Adjustable Gastric Band Surgery, often referred to as lap band or band surgery is usually performed as an outpatient procedure. In the surgery, an adjustable silicone band is placed around the upper portion of the stomach. Small incisions are made in the skin to allow the band to be placed (laparoscopic procedure). The band creates a small stomach pouch at the top of the stomach - the stomach is not surgically reduced in size. The smaller pouch that is created with the band results in smaller amount of food intake, and a feeling of fullness after eating smaller portions of food. Surgery typically takes 45 minutes to an hour during which general anesthesia is used. Patients will go home the same day. Recovery is roughly two weeks.
I actually went on a ketogenic diet last year to see if it would help my migraines. I have a history of chronic migraines which would usually last 3 days, sometimes longer. Triptans help a lot but I don’t like having to take them. I stayed in ketosis for about 8 months and experienced a significant reduction in migraines, from feeling some type of headache (mild o r severe) almost everyday to 1 or 2x per month while in ketosis. Although I’m very healthy otherwise, I do think my migraines may have something to do with blood sugar fluctuations (despite previously eating a whole foods diet and no refined carbs), and keto totally stabilized this. I eventually came off of Keto because I’m not really a meat lover. When I came off, but remained low carb, my migraines stayed under control for the most part. When I increase carbs, they do return.
StrongLifts is an app that claims to help you burn fat and build muscle. It works around a workout routine that is three times a week at 45 minutes per session. It uses various lifts and workouts to help generate more muscle. Along with that, the app includes Wear OS support, workout videos, a built-in timer, a bunch of automatic functions, and you can record your workout progress. It starts you out on a beginner's program and you can increase the difficulty as you go. We like this one because it works well for beginner's, but still has some advanced exercise routines for the more advanced members of the weight loss club.
It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]
Despite continuous advances in the medical world, obesity continues to remain a major worldwide health hazard with adult mortality as high as 2.8 million per year. The majority of chronic diseases like diabetes, hypertension, and heart disease are largely related to obesity which is usually a product of unhealthy lifestyle and poor dietary habits. Appropriately tailored diet regimens for weight reduction can help manage the obesity epidemic to some extent. One diet regimen that has proven to be very effective for rapid weight loss is a very-low-carbohydrate and high-fat ketogenic diet.[1][2][3]
Phentermine can also be hard for some women to quit. The pounds pile right back on once you wean off, says Dr. Jampolis, unless you use the pill in combination with exercise and a healthy eating plan. And for those drawn in by the promise of effortlessly slipping into a size zero, the buzzy thrill of being on an upper can sometimes feel even harder to give up. “Part of phentermine's popularity is that it’s a stimulant, and some people like that feeling,” Dr. Ryan says. It's part of a class of drugs that has been shown to have potential for addiction.
I personally have benefited greatly by drinking weight loss tea. Also known as herbal slimming teas, not only are these easily available, they are super delicious and you really do not have to spend hours making them. Detox teas or teetox as they are popularly known, gently cleanse the system, kick-start slow or sluggish digestion and also help in burning fat.
About a year ago, i had an paragliding-accident that was nearly fatal. I was in hospital for half a year and had to lie in bed all the time because my injuries were really, really bad. I didn't know what to do all day. I was so bored that I started to cheer myself up with some chocolate and other sweets. Before I had my accident, sports was my only hobby. After school, at weekends, whenever I could, I went cycling or did anything sporty. And of course, I ate healthy. No added sugar, no salt, not even white bread (not only because of the added sugar). I was soooo happy with my body. And then this happened. At first I lost about 15 kilos of muscles and then i started to gain weight again. But not muscles... That was belly fat. I sweared to myself to get rid of that fat again and tried everything as soon as i got out of the hospital. After some weeks I could walk normally again (more or less) and then I started cycling. Nothin worked... My muscles came back but the fat stayed. So I tried something else. I did not expect it to work but it really did. And thank god I finally managed to get my sixpack back. Well, it doesn't work as fast as it is displayed on the site, but it really works. Just try it. I just want to share this wonderful moment with you and give you the chance of losing you belly fat too. Here is the two product i used and I hope it will change your life as it did mine. https://bit.ly/2jfF3RK
Generally, most overweight people should initially try to lose weight using diet and exercise. Prescription diet pills are used in more severe circumstances, when weight loss has not been successful and the patient has important health risks associated with being overweight or obese. However, diet and exercise should always be used in conjunction with prescription weight loss drugs.

