13

votes

Is high cholesterol a sign of systemic inflammation, and what to do about it?

Answered on August 19, 2014
Created November 18, 2011 at 3:44 PM

I have really high cholesterol that seems to just keep climbing. More deets at this question posted a couple of days ago, but basically, in September my cholesteral was in the mid 200's, a few weeks later in the low 300s, and then on Nov 2 it's at about 400 (per a VAP).

My LDL is primarily large and bouyant. My trigs are low (69, down from 87) and have been on a downward curve. My HDL is going up (currently 89).

Have been Paleo since late summer after coming off of lots of whole grain goodness (ha!). Have lost almost 30 pounds since August, and I know from Dr. Davis's blog that recent weight loss can muck with your lipids.

My HS-CRP was .2 in September.

I had a CT Heart Scan and just got the results back. Zero plaque.

So that's all good.

Except for that cholesterol number: 407. Wow.

I went over to Chris Kresser's I Have High Cholesterol And I Don't Care post, and in response to a comment, he points out:

Chris Kresser September 20, 2011 at 7:25 am High cholesterol levels can be a marker for an underlying problem that should be investigated, and there are genetic conditions (like familial hypercholesterolemia) that cause very high cholesterol levels regardless of diet/lifestyle. Each person/case needs to be approached individually.

Similarly, Jaminet talks about how even puffy LDL is a sign that something's up, as it's sent out almost like little soldier's to fix stuff.

I don???t want to exaggerate the state of the literature here: this is a surprisingly poorly investigated area. But I believe these things:

  1. Cholesterol and LDL particles are part of the vascular wound repair process.

  2. Very high LDL levels are a marker of widespread vascular injury.

Now this is not the ???lipid hypothesis.??? Compare the two views:

The lipid hypothesis: LDL cholesterol causes vascular injury. My view: LDL cholesterol is the ambulance crew that arrives at the scene of the crime to help the victims. The lipid hypothesis is the view that ambulance drivers should be arrested for homicide because they are commonly found at murder scenes.

Makes sense to me, and I'm sure my total cholesterol number is being driven up by my very high LDL number. (Also, I think I'm one of those people whose serum cholesterol is affected by their dietary cholesterol, as when I was low-fat, my cholesterol was in the low-normals. Thank goodness we got our life insurance policies before I want paleo!!).

My CRP is .2, though, so that seems to contraindicate inflammation.

So what's inflammatory in me...and how do I fix it?

Also, somewhere else on that same post, Kresser responds to someone by saying that an inflammatory condition could raise cholesterol, and that an autoimmune issue could be an inflammatory condition.

I have an autoimmune condition: idiopathic thrombocytopaenia purpora (basically, my body makes antibodies against my platelets). I had my spleen removed in 1987 to treat after steroid therapy failed. My platelet count is now and has been (even through pregnancy) on the high side of normal.

I'm wondering what the take-away from all of this is.

a) Do I need to worry about the high cholesterol? (considering no plaque and puffy, I'm inclined to think no, especially since I'm female and according to Kresser's blog/podcast, high cholesterol in women doesn't seem to correlate to heart disease. But does it show that I have something else going on inside...., the inflammation???).

b) if I do need to worry about it, how do I address it?

Do I (1) use supplements to try to lower the LDL (like Jaminet suggests, i.e., copper)? Seems to me that if it is inflammation, I don't want to arbitrarily lower the "paramedics" in my blood. So does that mean I need to do Robb Wolf's autoimmune protocol (no eggs, dairy, nightshades?). I could, but I really don't want to, and I'm not sure what the benefit would be unless there is a "problem" with the high cholesterol number, which takes us back to the first question. (And, yeah, I love eggs. The others I could give up pretty easily, but eggs would be very, very hard.)

Bottom line questions:

  1. In light of the rising HDL, falling trigs and Puffy LDL, and zero Heart Scan score, how concerned should I be about that total cholesterol number?

    1. How do I isolate the source of the inflammation, if that is what's causing the total number to be so high? Could it even be inflammation with a .2 CRP score?

