01/11/2013

The Fallacies of Fat

29:43 minutes

In his new book Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease, endocrinologist and obesity doc Robert Lustig deconstructs the mythology of fat. He says exercise, for all its benefits, won’t help you shed pounds—and that fasting only worsens weight gain. Read an excerpt.

Segment Guests

Robert Lustig

Robert Lustig, M.D., is a professor of pediatrics at UCSF Benioff Children’s Hospital, and the author of Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.

Segment Transcript

IRA FLATOW: This is Science Friday. I’m Ira Flatow. This isn’t going to take you by surprise, but America is fat. One in three adults is obese. For kids, it’s one in six. But don’t forget the infants. Doctors say there’s now an obesity epidemic among six-month-old babies. And if you think you’re safe because you’re thin, consider that up to 40% of thin people have metabolic syndrome. In other words, on the road to Type 2 diabetes, even if they can’t tell by looking in the mirror.

My next guest says that some of the reasons we are fat is because we’ve been sold a bill of goods about what and how we should eat. For example, he says, “the health conscious among you may opt for juice over soda. In fact, calorie for calorie, 100% orange juice is worse for you than soda.” He says, “the corollary to a calorie is a calorie is the mantra, ‘if you’d only exercise, you’d lose weight.'” Not only is this wrong, he says it’s downright detrimental. He goes on, “the largest percentage of your calories is burned while sleeping and watching TV.” And finally, last quote, “a standard six ounce Yoplait yogurt has 11 grams of added sugar. So when you consume a Yoplait, you’re getting a yogurt plus eight ounces of Coca Cola.”

Robert Lustig talks about all of these factors and what he says are some common misconceptions about fat and dieting in his new book “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.” If you think a calorie is just a calorie, he might have you rethinking that. Let me introduce him. Robert Lustig is author of Fat Chance. He’s also professor of pediatrics endocrinology at University of California San Francisco, and heads the obesity program there. He joins us from KQED in San Francisco. Welcome back to Science Friday.

ROBERT LUSTIG: Thank you so much, Ira. Pleasure to be back.

IRA FLATOW: You’re welcome. You make such bold statements in this book. It’s bound to make some people very angry.

ROBERT LUSTIG: You’re telling me.

[LAUGHTER]

Although I have to tell you, the food industry has had that book out now for what, two, 2 and 1/2 weeks since it’s been released, and I’m waiting for the onslaught and I haven’t seen it. And I think maybe the reason is because it’s true?

IRA FLATOW: It’s true. You know, there’s something that came out yesterday released from Harvard. Let me start here because they just– hot off the presses, they say. From the Harvard School of Public Health, maybe you read this. And it talks about one of the most widely used industry standards, the whole grain stamp, actually identified grain products that were higher in both sugars and calories than products without the stamp.

ROBERT LUSTIG: Absolutely. And to be honest with you, whole grain doesn’t mean much. If you actually look at the USDA definition of whole grain, basically what it means is you start with a whole grain. That is, the starch in the inside, the kernel or the husk or the bran on the outside. And then whatever you want to do with it is perfectly fine. It’s still whole grain.

So if you pulverize it and add sugar to it, hey, it’s still whole grain because that’s just started with. But you know what? All the benefits that you get from whole grain are gone as soon as you pulverize it. So what it means is irrelevant because the definition is not helpful.

IRA FLATOW: So you mean when I see a whole grain bread made with, let’s say 100% of whole grain wheat or flour, it’s really not much better than regular white flour because it’s been pulverized?

ROBERT LUSTIG: Exactly. When you look at true whole grain bread, that’s like German fitness bread with the nuts and the season, it’s really dense. That’s a very different kind of bread than, say, what you have commercially available where they talk about double fiber and this and that. A lot of the fiber that they tout in these breads is actually added soluble fiber such as psyllium and things like that.

Now, you need those soluble fiber molecules but you also need the insoluble ones. You need the cellulose. You need the stringy stuff. You need the hard stuff. Because the two together actually help you form a barrier on the inside of your intestine.

