the valves if present, then trim off all the hard fat and stringy bits. You can now thinly slice and sear the meat, cube and skewer it on kabobs, or stuff and roast the heart whole.

Slow-Cooked “Heart on Fire” with Creamed Kale (MDA)
Grilled Beef Heart with Roasted Chili Peppers (MDA)
Grilled Chicken Hearts (Brazilian Kitchen Abroad)


Tongue is delicious and tender. Since it’s a muscle, its taste and texture are closer to meat than, say, liver. However, I fully admit that preparing it at home is not for the most squeamish among us. There’s no doubt you’re handling a tongue, and a huge one at that if it belonged to a cow. You might want to let someone else prepare it the first time you venture into eating tongue.

Nutritional highlights:

Tongue is particularly rich in vitamin B12 and zinc, while providing respectable amounts of the other vitamins and minerals associated with organ meats.

Preparation tips:

Tongue isn’t a dish you are going to whip up on a weeknight. It takes time. First, you need to simmer it—one or two hours for tongues from smaller animals like sheep, or three hours for cow tongue. Then, cool the tongue until you can handle it safely and peel off the outer skin (this is where the ick factor can set it). Now it’s ready to turn into something delicious. Many recipes call for the tongue to be sliced or cubed, then sauteed in hot oil until browned and crispy. You can also cook it on the grill.

Pro tip: Slow cookers and pressure cookers both make the initial cooking step a breeze.

Tender Beef Tongue with Onions and Garlic (MDA)
Crispy Grilled Beef Tongue Recipe (Serious Eats)


A lot of people have a visceral reaction to the idea of liver. I get it. Liver has a strong taste and distinct texture that can be a hurdle, especially if you were forced to eat it as a child. Maybe start with chicken liver, which is milder than beef or pork.

Nutritional highlights:

If there is one food to rule them all when it comes to nutrient density, liver is king. It provides tons of pre-formed vitamin A—about a whole week’s worth—and a hefty dose of copper and B12, along with other B vitamins, phosphorus, selenium, zinc, and folate.

In fact, it provides so much vitamin A that it raises concerns about eating too much liver. It’s unclear how much of a danger this actually poses, but in the spirit of better safe than sorry, don’t eat liver every day. Once or twice a week suffices. Pregnant women should check with their doctors regarding safe upper limits.

Preparation tips:

If you purchase liver from a butcher, it will probably be ready to cook, though you may need to peel away the outer membrane. Some recipes call for soaking in water or milk to create a milder flavor, but I never bother. Properly cooked liver should be slightly pink on the inside and smooth, almost velvety. Do not overcook liver! It becomes dry and crumbly—not appealing.

Bangin’ Liver (MDA)
Grilled Chicken Livers with Herb Butter (MDA)
Cajun Blackened Chicken Livers with Lemon and Garlic (MDA)


Kidney is wonderfully nutritious, but frankly, I wouldn’t recommend starting here if you’re brand new to offal. By itself, the flavor can be quite strong and offputting. Legendary French chef Jacques Pepin euphemistically called it “assertive.” Using fresh beef or lamb kidneys, and cooking for a long time with other tasty ingredients, helps a lot.

Nutritional highlights:

Kidney is loaded with B2 and B12, plus other B vitamins, iron, zinc, copper, and phosphorus. If you’re popping Brazil nuts for selenium, consider adding kidney to the mix. A four-ounce serving of lamb kidney covers more than four times your daily requirement.

Preparation tips:

Intact kidneys look like lobes connected by a strip of hard white fat. Trim the meat away from the fat and remove the outer membrane. Before cooking, rinse the kidneys and optionally soak them in milk or cold salted water for an hour or so. Some sources recommend parboiling for one minute before cooking, but it’s not strictly necessary. Once prepped, kidneys can be quickly pan-fried, braised, or stewed.

Deviled Kidneys (Hunter, Angler, Gardener, Cook)
Paleo Steak and Kidney Pie (The Paleo Mom)


The award for most incongruous food name goes to sweetbreads, which are actually the thymus gland of an animal. Some people call the pancreas sweetbreads, too. In any case, they are neither sweet nor bread. Sweetbreads aren’t as common as the other offerings included here, but they get a spot of honor for their mild flavor and unique nutritional profile compared to other organs. Plus, any time I talk about organ meats, foodies chime in and ask for sweetbreads to get more love, so here we are.

Nutritional highlights:

Like other organs, sweetbreads deliver provide B vitamins, phosphorus, and selenium. A four-ounce serving also contains more than 60 percent of your daily requirement of vitamin C.

Preparation tips:

Preparing sweetbreads is a multistep process. First, soak them in water with a squeeze of lemon juice for two to four hours or overnight, changing the water a few times. Drain and rinse the sweetbreads, then optionally blanch them by boiling for five minutes before plunging into cold water. Remove any connective tissue and the membrane. Now they are ready to be poached, grilled, roasted, or pan-fried.

Paleo Breaded Veal Sweetbreads (The Bordeaux Kitchen)
Sweetbread Fritters with Pesto (Offaly Good Cooking)

How to Start

Wade in Slowly

As I said, heart is a good option because it tastes like meat. I’m not saying you should, but you could trick your kids or your partner into thinking they are eating steak kabobs made with cubes of marinated beef heart. Chicken liver pate is another good option for dipping your toe in the water. It’s not the prettiest dish, but I’ve had good luck introducing skeptical friends to the world of liver with a nice crudité spread and homemade pate.

If you’re not sure about preparing organ meat yourself, order it in a good restaurant or, in the case of tongue, your local street taco truck. Seriously, tacos de lengua (tongue) are fabulous.

Disguise It

No rule that says you have to eat a big plateful of kidneys to build your organ cred. Start by mixing small amounts of organ into other meat dishes. Any dish that uses ground beef can handily disguise organs. Grind heart, liver, or kidneys in a food processor and mix it into meatloaf, chili, or taco meat. For hamburgers, which stay raw in the middle, I prefer to saute the organs before grinding, then combine it with raw ground beef. Your butcher may be willing to grind and blend it to save you the trouble.

Steak and kidney pie is a traditional Scottish fare that is particularly sentimental to me because my Scottish grandmother always had a freezer full of handheld pies. The steak helps balance the kidney and keeps it from being overwhelming.

Often, even people who claim not to like organs enjoy sausages like liverwurst or braunschweiger made with organs. Perhaps that’s in part because they are well seasoned, which helps mask the strong flavor of liver in particular. Along the same lines, you can use spices like curry to camouflage the taste.

Embrace it

Just go for it. Mind over matter. If necessary, give yourself a pep talk. Tell yourself you’re going to enjoy it, eating organs is good for you, and that you are a grown-up who can do hard things.

Honestly, I enjoyed organs more after going Primal. My tastes shifted to appreciate more savory flavors in foods. I feel more connected to my body and can appreciate in the moment when I am eating something truly nourishing. Even if it’s not objectively delicious—if there were such a thing—it’s almost like I can taste that it’s good for me. I know that sounds a little woo-woo, but I’ve heard other people say the same.

Worst case scenario, you can always supplement with desiccated organ pills. Ancestral Supplements has an impressive line-up of organ supplements. Try food first, though. Maybe you’ll love it.

Primal Kitchen Frozen Bowls

The post How to Eat More Organ Meat appeared first on Mark’s Daily Apple.

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