    2. What are folks thoughts on the impact of an autoimmune condition that is non-symptomatic b/c of the spleenectomy?

    3. In light of the weight loss, should I just wait another 6 months and test again to see if things settle? I'm pretty much at goal weight, so there won't be a continuing drop in weight.

Thanks mucho much!

(other potentially relevant info: I eat pretty low carb - maybe 10/15%. Fats primarily from coconut oil, eggs and grassfed beef or fish (usually wild caught) or lard. For the first month of paleo I supp'd with Fish Oil. Now, I take cod liver oil if we eat restaurant steak, but we eat mostly at home and grassfed beef. I generally avoid nuts. I don't use much olive oil and no vegetable oils at all. I cook with tumeric. I drink a lot of coffee, but also a lot of green tea. I supplement D3 and K2 and magnesium regularly. Sometimes Selenium and Copper. I use butter sometimes, but not often, usually in sauteed veggies b/c the kids don't like them w/o. Some heavy cream, but not much.)

0a2dd50f2d3951bf3fb83fc4638c9512

(1960)

on September 07, 2013
at 01:28 AM

Way to f-in go, man! Good work, and thanks so much for sharing this info with us. So, like, when's the AMA gonna catch on, exactly?

96440612cf0fcf366bf5ad8f776fca84

(19413)

on April 24, 2013
at 01:52 PM

Sorry, but it's just not true. Cholesterol is a repair mechanism/autoimmune response. Eating cholesterol "bad" or "good" (exogenously) makes little difference on what we make internally (endogenously). Obesity is not linked to cholesterol levels. Vegan bars are filled with carbs and soy which are detrimental to health. Flax provides the wrong kinds of omega3s. We need DHA and EPA, not ALA. They also oxidize very easily, and eating oxidized PUFAs is a very bad thing.

2b2c2e4aa87e9aa4c99cae48e980f70d

(1059)

on November 20, 2011
at 02:24 AM

Paleoish, My wrist bone density is excellent but my spinal MRI showed otherwise and my hip joint was ruined...

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:25 PM

Yes, I would love Dr. K's perspective...

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:24 PM

I'm not entirely convinced that it is too high, but I am concerned that it's a marker for something else going awry (which, I guess, would mean that, yeah, it's too high). Hoping that the whacking of the dairy will lower it. So I think I'm now my own experiment. Need to make an appt with the doc and see if I can get him on board; cheaper to get regular VAPs through him than through insurance....

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:21 PM

I haven't been tested, and it sounds like I probably should be. I don't have any signs, tho, and unlike you, FBG is low (70s), weight loss has not plateaued, and my bone density per Dexa is great.

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:18 PM

My question based on your comments, though, is what does "keep those things in perspective" mean? If cholesterol is good in that it is the "ambulance" then is it good that chol is high b/c it's cleaning up my particular medical oddities? Or is it bad b/c there are unknown oddities occurring??? (I tend to think that Travis/Jack are on the right track and I'm going cold turkey on all dairy and will retest in 3 or 4 months for some n=1 experimentation).

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:16 PM

As for antibiotics, yes, I've been on them, but not because of the spleenectomy. Just for various things over the years. Abt 10 years after the spleenectomy I had emergency surgery for meckle's diverticulitus (complete rupture, apparently rare, esp in young women) and was in hospital for a full week b/c of peritonitis and the like. Tons (obviously) of antibiotics. That was about 15 years ago, tho. (Obviously, I have a variety of strange medical issues. Yes, I guess I really am one of RW's unique flowers!)

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:13 PM

I honestly don't recall what my lipids were before paleo, but my spleen was removed well over 20 years ago, and my bloodwork has always been normal (per CW). My HDL has been climbing since September; went paleo in August. No idea what it was a few years before, though. I might have some insurance forms around here somewhere that say .... And yes, the spleenectomy resolved the ITP and I have no symptoms. No doc has ever mentioned higher risk of CVD (and I do have a cardiologist b/c of an arrhythmia that has resolved, so I would have thought he'd have mentioned that, but ya never know).