I liken it in the book to what happens with the hair catcher on your bathtub drain. So it’s this little plastic latticework with little holes in it. So, if you let the water run, the water goes down the drain. But if you take a shower and there’s hair coming, you know the hair gets caught and then you’ve got a stopped up drain. Same idea here. The insoluble fiber is the plastic latticework. The soluble fiber is the hair getting caught in the holes. And then when you have the two together, you have a real barrier.

And what that does is it reduces the rate of flux, the rate of absorption from the gut into the bloodstream so that your liver can actually handle the onslaught of all those calories. And so you end up doing the right thing with those calories instead of the wrong thing, which is making liver fat out of it. So, when you consume the two together, you’re good. Problem is that’s not what the food industry is selling you.

IRA FLATOW: One of things– let’s talk more about fiber because you mentioned that one of the worst things we can do with our fruits and vegetables is to put them through the juicer. Because that wrecks the whole fiber.

ROBERT LUSTIG: For the same reason.

IRA FLATOW: For the same reason.

ROBERT LUSTIG: Exactly. So basically, when you put juice in a juicer, you’re shearing the insoluble fiber to smithereens. The soluble fiber will still be there, but you need that scaffolding, that latticework to be able to generate that gel that’s on the inside of the intestine. You can actually see on electron microscopy the gel that forms on the inside of the intestine.

And what that does is it number one, prevents the absorption. Number two, it allows a lot of the calories that you’re consuming to be delivered further down the intestine so that the bacteria in your intestine will consume it instead. Perfect example, almonds. You consume 160 calories in almonds. How many of those do you absorb?

IRA FLATOW: I have no–

ROBERT LUSTIG: Turns out 130. 30 of those calories are going to get metabolized by the bacteria in your intestine because the fiber in the almonds will deliver more of the nutrient down the intestine so that the bacteria can get it. And that’s good because that means you actually absorb fewer calories than you eat. Again, a calorie is not a calorie.

So, fiber is one of the best things that we can do for ourselves. Fiber’s the stealth nutrient. Fiber is maybe the single most important thing we’ve got in our natural food diet. And of course, fiber is the thing that the food industry removes for its own purposes.

IRA FLATOW: 1-800-989-8255. Talking with Robert Lustig, author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.” We’ve been hearing a lot about high fructose corn syrup as contributing to the obesity epidemic. And one chapter of your book is called Fructose the Toxin. And you’re right, face it, we’ve been frucked.

ROBERT LUSTIG: I’m glad you said it and not me.

[LAUGHTER]

IRA FLATOW: I had my–

ROBERT LUSTIG: That’s right.

IRA FLATOW: –finger on the button in case it didn’t come out right.

[LAUGHTER]

But what do you mean by that? I mean, explain the different kinds of sugars and how high– corn syrup fits in.

ROBERT LUSTIG: Sure, absolutely. So there are monosaccharides, meaning single molecules, and then there are disaccharides, meaning combinations of two molecules together. The monosacharides rides are the following three: glucose, and glucose is important. And your body will make glucose if you don’t take it in because it’s so important because every cell in your body, in fact, every cell on the planet, can metabolize glucose for energy. Glucose is the energy of life. Glucose is, for lack of a better word, necessary.

Then you have galactose. Galactose is the monosacharide, the single molecule, that’s found in milk sugar. Now, unless you have a disease called galactosemia, which I help take care of, which is about one in 10,000 babies, which will kill you by age two months if you don’t diagnose it, your liver will turn galactose to glucose in about a nanosecond. So, galactose is essentially glucose for the overwhelming majority of the population. Obviously, those who have lactose intolerance can’t consume galactose because they can’t absorb it. And that’s a different issue but not the one we’re talking about right now.

And then there’s this other third molecule called fructose. And fructose is the sweet part of table sugar. It’s the molecule we seek. We love fructose. We think fructose hung the moon. We think that any food that has sugar, fructose, in it is a safe food to eat. And that is actually built into our DNA. It is a Darwinian precept. Because there is no foodstuff on the planet that is both sweet and acutely poisonous. This was the signal to our ancestors that any given food was good to eat. So we love this stuff. Think about it this way. You got children?

IRA FLATOW: Yeah.

ROBERT LUSTIG: How many times did you have to introduce a savory food to a baby before they would accept it? On average, it’s 13 times. That’s what science says. But, if the food is sweet, how many times? Just once. We are programmed to like the stuff.

