Osteoporosis & Nutrition

December 3, 2018

Did you know that one in three women will experience osteoporosis in their lifetime, and more women die from osteoporosis-related fractures than from breast, cervical and uterine cancer combined? We want to share our nutritional recommendations for bone health, so you don’t end up being one of the 10% of people who die from a broken bone. Listen in as we talk about the foods and lifestyle factors that can help maintain strong, healthy bones.

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CAROLYN: Welcome to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. I have an interesting fact to share with you today. In the US, 15 to 20 million people suffer from osteoporosis. In fact, that's like one in three women will have problems with their bones. Think about that. One in three women will experience osteoporosis in their lifetime. That's a lot.

JOANN: That is a lot. And here's another startling fact. More women die from osteoporosis related fractures, then from cancer of the breast, cervix and uterus combined. That's a lot of people. That's amazing. And osteoporosis related fractures cause about 200,000 deaths each year, which is about 10 percent of all deaths in the United States. So that means weak, fragile bones that break can often lead to the death of many older adults.

CAROLYN:  Well, as Dietitians and nutritionists we’re very knowledgeable about food and lifestyle factors that can lead to osteoporosis or that bone thinning. But we are also very knowledgeable about the foods and lifestyle factors that can help maintain those strong, healthy bones. So good morning everyone. I'm Carolyn Hudson and I'm a registered and licensed Dietitian and I've been a dietitian since 1980. So I have counseled hundreds and hundreds of people both young and old and one of the most important people I share information with concerning bone health is of course my mother. My mother just turned 91 years old and she's still very, very active. She explores hiking trails. She still kayaks on lake superior and I am sure the very next time she's up at our family cabin, she's going to be strapping on her snow shoes to track in the woods behind our cabin. Because she is so active, she has many opportunities to tumble and fall, so she needs to have healthy and strong bones. So this morning we want to share our bone health recommendations so that you don't end up being one of the 10 percent who die from a broken bone.

JOANN:  That's right. And as we were preparing for today's show on osteoporosis and nutrition, I pondered the question, why do Americans have such a high rate of osteoporosis? Of course we believe that maybe it's because of what Americans are eating. Michael Pollan, who is the author of In Defense of Food, he also has several other well-known nutrition books. He found that Americans spend only 27 minutes daily cooking and four minutes cleaning up.

CAROLYN:  I wish it was only four minutes at my house!

JOANN:  So that means people might be just throwing away boxes from fast food or a pizza box, something from a takeout restaurant down the street. My cleanup is not anywhere close to four minutes, but Carolyn and I both cook real food and the people who have four-minute kitchen cleanup are not actually cooking their meal or maybe just heating something up. So, have you figured out that fast food or processed food or takeout food is not good for your bones? My name is JoAnn Ridout. I'm also a registered and licensed dietitian and, like Carolyn, have been practicing for 30 plus years. I have been helping people understand that nutrition is so much more than just counting calories and to lose weight. So many people come in and just really still have that old mindset about calories in and calories out. And it is so much more than that. The food you put in your mouth daily affects your overall health, including the strength of your bones.

CAROLYN: So JoAnn, again, why do Americans have such a high rate of osteoporosis?

JOANN:  That's right. Great question. Fifty five percent of adults in the United States age 50 or older have either osteoporosis or low bone density, sometimes called Osteopenia. So again, we asked the question why. Here are a couple more questions for you. Are you over the age of 50 and do you have low bone density? Maybe another one of the root causes of osteoporosis could be following that low fat diet that was initially recommended 50 years ago. So I remember that in my career when everything shifted and 50 years ago it was still kind of new information. We weren't in school that long ago, but still it was new information. It was really thought to be the truth and the only way to go.

CAROLYN: I remember the first time my mother brought margarine into the house.

JOANN:  I do too. So, 50 years ago we were told to eat low fat, only to find in recent years the heart disease rate increased during that low fat eating phase. So, we know a low fat diet is not a bone building diet. In fact, a low fat diet is actually harmful to your bone health.

CAROLYN:  I remember back about 20 years ago or even 10 years ago, we were definitely recommending steaming our vegetables and eating vegetables without any fat. Hey, I'm guilty of that too because that's what I was taught in school. So, we all thought that eating fat, of course, makes us fat, but that is not true. And research has proven that to be very faulty information.