0e9ddbd345ed53954d2c3eb4edc954c9

(203)

on November 19, 2011
at 09:46 PM

I've got h.pylori and high LDL too. I've just created a separate post on this: http://paleohacks.com/questions/78340/h-pylori-and-high-ldl-cholesterol-link#axzz1eBZAk3W7

Medium avatar

(8239)

on November 19, 2011
at 09:07 PM

The AMA is rapidly losing membership, as its focus becomes more political than health-oriented. I don't expect the AMA to catch on, given their allegiance to an increasingly outmoded, counter-factual paradigm. But even if the AMA were suddenly to get hip to what health, wellness, and fitness are all about — still, I doubt that membership would grow. The minority of hip, functional-medicine, integrative physicians is way more interested in actually advancing wellness, than in attending annual conventions and paying dues to a bureaucratic body. Or so I see it...

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 03:56 AM

Thanks, Travis. That makes sense. I'll cut the butter/cream out entirely and see what happens....

3c6b4eed18dc57f746755b698426e7c8

(5147)

on November 19, 2011
at 01:55 AM

Robb Wolf's protocols would be mainly to reduce your autoimmune symptoms. If your lipids are going bonkers in response to Paleo, my guess is it's due to your genetics and/or your absence of spleen. Those who's had it removed have higher CVD risks due to sticky blood; plus you're vulnerable to infections since u have no spleen. Plus u have to deal w/these lipid #s. So I would keep these things in perspective, as ur not a normal person experiencing high TC/LDL after doing Paleo. HDL could also be high due to splenectomy.

3c6b4eed18dc57f746755b698426e7c8

(5147)

on November 19, 2011
at 01:43 AM

Did your HDL go up in response to Paleo or in response to splenectomy? Have u been on any antibiotic post spleen removal? Were you able to resolve your ITP by removing the spleen: in other words, your thin blood is now thicker, you don't bruise anymore or have internal bleeding risks. That is the key. Those who've had splees removed usually have higher CVD risks because of the "stickiness" - in your case, it was to redress ITP. Do u have any symptoms of ITP not resolved by the splenectomy?

Medium avatar

(39831)

on November 18, 2011
at 08:38 PM

The workouts would have increased mitochondrial density in the muscles and ensured that you were burning fats at rest though. I would think that not working out would have resulted in even higher TGs. Additionally, you'd probably have higher LDL since the cholesterol wouldn't be used as much in repair functions. I'm not sure how extreme we're talking about, but resistance exercise is something everyone should be doing.

Af1d286f0fd5c3949f59b4edf4d892f5

(18452)

on November 18, 2011
at 08:19 PM

Travis. that's a very interesting comment. Something like that is what I've long suspected could be happening w/ me. I've been doing a lot of research lately about lipid deposition and oxidation. I sorta wonder if my extreme diet/workout regimen caused my body to essentially not know what to do with the high lipids in my blood, so they just circulate. If my leptin sensitivity is strong enough to pretty much block fats from being stored in adipose tissue (I am very fit and lean) yet at the same time not being zapped for energy fast enough, then what if that is causing the climb in blood lipids?

Medium avatar

(39831)

on November 18, 2011
at 07:26 PM

I agree with everything that Jack has said here; the overall amount of butter/cream isn't necessarily important if your body for whatever reason is not using the cholesterol (that those foods cause your liver to not recycle) in the LDL at a fast enough rate.

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 06:53 PM

thankfully, no :) 46, no family history (mom has now had heart attacks and strokes, but after age 75 and after a life time of smoking). My blood pressure is (and always has been) just fine.

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 06:50 PM

Well, dang. I'll ditch the cream and switch to bacon fat for the veggies (a kid-friendly alternative). Either that or steam and let them pour melted butter on and I can use CO.