I ordered this tea to aid in both my weight loss efforts and to detox my system. My metabolism has slowed down, i’m tired all the time and I am battling hormone issues. I’ve only been drinking the tea for approximately a week and I already feel more energetic and healthier. I have changed my eating habits and the tea is now a daily part of my diet. It’s changing my life!
The keto diet works by eliminating carbohydrates from the your daily intake and keeping the body’s carbohydrate stores almost empty, therefore preventing too much insulin from being released following food consumption and creating normal blood sugar levels. This can help reverse “insulin resistance,” which is the underlying problem contributing to diabetes symptoms. In studies, low-carb diets have shown benefits for improving blood pressure, postprandial glycemia and insulin secretion. (7)
Elissa Goodman, celebrity holistic nutritionist and cleanse expert, substantiates the website's claim. She agrees that HCA is said to block fat absorption and suppress the appetite and inhibits a key enzyme, citrate lyase, that the body needs to make fat from carbohydrates. This is supposed to help you feel fuller more quickly and help convert the food you eat into energy as opposed to being stored as fat. "However, the most promising studies to prove this were animal studies," Goodman says. "The studies of Garcinia Cambogia in humans do not show any mind-blowing results."
Hello, may I ask if someone has some experience week fasting for 14 days? I was told that the food which should be started taken after 14 days of fasting has to be in very simple and in slow amount. Unfortunately 1-2 days after fasting I am allowed to take only bouillon out of buckwheat, barley, from the 3rd day buckwheat mush, and only from 5th day milk or sour cream, oil since 11th day. Can anyone advice how should I adopt this come back food path to Ketogenic diet? Thank you in advance, Maria
The popular belief that high-fat diets cause obesity and several other diseases such as coronary heart disease, diabetes, and cancer has not been observed in recent epidemiological studies. Studies carried out in animals that were fed high-fat diets did not show a specific causal relationship between dietary fat and obesity. On the contrary, very-low-carbohydrate and high-fat diets such as the ketogenic diet have shown to beneficial to weight loss.
Oh god weight loss apps?? Seariousely? First the annoying fake tv commercials that hire people that are fake!! It’s call slowdown eat in portions and work out 5 times s week I’m 21 6 foot 5 195 male and have fat brothers and they cry and sip there diet sodas like that’s going to help wahhh wahhhh wahhh!! Ya fat people drive there smart car type cars going through fast foods and seeing them sick asses eat while the drive makes me puke they eat like there’s no tomorrow slow down porky the pigs out there!!

There's a proven link between obesity and depression, and while the majority of patients who undergo bariatric surgery do experience an overall improvement in their well-being after surgery, feelings of depression can worsen for some. Researchers from Yale University published a study in the Obesity Journal in which 13 percent of patients studied reported an increase in Beck Depression Inventory – a numerical rating that measures eating disorder behavior, self-esteem, and social functioning – six to 12 months after gastric bypass surgery, a time frame that the authors conclude is an important period to assess for depression and associated symptoms.
A new device uses a pump to drain part of the food in your stomach after a meal. The device includes a tube that goes from the inside of your stomach to a port on the outside of your abdomen. The port is a small valve that fits over the opening in your abdomen. About 20 to 30 minutes after eating, you attach tubing from the port to the pump and open the valve. The pump drains your stomach contents through a tube into the toilet, so that your body doesn’t absorb about 30 percent of calories you ate. You can have the device removed at any time.
In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate, and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet.[10] Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.[10]
John Staughton is a traveling writer, editor, and publisher who earned his English and Integrative Biology degrees from the University of Illinois in Champaign, Urbana (USA). He is the co-founder of a literary journal, Sheriff Nottingham, and calls the most beautiful places in the world his office. On a perpetual journey towards the idea of home, he uses words to educate, inspire, uplift and evolve.
Phentermine can also be hard for some women to quit. The pounds pile right back on once you wean off, says Dr. Jampolis, unless you use the pill in combination with exercise and a healthy eating plan. And for those drawn in by the promise of effortlessly slipping into a size zero, the buzzy thrill of being on an upper can sometimes feel even harder to give up. “Part of phentermine's popularity is that it’s a stimulant, and some people like that feeling,” Dr. Ryan says. It's part of a class of drugs that has been shown to have potential for addiction.