Now, you put glucose and glucose together, that’s called maltose. That’s what’s in beer. You put glucose and galactose together, that’s lactose. That’s what’s in milk. And then you put glucose and fructose together, that’s sucrose or table sugar. Everybody understand the different kinds now. So we have six different compounds we’re talking about when we talk about sugar.

But I’m only talking about the sweet stuff. I’m talking about sucrose or high fructose corn syrup, which is basically one glucose, one fructose, it’s just made from corn. There’s an enzyme process that turns glucose into fructose. It’s still half and half, one and one, and that’s why it’s irrelevant. They’re the same.

Table sugar, cane sugar, beet sugar, that’s what the whole world has. High fructose corn syrup is only available in the United States, Japan, Canada, and very limited exposure in parts of Europe. And guess what? The whole world now has obesity and metabolic syndrome. So, it’s not about high fructose corn syrup per se.

The reason high fructose corn syrup is such a problem is because it’s cheap. It’s so cheap that it found its way into foods that never had sugar before. It found its way into salad dressings. It found its way into pretzels. It found its way into hamburger buns. It found its way into hamburger meat. Ask Taco Bell what they put in their meat. Bottom line, we are gorging on the stuff because it is now cheap. And in 1973 when DuPont invented the two liter bottle, now we have the perfect fructose delivery vehicle. And look what’s happened to obesity and metabolic syndrome since.

IRA FLATOW: And fructose makes you want to have more of it, doesn’t it?

ROBERT LUSTIG: That’s right. And there was a paper that just came out last week. It’s gotten a lot of press from Yale, Journal of the American Medical Association, showing that fructose doesn’t cause changes in cerebral blood flow like glucose does. And it doesn’t cause satiety like glucose does. And it doesn’t change the hormones that regulate energy balance like glucose does.

So, glucose is, for lack of a better word, good. And fructose, for lack of a better word, is not.

IRA FLATOW: We’re going to take a break and come back and talk lots more with Robert Lustig, author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.” Our number, 1-800-989-8255 You can tweet us @scifri, get into the conversation. Do you agree with Dr. Lustig? Have you got stuff you’d like to talk about? We’ll be back right after this break.

This is Science Friday. I’m Ira Flatow. We’re talking about food and nutrition with Robert Lustig, author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.” So much to talk about. I don’t want to get stuck on fructose because there’s a lot more stuff in your book, but I can’t avoid it because it’s a topic of discussion. And some of your cr–

ROBERT LUSTIG: Everybody wants to know about it.

IRA FLATOW: Yeah, some of your critics even like to point to the fact that we’re consuming less high fructose corn syrup and added sugars today, but we’re still getting fat. Well how do you respond to that?

ROBERT LUSTIG: Absolutely. Well first of all, we are consuming a little bit less than we were, say, a decade ago. A decade ago, we were consuming 140 pounds of sugar per year, per person. We are right now at 130 pounds. So yes, we have cut back slightly.

The problem is that the data suggests that our bodies can only process approximately, I would say somewhere between 50 and 65 pounds of sugar, per year based on calculations that are related to what we do with alcohol. And fructose and alcohol are basically metabolized by the liver pretty much the same. And that was sort of the thing that got all the attention, was the analogy between the two. So, we are still about double over our allotment.

And that’s the problem. The problem is that even though we have cut back slightly because diet sodas have increased their appeal. Currently in America, 42% of all beverages made by the soda companies are now diet. So that has reduced total sugar consumption slightly. It’s not nearly enough and we are still way over our threshold.

IRA FLATOW: So what’s the antidote to this?

ROBERT LUSTIG: Well, the antidote, unfortunately, in so many public health venues– and this is a public health crisis. Medicare will be broke by the year 2024 unless we get a handle on this. And there is no drug target for metabolic syndrome. Bottom line, the answer is reduce availability. And that, of course, gets everybody’s hackles up.

The whole concept of the libertarianism, keep your hands out of my kitchen. Don’t tell me what to eat. Well you know what? We’ve already been told what to eat. Because of the 600,000 food items that are available in the American grocery store today, 80% of them are laced with added sugar. This is work from Barry Popkin at the University of North Carolina.