Af1d286f0fd5c3949f59b4edf4d892f5

(18452)

on November 18, 2011
at 05:59 PM

P.I. - you are doing a lot of things right. Fyi.. that butter/cream intake is enough to raise you LDL. Everyone responds differently to those 2 dense fat sources and whole fat dairy in general. For some, it really spikes LDL. others not as much. Also, if you just got done losing a bunch of weight, I agree that you should retest later once the "weighloss artificats" are gone. See ya on the trail :)

Af1d286f0fd5c3949f59b4edf4d892f5

(18452)

on November 18, 2011
at 05:58 PM

P.I. - you are doing a lot of things right. That butter/cream intake is enough to raise you LDL. Everyone responds differently to those 2 fat sources and whole fat dairy in general. For some, it really spikes LDL. others not as much. Also, if you just got done losing a bunch of weight, I agree that you should retest later once the "weighloss artificats" are gone. See ya on the trail :)

Medium avatar

(10611)

on November 18, 2011
at 05:42 PM

It doesn't look like inflammation. If you're 72 years old, have a family history of stroke/heart problems, or high blood pressure you might have some cause for concern.

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 05:07 PM

forgot to say, yeah, I feel great. Best ever since going paleo. And my body weight is healthy (134 at 5'7"), though my body fat percentage is a bit high (28% per a Dexa scan). possibly as I work out more that will impact the cholesterol, too. Going to start the Body by Science Big 5 workout, and continue with tabata sprints. And walking/biking with the kids.

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 05:05 PM

Yes, that's it exactly. The quick-flinch, oh-sh*t-I'm-f*cked response from a lifetime of hearing how bad cholesterol is even if everything I've learned says otherwise.

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 05:04 PM

Thanks for the input. Yeah, I eat maybe 4 tablespoons of butter/week, maximum. More likely half that, and some weeks none. HWC has creeped up a bit (with holiday spiced coffees that are yummy with cream after dinner), but even then, I don't think it's more than maybe 7-8 tbsps/week. But maybe I'm wrong and that is a lot? I might do another VAP in 2 mos, so that any weightloss artifacts will be gone. If TC is still climbing along with LDL, I may try option B and see how trigs/HDL are impacted. If negatively, I'll probably go with option A, which is certainly the one I like best:)

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6 Answers

8
Af1d286f0fd5c3949f59b4edf4d892f5

(18452)

on November 18, 2011
at 04:01 PM

I would have guessed that you eat lots of butter and heavy cream, but you say at the end that you don't.

Yes 407 is high, but remember that it is still not completely understood what is optimal, if there even is such a thing.

You have some seriously strong positives working in your favor:

  1. Rockstar HDL (which, of course, is a big chunk of your total)
  2. Large "Type A" particles, which is still generally believed to be better than small dense.
  3. Low Trigs. In fact, your HDL is higher than your trigs. That's very good.
  4. Zero plaque shown on scan
  5. .2 CRP, which is on the floor

If you feel excellent, and have a healthy body weight and are happy, you could:

A. Do nothing... Rock on.

B. Try to reduce your LDL by reducing LDL raising foods like dairy and eggs and possibly coconut oil.

If you try to reduce your LDL, and notice and increase in trigs, decrease in HDL, and other markers going the "wrong" direction, it is then that I would step back and seriously consider that maybe your body is happy in a higher cholesterol range than others.

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 05:07 PM

forgot to say, yeah, I feel great. Best ever since going paleo. And my body weight is healthy (134 at 5'7"), though my body fat percentage is a bit high (28% per a Dexa scan). possibly as I work out more that will impact the cholesterol, too. Going to start the Body by Science Big 5 workout, and continue with tabata sprints. And walking/biking with the kids.

Medium avatar

(39831)

on November 18, 2011
at 07:26 PM

I agree with everything that Jack has said here; the overall amount of butter/cream isn't necessarily important if your body for whatever reason is not using the cholesterol (that those foods cause your liver to not recycle) in the LDL at a fast enough rate.

Medium avatar

(39831)

on November 18, 2011
at 08:38 PM

The workouts would have increased mitochondrial density in the muscles and ensured that you were burning fats at rest though. I would think that not working out would have resulted in even higher TGs. Additionally, you'd probably have higher LDL since the cholesterol wouldn't be used as much in repair functions. I'm not sure how extreme we're talking about, but resistance exercise is something everyone should be doing.