The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.
Because modern diet pills were introduced to replace amphetamines as appetite suppressants, the drugs have many similarities, including a potential for dependence and addiction. Amphetamines comprise a class of drugs used to increase performance. Diet pills may cause increased energy and feelings of euphoria, increasing the likelihood of addiction. Other factors that influence the development of a diet pill addiction include biological factors, environmental factors, home and family, peer and school, early use, and how the drug is taken. Common side effects of diet pill abuse might include:
This app, made by the fitness wizards at the popular health blog Daily Burn, is great for beginners who aren't sure how much power they need in their workout app. Out of the metaphorical box, this free app lets you view professionally written wellness and exercise articles, create weight goals, and track workouts and weight. True: It's not free forever, but you can do a 30-day trial and decide if you want to spend $20 per month to keep using it. If you decide to keep going, you'll get new workouts every day, tailored to your needs.
Before you head out to dinner, pour yourself a cup of green tea. The active ingredient in green tea, EGCG, boosts levels of cholecystokinin, or CCK, a hunger-quelling hormone. In a Swedish study that looked at green tea’s effect on hunger, researchers divided up participants into two groups: One group sipped water with their meal and the other group drank green tea. Not only did tea-sippers report less of a desire to eat their favorite foods (even two hours after sipping the brew), they found those foods to be less satisfying.
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[18] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[48] Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.[18]
Tell your healthcare provider about all of your medical conditions including if you have: depression or other mental illnesses; attempted suicide; seizures; head injury; tumor or infection of brain or spine; low blood sugar or low sodium; liver or kidney problems; high blood pressure; heart attack, heart problems, or stroke; eating disorder; drinking a lot of alcohol; prescription medicine or street drug abuse; are 65 or older; diabetes; pregnant; or breastfeeding.
While you might think of Fitbit as a device you need to buy and wear, you can use the app with just your iPhone or Android device. Your phone has enough sensors to track most of what the Fitbit app needs to help you get in shape and lose weight. If you like the app and want more tracking when you aren’t carrying your phone, you can always buy a Fitbit device later.
Your personal coach, however, isn’t necessarily a registered dietitian or certified psychologist. According to its website, areas of expertise include psychology, social work, nutrition, exercise physiology. Coaches complete a Noom-specific certification program that is recognized by the International Consortium for Health & Wellness Coaching, and they complete the Centers for Disease Control’s Diabetes Prevention Program (DPP) Lifestyle Coach training.
Red tea, also known as rooibos, is a great choice for when you’re struggling with midday stress. What makes rooibos particularly good for soothing your mind is the unique flavanoid called Aspalathin. Research shows this compound can reduce stress hormones that trigger hunger and fat storage and are linked to hypertension, metabolic syndrome, cardiovascular disease, insulin resistance and type 2 diabetes.
When she first started popping the mint-size meds, Brittany noticed that her heart would race on-and-off for hours, and she’d feel weirdly antsy. This made her uncomfortable—until, just weeks later, she put on a pair of shorts. “I had always been so insecure about my legs,” she says. Now she thought she looked good. And well, that made her heart race too.
In essence, it is a diet that causes the body to release ketones into the bloodstream. Most cells prefer to use blood sugar, which comes from carbohydrates, as the body’s main source of energy. In the absence of circulating blood sugar from food, we start breaking down stored fat into molecules called ketone bodies (the process is called ketosis). Once you reach ketosis, most cells will use ketone bodies to generate energy until we start eating carbohydrates again. The shift, from using circulating glucose to breaking down stored fat as a source of energy, usually happens over two to four days of eating fewer than 20 to 50 grams of carbohydrates per day. Keep in mind that this is a highly individualized process, and some people need a more restricted diet to start producing enough ketones.
Our team, led by Dr. Thomas White, has a passion for helping patients reach their health goals. By providing guidance for both bariatric surgery and other non-surgical options, we are committed to equipping each patient with the tools and information they need for healthy weight loss. We are the area's most experienced in laparoscopic procedures, completing 99% of our bariatric surgery procedures laparoscopically.