JOANN: That's right. So now we recommend sautéing vegetables in butter and coconut oil in ghee, which is clarified butter or even in Bacon Grease. So, all of these are saturated fats that build a strong bone mesh for the minerals to attach to. So now I'm going to share with you one of my favorite ways to make Brussels sprouts. It was interesting because I was having a conversation with one of my clients this week about Bacon Grease, and he said, “Yeah, my wife always pours it in a jar or a can and throws it in the garbage.” And I said, “I pour mine in a jar and I save it.”

CAROLYN:           I had a client asked me the same thing, “You save your bacon grease?” I said, “Oh yeah, of course I do!”

JOANN:                Of course, because it makes great Brussels sprouts. All you do is clean those Brussels sprouts, cut them in half, lay face down on a baking pan, and then you bake them at 3:50 or 375, 400, however you like that, at least about 30 minutes or until they're done, until they're soft. And then the best is if you top it was crumbled bacon when you pull it out and put it in a bowl, it's really yummy.

CAROLYN:  So I melt my bacon grease. I turn on the oven, put the pan in with the Bacon Grease, and then I lay my Brussels sprouts down and oh, so good.

JOANN:  It is. It's very easy.

CAROLYN: So, let's get back to the nutritional science about building strong bones. First, all bones are alive. JoAnn, do you think that most people think about bones being alive?


CAROLYN: Every time I tell that or say that to a client, they go, “Really?” And I go, “Yeah, well, of course.” Think about this, how could we be building or drawing minerals out of the bone if they weren't alive, right? So, we don't want dead bones, which can happen when people take many of those prescription medications on the market today. Many of my clients come in thinking that with low bone density, they come in, they've got low bone density, maybe even osteopenia at that price point. And they're surprised because they think that they're bigger frames so they have less risk of that osteopenia. But really that's not true, is it?

JOANN: No, it isn't. It isn't. And it's time for our first break. So we'll come back to this.

CAROLYN: So, you are listening to Dishing Up Nutrition. This morning, JoAnn and I are presenting information about food that supports strong bones and foods you should avoid. We also understand that many of you want to know the supplements you should be taking. So, after each break, we will talk a little bit about some supplements that support bone health and supplements that you should avoid.


JOANN: Welcome back to Dishing Up Nutrition. We understand most people with osteoporosis will first look for a calcium supplement. Calcium comes in different forms and one farm that's very ineffective is calcium carbonate. It's an inexpensive form of calcium. Only 10 percent is absorbed, so if you are taking Tums for calcium, it's very ineffective because it's calcium carbonate and most of the calcium chews on the market are also calcium carbonate, so we recommend that you avoid calcium carbonate and look for a more absorbable form of calcium. And Carolyn will share more about that just before our next break, but before we get to that, would you repeat that myth we talked about that only smaller bone people are at risk?

CAROLYN:  Right. I have clients that come into my office and they're bigger framed women mostly and they end up with the Osteopenia or an osteoporosis diagnosis and they’re surprised, they said, “I'm a large frame person. I shouldn't be at risk for osteoporosis. What happened?”

JOANN:  It's true. So in the past, if you ate that low fat diet that was bone thinning, maybe you had toast with jam or a glass of juice, a half a cup of oatmeal with some skim milk and honey for breakfast, maybe you didn't realize that you were not feeding your bones. And all those foods turn to sugar, so as a result, your bone density test shows you have osteoporosis.

CAROLYN: So a better bone building breakfast would be like two eggs and I really like the free range eggs. I cook them in butter and I have sautéed vegetables with them, sometimes even olive oil or coconut oil. So fats, surprisingly enough to a lot of our clients, are essential for that building healthy, strong bones and we need a variety of different fats. Saturated fat from butter plus two essential fatty acids help us build those strong bones.

JOANN: That's right and those good fats are butter, ghee, which is clarified butter, again, coconut oil, avocado oil, olive oil, make up that bone mesh that minerals attach to for strong bones. However, damaged, refined fats, so we have to be careful about our fats.  So, things like vegetable oil and corn oil, soybean oil, canola oil and cottonseed oil do not support a strong bone mesh. So when that bone mesh is examined in the volumes of people who have been using these refined and damaged oils, the bone mesh actually has areas where there's no bone mesh there at all. There are holes in the bone mesh. So, the result is weak, fragile bones.