Bottom line is you’ve already been told what to eat. You don’t have a choice about what to eat. Your choice has already been co-opted. So when this comes right down to it, it’s really, who do you want in your kitchen? You want the government who will take away your wallet and your freedom? Or do you want the food industry who has already taken away your wallet, your freedom, and your health? That’s your real choice.

IRA FLATOW: Let’s go to Hannah in Napa, California. Hi, Hannah. Welcome to Science Friday.

HANNAH: Hi, thanks for taking my call. I really have always tried to eat very healthy that wasn’t until I developed gestational diabetes that I realized how incredibly complex it is and how much misinformation there is out there, particularly around sugar.

Now that I have an infant, a six month old– I have other children but just been since having gestational diabetes that I’ve learned about this– but now have a six-month-old and I’m trying to introduce solid foods– you hear her in the background there– what about the baby cereal that’s touted as whole grain, organic? What– following your recommendations, Dr. Lustig, how do you feed a baby healthy, solid food?

IRA FLATOW: Thanks for calling, Hannah. We’ll let you get back to your kids.

ROBERT LUSTIG: Excellent question. The fact of the matter is that even baby formula is laced with sugar. The formula Isomil is lactose free. What do they substitute? They substitute sucrose. Coca Cola is 10.5% sucrose, Isomil is 10.3% sucrose.

And there is sugar in virtually all of standard baby foods. And the reason is because that way, the kid will eat it. So, we have this big issue about whether or not this is a good thing or not. Obviously, parents want their kids to eat. The question is, is this the best way to get them to do it?

There’s a toddler formula out there called Enfagrow. And basically what it is, is it’s a toddler milkshake. It’s enormously chock full with sugar.

IRA FLATOW: So what’s a mother to–

ROBERT LUSTIG: And the company that makes it–

IRA FLATOW: What’s a mother to do? Can you make your own food or is there something?

ROBERT LUSTIG: Yes, you can. Of course you can. What do you think happened before there was Gerber? What do you think happened before there were all these baby food companies? Yes you can. What I think the baby food companies need to do is they need to cut back on the added sugar. I think that the entire food industry needs to cut back on the added sugar.

IRA FLATOW: Well with concerned–

ROBERT LUSTIG: They have no impetus to do so.

IRA FLATOW: But with concerned mothers like Hannah, would there not be a market for something like that? They might take advantage of.

ROBERT LUSTIG: Well, let’s see. I’m waiting to see whether or not enough education of the public will actually put pressure on the food industry to do so.

IRA FLATOW: And let me go to Ellen in Oakland. Hi Ellen, welcome to Science Friday.

ELLEN: Hi, thank you. Dr. Lustig, I am a huge, huge fan of yours.

ROBERT LUSTIG: Thank you.

ELLEN: I don’t understand why scientists sometimes joke about this, about your research. But here is my question.

ROBERT LUSTIG: I’m not sure why either.

ELLEN: I’m actually a nurse practitioner. And I’m addicted to sugar. It’s sad, but true. Totally addicted. What would be your suggestion for getting somebody off sugar? Obviously, you can say stop eating it. But as you know, if you have an addiction, that’s easier said than done.

IRA FLATOW: All right Ellen, thanks for calling.

ROBERT LUSTIG: It’s a great question. And to be honest with you, I wish I had sort of the easy off the cuff answer. We know from other addictive substances that because the dopamine receptors in the reward center are down regulated by whatever that substrate is– and it can be nicotine, alcohol, heroin, cocaine, amphetamine– it takes three weeks of abstinence for those dopamine receptors to come back. And the cravings still stay for many, many months, even sometimes years afterwards. This is a major problem in addiction, is how do you deal with those?

So, how do we deal with addiction with any other substance? The answer is number one, cold turkey. Number two, there are some medications that can be used. For instance, say, Wellbutrin is used for smoking, and there are some other things you can do. Ultimately, the best way to do it is to wean yourself off.