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 05:04 PM

Thanks for the input. Yeah, I eat maybe 4 tablespoons of butter/week, maximum. More likely half that, and some weeks none. HWC has creeped up a bit (with holiday spiced coffees that are yummy with cream after dinner), but even then, I don't think it's more than maybe 7-8 tbsps/week. But maybe I'm wrong and that is a lot? I might do another VAP in 2 mos, so that any weightloss artifacts will be gone. If TC is still climbing along with LDL, I may try option B and see how trigs/HDL are impacted. If negatively, I'll probably go with option A, which is certainly the one I like best:)

Af1d286f0fd5c3949f59b4edf4d892f5

(18452)

on November 18, 2011
at 05:58 PM

P.I. - you are doing a lot of things right. That butter/cream intake is enough to raise you LDL. Everyone responds differently to those 2 fat sources and whole fat dairy in general. For some, it really spikes LDL. others not as much. Also, if you just got done losing a bunch of weight, I agree that you should retest later once the "weighloss artificats" are gone. See ya on the trail :)

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 03:56 AM

Thanks, Travis. That makes sense. I'll cut the butter/cream out entirely and see what happens....

Af1d286f0fd5c3949f59b4edf4d892f5

(18452)

on November 18, 2011
at 08:19 PM

Travis. that's a very interesting comment. Something like that is what I've long suspected could be happening w/ me. I've been doing a lot of research lately about lipid deposition and oxidation. I sorta wonder if my extreme diet/workout regimen caused my body to essentially not know what to do with the high lipids in my blood, so they just circulate. If my leptin sensitivity is strong enough to pretty much block fats from being stored in adipose tissue (I am very fit and lean) yet at the same time not being zapped for energy fast enough, then what if that is causing the climb in blood lipids?

Af1d286f0fd5c3949f59b4edf4d892f5

(18452)

on November 18, 2011
at 05:59 PM

P.I. - you are doing a lot of things right. Fyi.. that butter/cream intake is enough to raise you LDL. Everyone responds differently to those 2 dense fat sources and whole fat dairy in general. For some, it really spikes LDL. others not as much. Also, if you just got done losing a bunch of weight, I agree that you should retest later once the "weighloss artificats" are gone. See ya on the trail :)

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 06:50 PM

Well, dang. I'll ditch the cream and switch to bacon fat for the veggies (a kid-friendly alternative). Either that or steam and let them pour melted butter on and I can use CO.

2
Medium avatar

on November 18, 2011
at 04:09 PM

I second Jack's response. Cholesterol has for a very long time been a "devil term." We continue to hear about the importance of "reducing cholesterol," regardless of other factors, hence the quick-flinch response is pretty well ingrained in most of us. Just for a sense of proportion, suggest you Google something like "benefits of cholesterol," if only to remind oneself about the role played by cholesterol in health.

0a2dd50f2d3951bf3fb83fc4638c9512

(1960)

on September 07, 2013
at 01:28 AM

Way to f-in go, man! Good work, and thanks so much for sharing this info with us. So, like, when's the AMA gonna catch on, exactly?

E06dcdb3f856057025e9776e038d8072

(305)

on November 18, 2011
at 05:05 PM

Yes, that's it exactly. The quick-flinch, oh-sh*t-I'm-f*cked response from a lifetime of hearing how bad cholesterol is even if everything I've learned says otherwise.

Medium avatar

(8239)

on November 19, 2011
at 09:07 PM

The AMA is rapidly losing membership, as its focus becomes more political than health-oriented. I don't expect the AMA to catch on, given their allegiance to an increasingly outmoded, counter-factual paradigm. But even if the AMA were suddenly to get hip to what health, wellness, and fitness are all about — still, I doubt that membership would grow. The minority of hip, functional-medicine, integrative physicians is way more interested in actually advancing wellness, than in attending annual conventions and paying dues to a bureaucratic body. Or so I see it...