CAROLYN: So, I just mentioned that saturated fat is important for strong bones and so are two essential fatty acids, Omega-3, an essential fatty acid from fish oil, helps to boost the absorption of calcium into the bones. So, Omega-3 oil also helps with the absorption of vitamin D and we know that hundreds of research studies have found that sufficient vitamin D is critical for the absorption of the mineral calcium into the bones. So, I recommend that all my clients should have their vitamin D level checked annually at their annual physical and that level then for optimal should be 50 to 80. I like my clients to be closer to that 80 mark. But, many doctors think that 30 or some of those lab values, it says this is where you should be. Thirty is okay, they say, but really that's an average. JoAnn, what do you think? What do you say to your clients?

JOANN:  I agree. I say the same thing, a more optimal level, 50 to 80. But that average, many doctors are saying, in fact, my doctor said that to me. “Well, you're in the in the average range, so we don't need to test your vitamin D every year anymore.” But we have to push back to that. No, I really need to have it tested because I do know I have a hard time absorbing it, so I have to be really careful about that.

CAROLYN: I just recently had mine checked and was a little above 80 and my doctor said, “Oh, that's good.” So I was really happy. I went, okay, you're a keeper.

JOANN: Because a lot of doctors would have said, “Oh, that's too high.” So another essential fatty acid that's needed for strong bones is GLA, which is gamma linolenic acid. GLA helps to make up the bone mesh and also helps with the absorption of calcium and other minerals into the bones. So, calcium alone is not the only answer for strong bones.

CAROLYN:  Oh, isn't that a fact? And most people think, “Oh, if I just take a calcium supplement, my bones are going to be just fine. Right?”

JOANN: Exactly. So we know that it takes a lot more than that. So just a weight bearing exercise is not the only answer for strong bones. In order to have strong bones, we need good fats for that bone mesh to be solid. Also, we need important minerals, so calcium is important, but also equally important is magnesium. And then also zinc and selenium. And we need a variety of those trace minerals. We also need vitamin K from leafy green vegetables. We need a variety of nutrients to keeps our bones alive and growing.

CAROLYN: So, Dr Mary Enig and Sally Fallon Morell, the authors of The Skinny on Fats reported that for calcium to be an effectively incorporated into a bone, at least 50 percent of the fat should be saturated. And I bet our clients and some people listening to us this morning going “50 percent saturated fat, you girls are nuts!” Butter is a good saturated fat. Ghee, again that clarified butter is a good saturated fat. Coconut oil, again, is a good saturated fat. Even Lard and Bacon grease is good for supporting healthy bone mesh and strong bones. So, I'll often cook my eggs in that bacon grease that you were talking about with the Brussels sprouts earlier and I love it. So earlier I said that we need Omega-3 fatty acid to support that good bone mesh. And, of course, you can take a fish oil supplement. On average, one fish oil supplement contains about a thousand milligrams or one gram of Omega-3. So, if you're not a supplement person, you could do like three ounces of wild caught salmon. That would contain about one, almost two grams of the Omega-3 fatty acids. So I have a little story to share because early in my career I had the opportunity to work with a number of indigenous people living in far northern Canada. They didn't have any grocery stores up there, at least not very much. So, they caught fish and of course we're in far northern Canada. It was cold water fish. They also ate moose and other wild game that they had hunted. These foods are really high in omega-3 fatty acids and all of these indigenous people, they had very strong bones. And guess what? They didn't drink any milk and they weren't taking calcium supplements.

JOANN: That's amazing. That's a big difference from what we've been told in the past. So, it's almost time for our next break.

CAROLYN:  You are listening to Dishing Up Nutrition. Today we are discussing bone health. A popular and effective calcium is calcium citrate. Your body uses about 50 percent of this form of calcium. If you're looking to maintain normal bone density, we have many effective calcium supplements available on our website and at our Nutritional Weight & Wellness locations. Many of my clients like the activated calcium because it contains a variety of forms of calcium, including this calcium citrate in addition to vitamin D and a Betain HCl, which aids in the digestion and absorption of calcium. Many people appreciate that activated calcium comes in a capsule, so it's much easier to swallow.