Now, how do you wean yourself off sugar when everything that’s out there contains it? That’s the problem. So, we can’t get kids off sugar. We also can’t get kids off sugar in my clinic because the parents are addicted. So I’ve got two patients, the kid and the parent. The kid may want to do the right thing but the parent won’t let them–

IRA FLATOW: Yeah, there’s no easy answer.

ROBERT LUSTIG: –because keep away from my cookies. So it’s a real, it’s a major problem.

IRA FLATOW: Let me go into one of the most interesting and most surprising parts of your book, is the chapter on exercise where you write, quote, “there is not one study that demonstrates that exercise alone causes significant weight loss.” And the clincher is, “the largest percentage of your calories is burned while sleeping or watching TV.”

ROBERT LUSTIG: Absolutely. And I’m not even the first person to say that. You may remember a Time Magazine cover article about three years ago called “The Myth of Exercise.” They said it way before I did. The fact is that exercise does not cause weight loss.

What does exercise– by the way, exercise is the single best thing you can do for yourself. So I am not in any way, shape, or form demeaning exercise. I think exercise is the best antidote for anything that’s wrong. So, please don’t call in and say Lustig says exercise is useless. Not at all.

What does exercise do? What’s the real value of it? Here’s what it is. Exercise builds muscle. And muscle make mitochondria. And mitochondria are where the energy is burned. So if you have more mitochondria, that means you’re going to have less chance of overloading those mitochondria and turning that excess foodstuff– in particular, fructose– into liver fat. So you can keep your liver, you can keep your muscle insulin sensitive. You can keep your insulin levels down.

And it’s all about the insulin. Everybody thinks it’s about the calories, absolute garbage. It’s about the insulin. It’s the insulin’s stupid. And if you don’t believe me, Jim Johnson from the University of British Columbia just published a paper two months ago in Cell Metabolism where he has a beautiful animal model where they can regulate the amount of insulin that the animal makes from scratch. And whatever that insulin level is, that’s how much that animal gains.

So, there are people who get the fact that a calorie is not a calorie. There are people who understand that things that make your insulin go up are the things that are going to make you gain weight. Perfect example, Gary Taubes has been saying this now for 10 years. That’s exactly right. So, this is where Gary and I actually agree.

It is the insulin’s stupid. And there are a lot of people who understand that and believe that, especially endocrinologists. But the problem is that’s not what the food industry and that’s not what the government wants you to believe.

IRA FLATOW: 1-800-989-8255 Interesting tweet from Miranda, who writes, “can I still have beer if I cut out other processed sugars? I’m from Wisconsin, after all.”

[LAUGHTER]

ROBERT LUSTIG: Well, I used to live in Wisconsin. I was a faculty member at the University of Wisconsin for five years. And I like a beer every once in a while too. The problem with alcohol is that normally, it has a J shaped curve. A little bit of alcohol is good for you. A lot of alcohol, obviously, is not. And there’s a nice place in the middle.

The problem with beer and also shochu, which is a Japanese carbohydrate containing alcoholic beverage, is that there’s no edge on the J. It’s basically a straight up curve. And the reason is because beer is both glucose and fat– because alcohol gets metabolized like fat as fructose does– at the same time.

And so, the glucose in the beer will get metabolized to glycogen or liver starch, and the alcohol will get metabolized as fat. Thereby overwhelming your liver mitochondria. Thereby causing the same level of insulin resistance. So of the various alcoholic beverages that are out there, I would say the beer is not the best choice to tie one on with.

IRA FLATOW: Is wine or spirits?

ROBERT LUSTIG: Wine’s much better.

IRA FLATOW: Same thing?

ROBERT LUSTIG: Well, as long as you do them, as everyone says, in moderation. Hey, I partake as well. Bottom line is everything in moderation. The problem is that the food industry has not allowed us to moderate our sugar consumption because they know when they add it to the food, we buy more. For all the reasons we’ve talked about.

IRA FLATOW: You say it’s a bad idea to skip meals if you want to lose weight. Skipping breakfast, for example, bad idea.

ROBERT LUSTIG: Right, very bad idea for several reasons. First reason, there’s something called the thermic effect of food, TEF. You have to put energy in to get energy out. And the earlier in the day you put energy in to get energy out, the more you’re going to burn. So, if you eat breakfast, you’ll start that process earlier and you will actually burn energy faster during the day and feel better too. You’ll actually do better in school.