What is the ketogenic diet exactly? The classic ketogenic diet is a very low-carb diet plan that was originally designed in the 1920s for patients with epilepsy by researchers working at Johns Hopkins Medical Center. Researchers found that fasting — avoiding consumption of all foods for a brief period of time (such as with intermittent fasting), including those that provide carbohydrates — helped reduce the amount of seizures patients suffered, in addition to having other positive effects on body fat, blood sugar, cholesterol and hunger levels. (1)


Burdock is also a popular ingredient. It’s a plant root that promotes healthy liver cells and purifies the blood. Yerba mate is made from dried leaves of an evergreen holly and has the benefits of tea and coffee. It boosts energy and increases alertness without causing jitters like coffee, and is packed with vitamins and minerals like vitamin A, B2, iron, and flavonoids and amino acids.
That said, there are some amazing teas out there. Teas that taste delicious — preventing you from getting bored and picking up a sugar- and chemical-packed soda — and that can genuinely assist you in your healthy dieting goals. Some teas have "many beneficial compounds that can battle and actually block the absorption of fat," Dr. Verma says.[slideshow:
Aside from carb flu, be warned that staying in long-term, continuous ketosis may have drawbacks that may actually undermine your health and longevity. To stay on the safe side, I recommend undergoing a cyclic ketogenic diet. The "metabolic magic" that ketosis brings to the mitochondria actually occurs during the refeeding phase, not during the starvation phase.
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.[42]
Even in the small percentage of patients who ultimately lose little weight after surgery, significant metabolic benefits persist, according to findings at the Cleveland Clinic. In a study of 31 obese diabetic patients who had not lost a lot of excess weight five to nine years after surgery, a “modest” weight loss of just 5 to 10 percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities, Dr. Stacy Brethauer and colleagues reported.
Red tea, also known as rooibos, is a great choice for when you’re struggling with midday stress. What makes rooibos particularly good for soothing your mind is the unique flavanoid called Aspalathin. Research shows this compound can reduce stress hormones that trigger hunger and fat storage and are linked to hypertension, metabolic syndrome, cardiovascular disease, insulin resistance and type 2 diabetes.
Also, consider supplementing with the amino acid leucine, as it can be broken down directly into acetyl-CoA, making it one of the most important ketogenic amino acids in the body. While most other amino acids are converted into glucose, the acetyl-CoA formed from leucine can be used to make ketone bodies. It’s also present in keto friendly foods like eggs and cottage cheese.
I am Rahul Yadav, Founder of Kaa-Yaa I have just come across your blog post and found great resource. Please consider our app Kaa-Yaa for such resources. Kaa-Yaa is a fitness training app designed to help you achieve your fitness goals through personalized workout programs that can be performed at your home or in the gym. Google Play URL: https://play.google.com/store/apps/details?id=com.kaayaa.kaayaa
Even doctors who prescribe the drug to only patients who really need it may not monitor these patients as closely as they should. Stacey's doctor let her stay on phen for five months, which is a month longer than the twelve weeks stipulated by the FDA. Brittany’s doctor gave her a 'script without requiring her to come back for so much as a single check-up. “My doctor didn’t give me any tests and I wasn’t monitored at all,” she says. Her heart often felt fluttery while she was on it, like paper blowing in the breeze: "That did freak me out, but nothing else worked."
Google Fit has a lot of advantages compared to other weight loss apps. For instance, it comes pre-loaded on most Android devices. That means all you have to do is turn it on. Additionally, it's completely free to use and it's cross-platform. You can also have it track fitness from a number of wearables, including Android Wear, Xiaomi Mi bands, and apps like Runkeeper, Strava, MyFitnessPal, and others. It's still somewhat of a work in progress for Google so we're sure it'll see various improvements and redesigns over the coming years. However, it's a good first step for beginners and a must for Wear OS owners.

* Disclaimers: Content: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Advertising: Bariatric Surgery Source, LLC has entered into referral and advertising arrangements with certain medical practices, original equipment manufacturers, and financial companies under which we receive compensation (in the form of flat fees per qualifying action) when you click on links to our partners and/or submit information. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Read More
The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.