JOANN: Welcome back to Dishing Up Nutrition. When you are choosing a bone-building supplement, what do you look for? First, I would pick one that has calcium citrate and a special bone building ingredient called microcrystalline hydroxyapatite compound, or it might say MCHC on the label. Most of the high quality and effective bone building supplements contain MCHC. Osteoporosis today is such a major health problem. Taking the correct calcium supplements critical for your bones. That MCHC is also used to help dentists rebuild jaw bones so it's definitely an alive bone food. So, we understand how important it is to maintain strong and healthy bones and choosing the correct supplement is also crucial. So, if you have questions about what bone building supplement you may need, call us at 651-699-3438. We will help you find the supplement that is best for your bones. So, we have been talking all about healthy fats this morning so far, and so we're going to shift a little. Often, a new client comes into the office and they are eating oatmeal for breakfast. That's been considered a heart healthy breakfast for so many years. And yes, a half a cup of cooked oatmeal might be okay. But one new client I saw recently was eating a big bowl full. So, about two cups of cooked oatmeal, which equals 108 grams of carbs. That's a lot. That breaks down to 27 teaspoons of sugar. And then this person would throw in about 20 raisins. And another five teaspoons of sugar plus a couple tablespoons of honey, a half a cup of skim milk. That added another seven teaspoons of sugar. So, in total, this person was eating almost 40 teaspoons of sugar just at breakfast. All in all, just trying to eat a heart healthy breakfast.

CAROLYN: And they thought that this was going to be a really, really good breakfast, but all that sugar is not good for your bones. So, are you wondering, listeners, how does sugar negatively affect my bones? So, here's a little nutritional science to help explain this. So, for your body to break down that sugar, it needs minerals. And when you eat that high sugar diet, you're going to use up a lot of those minerals. Those minerals are calcium, magnesium, and phosphorus that your bones need. So, when you eat that high sugar diet, these key minerals are actually leaching or coming out of your bones. When you eat those high sugar carbs like the oatmeal or the cookies, the calcium, magnesium, a strontium are all pulled from your bones. The more sugar in your diet, the more your bone density decreases. So that sugar and soda, they're known to leech minerals from your bones.

JOANN: That's right. And even Diet Soda. I have to throw this in here because that is so important. Some people think, okay, the sugar in soda’s leeching minerals from my bones, but the Diet soda might be a better choice, but it's not. It's not because not only the artificial sweeteners, but also the carbonation is affecting the bones. So that's another negative. And we've talked about the importance of fats for strong healthy bone mesh, and so let's talk about an adequate amount of protein to make the Collagen in your bones. We hear about a lot about college and these days. Collagen allows your bones to be flexible but strong. So many of the medications for your bones can lead to those dead bones we've talked about. They're not flexible, they're no longer alive, so they can be brittle. They can shatter if you happen to fall. Think of it this way. So, without protein in your bones, your bones would resemble eggshells. They would be fragile. They would crumble easily. So, without that Collagen that is actually made from protein, the calcium and other minerals cannot combine to form bones.

So one of the foods very high in collagen is homemade bone broth made from chicken bones, or you can even use grass fed beef bones. I made some last week. If you have leftover turkey bones right now, here's an easy to utilize those bones and make a great bone broth. So I take whatever bones I'm using, either the organic turkey bones or chicken bones or even that grass fed beef. I add a few vegetables in there, likes carrots, celery, onion, and some water. Put it in the crock pot. You can cook that for 12 to 24 hours. I do mine overnight. That's a really good time to put it in right before you go to bed. And then overnight, some people cook it for 12 hours, but 24 is even better. So, for clients with osteoporosis, I often recommend drinking about 12 ounces of that homemade chicken broth or beef broth daily. It's a great substitute for your morning coffee or for your afternoon tea. So, that Collagen in the bone broth helps keep wrinkles away. So that home made bone broth is good for your bones and it's good for your skin. So that sounds like a win-win to me.

CAROLYN: And I have clients that don't really want to make their own homemade bone broth. And so there are a number of good a bone broths available now, particularly at the co-op stores, but they're quite tasty. A little expensive, but certainly it helped. So those people who don't like that overnight cooking and making their own bone broth.

JOANN: And Sassy Spoon, a restaurant in South Minneapolis sells it and it's already made. So that is a great source, too.