Number two, if you don’t eat breakfast– and so many kids don’t. They just fly out the door in the morning and don’t eat breakfast. What happens is the hunger hormone ghrelin keeps rising as the day goes on. And so you will end up over eating at lunch and probably over eating at your 3:00 PM snack when you get home. And now over eating a dinner as well and you will have consumed way more calories. So you think you’re actually saving calories by missing a meal, not at all. So you’re burning less, ultimately eating more, and driving weight gain and metabolic syndrome. Bad idea.

IRA FLATOW: If you keep the temperature in your home or your apartment down lower and keep it a cool place, can you burn calories faster or more calories, lose weight, just by keeping the temperature down because you have to keep your body temperature up?

ROBERT LUSTIG: That’s never been shown. Some people think that that’s true and it might even be true. But no one’s actually ever done the study to say, OK, let’s take everybody’s ambient temperature down 10 degrees and see if it causes weight loss. My guess is it won’t work. My guess is that you will burn energy a little faster because you’re going to try to create some body heat. But ultimately, that’s going to translate into increased caloric intake to try to make up for it. I don’t think it’s going to work.

IRA FLATOW: Talking with Robert Lustig, author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease” on Science Friday from NPR. I’m Ira Flatow, learning a lot today. Can you be obese or overweight and still be healthy?

ROBERT LUSTIG: Absolutely, for sure. 20% of the obese population has completely normal metabolic parameters. They have normal metabolic machinery and they will live a completely normal, healthy life and die at a normal age. They’re just obese. They are what we would call fat and fit.

And it’s easy to be fat and fit. You exercise. The problem is that all the doctors out there tell their patients if you’d only exercise, you’d lose weight. And, of course, it doesn’t work. So what happens? They stop exercising because it didn’t work.

So, as far as I’m concerned, that is the greatest disservice that the medical profession can do to a patient. Understand what exercise is for. It’s for burning that belly fat, for burning that visceral fat, for burning the fat that ultimately contributes to metabolic syndrome. So, can you be fat and healthy? Absolutely. And can you be thin and sick? Absolutely.

As you said in the trailer leading up to the show, up to 40% of normal weight people have the same metabolic dysfunction as the obese. They’re just not obese. And they’re going to die of those diseases, cancer, dementia, Type 2 diabetes, lipid problems, stroke, et cetera. And they don’t know it. That’s one of the reasons why everyone needs to get with the program and everyone really needs to read this book.

IRA FLATOW: But if it’s not going to make you lose weight, you’re saying do other things besides just exercising to bring that weight back down. Eat correctly and that will lower your body weight.

ROBERT LUSTIG: Well, what does it correctly mean? That’s really what we’re talking about here, is what does it correctly mean? What I say in the book is that the two things that every successful diet share in common, the Atkins diet, the Ornish diet, the glycemic index diet, the South Beach diet, the paleo diet, you name the diet. There are two things that every single successful diet have in common, low sugar, high fiber. Those are the two things that every successful diet share.

So, what’s a low sugar high, fiber diet called? It’s called real food. This is a processed food phenomenon. And when our processed food basically took over our diet in the ’70s– and we did it for many reasons. We did it for convenience. We did it for cost. We did it because we now had two parent working families. We did it because the fast food industry went through the roof. We did it because we had the two liter bottle. We did it for a whole bunch of reasons.

But the bottom line is when we made that transition, that’s when all of this occurred. This is a processed food phenomenon. We need to get back to what we used to do because there’s no drug target. There’s no way to fix this other than doing that. And like I said before, we don’t have the money to be able to do otherwise.

IRA FLATOW: So, buy food with no labeling on it that doesn’t have any.

ROBERT LUSTIG: Absolutely. If it doesn’t have a label, it means it’s real food. As soon as you’re buying– when you’re reading labels, that means you’re buying garbage. It’s that simple. Because real food doesn’t need a label.

IRA FLATOW: That’s a good place to end it. Thank you very much, Robert Lustig, for joining us today.

ROBERT LUSTIG: Thank you for having me, Ira.

IRA FLATOW: You’re welcome. Robert Lustig, author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.”

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