1
Cdb9e467dac06a12c515ddfd18a4cdda

(140)

on November 19, 2011
at 08:04 PM

Your cholesterol is way too high. There are a lot of cholesterol skeptics these days, but low cholesterol is better. That is how we evolved: http://hanswuhealth.blogspot.com/2011/11/cholesterol-targets.html

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:24 PM

I'm not entirely convinced that it is too high, but I am concerned that it's a marker for something else going awry (which, I guess, would mean that, yeah, it's too high). Hoping that the whacking of the dairy will lower it. So I think I'm now my own experiment. Need to make an appt with the doc and see if I can get him on board; cheaper to get regular VAPs through him than through insurance....

1
2b2c2e4aa87e9aa4c99cae48e980f70d

(1059)

on November 19, 2011
at 03:03 PM

I would consider the possibility of inflammation. If Dr. K wasn't on vacation he probably would agree.

Have you been tested for gut issues? In my case we've been working on getting h. Pylori and unidentified (non-candida) yeast/fungus overgrowth and leaky gut under control. I have no obvious gut symptoms, just high LDL, high FBG and weight loss plateau and osteoarthritis.

Metametrix GI Effects is a good test.

2b2c2e4aa87e9aa4c99cae48e980f70d

(1059)

on November 20, 2011
at 02:24 AM

Paleoish, My wrist bone density is excellent but my spinal MRI showed otherwise and my hip joint was ruined...

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:21 PM

I haven't been tested, and it sounds like I probably should be. I don't have any signs, tho, and unlike you, FBG is low (70s), weight loss has not plateaued, and my bone density per Dexa is great.

E06dcdb3f856057025e9776e038d8072

(305)

on November 19, 2011
at 10:25 PM

Yes, I would love Dr. K's perspective...

0e9ddbd345ed53954d2c3eb4edc954c9

(203)

on November 19, 2011
at 09:46 PM

I've got h.pylori and high LDL too. I've just created a separate post on this: http://paleohacks.com/questions/78340/h-pylori-and-high-ldl-cholesterol-link#axzz1eBZAk3W7

0
972cce45d745fe61b3f9afb5817165bd

on April 24, 2013
at 06:53 AM

Hello, Yes, cholesterol which increase Obesity is associated chronic inflammation contributes to metabolic dysfunction and propagates atherosclerosis. There is bad cholesterol and good cholesterol. So you have to eat food which has good cholesterol like nuts, flax seeds and fishes. If you are habitual of snacking so always try to take healthy snacks like salad, vegan bars etc. my friend suggested me about sheffafoods. Then I tried it. It is good site for healthy snacks and as well as they are very tasty. They also provide salad sprinkle which make your simple salad tasty. For this you can try sheffafoods site.

96440612cf0fcf366bf5ad8f776fca84

(19413)

on April 24, 2013
at 01:52 PM

Sorry, but it's just not true. Cholesterol is a repair mechanism/autoimmune response. Eating cholesterol "bad" or "good" (exogenously) makes little difference on what we make internally (endogenously). Obesity is not linked to cholesterol levels. Vegan bars are filled with carbs and soy which are detrimental to health. Flax provides the wrong kinds of omega3s. We need DHA and EPA, not ALA. They also oxidize very easily, and eating oxidized PUFAs is a very bad thing.

0
B78cfb24c651438288d2c54533975ca2

on April 10, 2013
at 04:53 AM

Although in your case (with low heart scan score), it may not be indicative of heart risk, but a high 400 cholestrol is indicative of something out-of-balance in the body and needs to be investigated.

Since you have autoimmune condition, you should get tested for gluten sensitivity and sensitivity to gluten-cross reactive foods (which includes eggs). Continuing to consume foods in which you are sensitive to results in inflammation. As others have mentioned, the inflammation can be the cause of high cholesterol.

Another point is going too low carb can raise cholesterol due to low carb decreasing thyroid function and reducing LDL receptor activity. More about that written here: http://blissfulwriter.hubpages.com/hub/The-Case-for-Safe-Starch

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