CAROLYN: And I love it. It tastes so good. So, if you have osteopenia or osteoporosis, are you thinking, “Oh my goodness, where am I going to start?”   We at Nutritional Weight & Wellness believe you start right in your kitchen, which most likely means spending more than 27 minutes per day cooking real food. And eating four to six times a day. I recommend you start by first eliminating as much sugar as you can from your diet. From your cupboards as well. So, go through those cupboards and throw a few things out. Remember, sugar uses up those minerals like calcium because we have to metabolize that sugar. And so that's when it's leached. Those minerals are leached from our bones. A better choice for your bones is to trade in those sugary carbs for vegetable carbs. So, eating asparagus and green beans, Broccoli, cauliflower, peas, Brussel sprouts, or any vegetable that you are fond of is a good thing. And remember, you can and should cook them in real fat or you can even add butter to the top of them.

JOANN: Yes, that's always good. So, when I'm thinking about bone health, I often discuss the good fast to eat and the bad fats to avoid with my clients. So, I would like to recap this one more time. Those fats for good bone health are butter, coconut oil, Lard, preferably organic, avocado oil, olive oil, nuts, olives, and avocados. So, the fats you want to avoid are refined oils such as vegetable oil, soybean oil, corn oil, canola oil, and cottonseed oils. So be sure to recheck those labels. Also look to make sure it either says unrefined or cold pressed or expeller-pressed on that label because if it doesn't say those words, it's likely refined. So check the label on a frozen pizza, on a candy bar, the fast food salad dressing, a bag of nuts at the checkout aisle and look and see how many carbs they contain.

CAROLYN: So, it's already time for our last break.


JOANN: Welcome back to Dishing Up Nutrition and our show on osteoporosis and nutrition. If you found this show helpful, encourage your mother, your aunt, your grandfather, or a friend to listen to the podcast of this show. Because having weak, fragile bones is a very serious problem for about 50 percent of the people over age 50. That's a really high number. If you have osteoporosis or Osteopenia, we recommend adding the bone building supplement called Pro Bono. So many of our clients have restored their bone strength and their bone density by taking pro bono daily along with a cup of homemade bone broth. So pro bono is a complete bone building supplement. Call us at 651-699-3438 and we’ll happily answer your questions about what calcium product is best for you. So, we have been covering quite a few topics this morning related to bone health. So, I want to recap because right before break I was talking about the good fats to eat, bad fats to avoid. So again, the fats for good bone health, are butter and coconut oil, organic lard, ghee, avocado oil, olive oil, nuts, olives, and avocado. And then the fats you want to avoid are refined oils such as that vegetable oil, soybean oil, corn, canola and cottonseed oils. And we talked about reading the label, right? We want to look for the words unrefined, cold pressed and expeller pressed.

CAROLYN:  And I know something I always tell my clients is if you're in the store and you see there is one whole section of oils and they're all in clear bottles, usually plastic, you can see right through them, move away. Go to the section which should be pretty close to right next door to it. And those are dark bottles and you can't see through them. So that's a visual thing that you can have in your brain.

JOANN: That's very true. And then also check the label on a frozen pizza or candy bar, maybe a bag of nuts that you found at the aisle. We want to see what the good fats are in there or if there are good fats in there. Best to see on a bag of nuts that there's no added fats. They may be dry roasted or raw. And then we have a great recipe, too, to roast our own nuts. Also we're looking for how many carbs on that label. So you want to keep the sugar down, too.

CAROLYN: Yeah. Because remember those carbs turn to sugar in your body. And then that sugar, to process it, leaches those minerals from your bone.

JOANN: So the good fats build the bone mesh. They're critical for strong bones and then those bad fats are damaged, they cause holes in your bone mesh. That can result in weak, fragile bones.

CAROLYN:Definitely. So we've discussed how protein is necessary for strong bones and also necessary to build Collagen to support bone health. So most people need 12 to 14 ounces of protein daily and that should be spread throughout the day over four, five, or six meals or snacks. So, here are some examples for you. One egg would be equal to one ounce of protein. So, for breakfast this morning I had two eggs. So, that's two ounces of protein. You could also have one scoop of whey protein powder. That usually contains somewhere between 17 and 21 grams of protein or equivalent to two to three ounces of protein. And the seven ounce can of tuna or salmon is going to contain about three and a quarter ounces of tuna after draining the liquid. You could have a salad for lunch with one hard boiled egg and almost that entire can of tuna or salmon and you would be happy and maybe your dog might be really happy to eat some of that tuna also. So, you'll end up with maybe about four ounces of protein for lunch.