But that doesn't necessarily mean it doesn't work. So I decided to test that theory and try Fit Tea for a full 14 days and record how I felt, what I saw, and if it fulfilled its claims at the end. Going into the experiment, my expectations were not particularly high. It is just tea, after all. If I've learned anything from my time spent with beauty editors, fitness experts, and nutritionists, it's that healthy weight loss with staying power doesn't happen overnight. Then I read the reviews:
Fen-phen was shown to cause heart valve problems in up to one-third of people who used it, in addition to a potentially fatal lung condition called primary pulmonary hypertension (PPH). By 1997, the FDA had banned fenfluramine, one of the two drugs contained in the combo, and yanked fen-phen from the market. But not before thousands of people suffered serious side effects and even died, including Mary Linnen, 30, of Massachusetts, who was dead from PPH just ten months after taking fen-phen to lose weight for her wedding. Tens of thousands of legal claims were filed against the makers and distributors of fenfluramine, with pharma company Wyeth ultimately setting aside $21 billion for payouts.

Your glycogen stores can still be refilled while on a ketogenic diet. A keto diet is an excellent way to build muscle, but protein intake is crucial here. It’s suggested that if you are looking to gain mass, you should be taking in about 1.0 – 1.2g protein per lean pound of body mass. Putting muscle on may be slower on a ketogenic diet, but that’s because your total body fat is not increasing as much.5Note that in the beginning of a ketogenic diet, both endurance athletes and obese individuals see a physical performance for the first week of transition.
A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
I was a Corpsman (not a corpse-man as some recent somewhat fanatical president would say), and I can tell you many stories of Marines and Sailors who maintained restrictive diets (aka picky eaters). Most obvious was lack of sustaining energy (hypoglycemia) at mile 15 (with 80lbs of gear including a 6.5lb rifle and 200 rnds of ammo, etc.) and depletion of essential vitamins, electrolyte imbalance. They were always the first to collapse and have to hear me scold “see I told you so.” An IV of D5W usually does the trick (D is for dextrose, OMG!)
^ Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–63. doi:10.1542/peds.102.6.1358. PMID 9832569. https://web.archive.org/web/20040629224858/http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM Lay summary]—JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.
Amphetamines (marketed as Benzedrine) became popular for weight loss during the late 1930s. They worked primarily by suppressing appetite, and had other beneficial effects such as increased alertness. Use of amphetamines increased over the subsequent decades, including Obetrol and culminating in the "rainbow diet pill" regime.[15] This was a combination of multiple pills, all thought to help with weight loss, taken throughout the day. Typical regimens included stimulants, such as amphetamines, as well as thyroid hormone, diuretics, digitalis, laxatives, and often a barbiturate to suppress the side effects of the stimulants.[15] In 1967/1968 a number of deaths attributed to diet pills triggered a Senate investigation and the gradual implementation of greater restrictions on the market.[16] While rainbow diet pills were banned in the US in the late 1960s, they reappeared in South America and Europe in the 1980s.[15] Eventually rainbow diet pills were re-introduced into the US by the 2000s and led to additional adverse health effects.[17][18][19]
Every effort is made to ensure that all our information is correct and up to date. However, Epilepsy Society is unable to provide a medical opinion on specific cases. Responses to enquiries contain information relating to the general principles of investigation and management of epilepsy. Answers are not, and should not be assumed to be, direct medical advice and is not intended to be a substitute for medical guidance from your own doctors. Epilepsy Society and any third party cannot be held responsible for any actions taken as a result of using this service. Any references made to other organisations does not imply any endorsement by Epilepsy Society.
Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?
Rooibos tea is made from the leaves of the “red bush” plant, grown exclusively in the small Cederberg region of South Africa, near Cape Town. What makes rooibos tea particularly good for your belly is a unique and powerful flavonoid called Aspalathin. Research shows this compound can reduce stress hormones that trigger hunger and fat storage and are linked to hypertension, metabolic syndrome, cardiovascular disease, insulin resistance and type 2 diabetes. Yup, sometimes the kettle can be as effective as the kettlebell.
Back in the early '90s, doctors thought they had struck gold with a combination of drugs, fenfluramine and phentermine, or fen-phen, that seemed to magically melt fat away. But within a couple of years some patients began to develop very scary side effects: damage to heart valves that could lead to heart failure and a kind of high blood pressure, pulmonary hypertension, that proved to be fatal in some cases.
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