JOANN: That's right. And so we talked about bone broth earlier and I mentioned that I had used beef bones recently to make bone broth. So, what I did last weekend was I did make that bone broth. So I let it cook overnight in about 24 hours. At the end of that time, I strained off the bones out of there and the extra veggies out of there that had been cooked. So just had that broth there. I then turned that bone broth into I think one of the best batches of hamburger soup that I've ever made. I love that hamburger soup recipe. I was kind of set for the week with that big batch of soup and I had it for lunch every day during the week and it was really a great thing to have on hand. So I often do that batch cooking so that I can make it through the week. I do that recipe or or maybe chili or chicken wild rice soup or something. And I try to use bone broth as much as I can for the soups I make.

CAROLYN: So we talked about in a maybe sipping on bone broth during the day, but the other thing that I do with my bone broth is I always try to freeze a little bit of it in an ice cube tray. And then I take those out of the ice cube tray and put it in individual bags or containers. And then I use one of those ice cubes in my stir fry or almost everything that I'm cooking, so I'm always using some of that bone broth and it adds so much flavor. I know one thing I always do with my bone broth is I do use a little cheese cloth bag and I'm lucky I've got a really nice sunroom area so I get to grow a lot of my own herbs inside in the winter and of course outside in the summer. So I go over and I snipped in some little bit of thyme and a little bit of oregano. And sometimes some rosemary if that works in the recipe that I'm doing and it adds so much flavor and I just love that. So, maybe you want to give some ideas of some of the other protein sources that you would eat during the day, JoAnn.

JOANN:  Right. Another one that I often do is our Chicken Sonoma Salad. Oh, I love that one. That is such a good recipe. I know we serve it at our Menopause Seminar and people rave about it. But, I made that recipe last weekend and all I did was cook up some chicken breasts, chop them up, and went and got some good grapes and Pecans and a good quality mayo. I happened to use avocado mayo for this recipe and it was wonderful. And then again that I put that over a bed of Greens and very often then when I have that on hand, that's either my lunch or my dinner for the week. I generally cook for the week so that I might not spend 27 minutes each day, but I spend about four hours one day a week and then I'm kind of set for the whole week.

CAROLYN: I think you mentioned avocado mayo. So, I think maybe we should explain Mayo. Mayo can be really tricky. Mayo is all fat, basically, made from oils. Most of the Mayo that we see on the grocery store shelves is made with some of those refined fats, even if it says on the front of the label, “Made with Olive Oil.” That's not necessarily true, right? So we have to be really careful with that one. I also love the avocado mayo. I think that one's really one of my favorite. So, you've got to read the labels, see what oil it's made with and if it's a cold pressed or expeller pressed or something like that, any of those oils, that would be okay.

JOANN: Right. And the only two brands of Avocado Mayo I've seen on the shelf. Well, I've seen a lot. I know there's probably more brands in this, but you have to be careful of some of the big name brands because sometimes they have soybean oil and canola, and a little avocado. But Chosen Foods and Primal Kitchen are two brands that I know for sure that is a good quality. So, back to our recommendations. Of course we recommend no smoking because that leads to bone density issues. Also, no drinking alcohol because that breaks our bones down. No over exercising. So, you might wonder what that over exercising is. So, over five hours a week of very intense exercise would be considered excessive. That’s not saying you can't walk five hours a week, that's fine.

CAROLYN:  That intense exercise.

JOANN: So we also recommend effective bone building supplements and recommend exercise on a regular basis, not too much, not too little.

CAROLYN:  Calcium citrate. What other supplements? The Pro Bono, MCHC, and we should been avoid calcium carbonate.

JOANN: Yes, exactly. So go check your calcium bottles if you're at home and make sure there's no calcium carbonate in them. So, our goal at Nutritional Weight & Wellness is to help each and every person experience better health through eating real food. It's a simple, yet powerful message. Eating real food is life changing. Thank you so much for listening and have a wonderful day.

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