Hashimotos Autoimmune Thyroiditis: Eating for Health Applications for Recovery
By Jodi Friedlander, N.C. & Edward Bauman, M.Ed., Ph.D.
As the world becomes more polluted, the incidence of “autoimmune” disease will steadily increase. Our environment is killing us and no medicine can protect us.
In most cases, little attention is paid to the causes or contributing factors that drive autoimmune conditions. Autoimmunity is most easily understood as a “hyper-immune” state. With conditions as diverse as multiple sclerosis, lupus, rheumatoid arthritis, scleroderma, and even some forms of diabetes, the confluence of stress, toxicity, trauma, and poor nutrition, with an element of genetic susceptibility, promotes aggressive immune function that destroys sensitive body tissue.
Merely suppressing the immune system is not sufficient to reverse the onslaught of inflammation, degeneration, and loss of both tissue structure and function that occurs with autoimmunity. The Eating for Health approach, with its emphasis on alternating a cleansing, detoxifying diet with a reparative, building diet, is the natural way to tease out the pathological elements that are driving excessive immune response. A variety of metabolic, functional laboratory tests are advised, to identify offending antigenic (immune arousing) substances for which a specific integrative diet, supplement, and lifestyle program can be devised. Initially, natural and medical approaches offer the highest level of care. In time, as a person heals, he or she can look forward to being less rigid and rigorous in application of these strategies.
This article focuses on what happens when the thyroid or its hormones get targeted for a persistent immune attack. Alongside the obesity epidemic, the incidence of hypothyroidism appears to be escalating wildly, and since low thyroid function generally causes weight gain, the two are often intimately connected. While the rise in obesity is obvious to anyone with visual acuity, low thyroid function is not so generally apparent, nor is it diagnosed easily by most doctors in its subclinical stage. For this reason it is important for consumers, nutrition professionals, and healthcare practitioners to learn to recognize its symptoms and manifestations. Hypothyroid, left untreated, can contribute to unwanted weight gain and create a host of debilitating symptoms that can lead to serious health problems.
What It Is
The thyroid is a small butterfly-shaped gland that sits at the base of the neck, under the Adam’s apple. It is responsible for synthesizing several hormones that affect the energy production of almost every cell, tissue, and organ in the body. It controls metabolism, regulates body temperature, and affects body weight, muscle strength, energy levels, and fertility.
The primary hormones produced by the thyroid — T4 and T3 — are formed from the amino acid tyrosine, combined with iodine. Hormone production is dependent on the ability of the hypothalamus to sense the body’s need for more thyroid hormone and to signal the pituitary gland via thyroid releasing hormone (TRH). Thyroid stimulating hormone (TSH), released from the pituitary gland, influences and controls production of these hormones. TSH levels rise and fall in response to fluctuations in the amount of circulating hormones in the bloodstream. Hypothyroidism can occur due to dysfunction in any of these glands, causing underproduction of thyroid hormone. It can also result from other problems, including inefficient conversion in the cells of T4 to T3 (the more biologically active of the two hormones) and insensitivity of hormone receptors in cells. Low thyroid activity contributes to a large number of physiological effects throughout the body due to reduced enzyme function from lowered body temperature (Brady, 2000).
Hashimoto’s thyroiditis (HAIT or HT), also known as autoimmune thyroiditis, is an autoimmune inflammatory condition mediated by immune system T helper (Th) cells, in this case by subsets known as Th-1 (Phenekos et al., 2004) and Th-17 (Shi et al., 2010). In HT the body produces antibodies that attack its own thyroid gland. The symptoms are generally the same as for other forms of hypothyroidism, but if it is left untreated, the gland may ultimately be destroyed. It is marked by the presence of autoantibodies and is often associated with other autoimmune conditions, especially celiac disease.
A significant number of those diagnosed with Hashimoto’s are completely asymptomatic, while a small proportion of both men and women are subclinical, meaning that though circulating levels of thyroid hormones are normal, TSH is rising in response to the attack on the gland (Amino & De Groot, 2003). The disease can eventually cause a depletion of circulating thyroid hormones, creating symptoms of low thyroid function, though not everyone with the autoantibodies goes on to develop hypothyroidism.
Who Gets It
Hashimoto’s Thyroiditis is the most commonly diagnosed form of hypothyroidism in the United States, with overt symptoms affecting approximately two percent of the population (Chistiakov et al., 2005), but it is generally recognized that it occurs far more frequently than is diagnosed. According to thyroid expert Richard Shames, M.D., nonautoimmune hypothyroidism does exist, but its occurrence in developed countries is rare compared to that of the autoimmune variety (Shames, 2003; p.105). As with most autoimmune conditions, while Hashimoto’s occurs in all age groups, including children, and in both genders, it is most prevalent in women, generally developing between the ages of 30 and 50. By age 60, it is estimated that 20 percent of women are hypothyroid (Blanchard, 2004). Depending on which studies are read, women are anywhere from 10 to 50 times more likely to develop HT than are men. The reason for this appears to be that the same system that regulates immunity also regulates reproductive cycles in women (Plapp, 2002).
Hashimoto’s Thyroiditis can be asymptomatic, but when symptoms appear, they generally begin as a gradual enlargement of the thyroid gland (goiter) and/or the gradual development of hypothyroidism, the symptoms of which include:
- Anemia (both iron-deficient and pernicious)
- Brain fog (forgetfulness, sluggish thinking, loss of energy for life)
- Chest pains
- Cold intolerance; cold hands and feet
- Dry, coarse skin
- Early graying of hair
- Exhaustion after exercise
- Frequent colds and flu and difficulty recovering from infection
- Headaches, including migraines
- High cholesterol, especially LDL
- Infertility; miscarriage
- Low basal temperature
- Low libido
- Muscle cramps/tenderness
- Hair loss
- Restless leg syndrome
- Seasonal (cold weather) exacerbation of symptoms
- Severe PMS
- Sleep disturbances
- Slowed speech and ankle reflexes
- Tired, aching muscles
- Weak, brittle nails
- Weight gain
There are also other, less frequent symptoms, including increased blood pressure and excess earwax. A more complete list can be found in the book, The Diet Cure, by Julia Ross, M.A.
There can also be profound health implications from lowered thyroid function, including short stature, reduced attention span, and lowered IQs in children born hypothyroid (Blanchard, 2004; p. 20). And, though studies are conflicting, hypothyroidism appears to confer an increased risk for cardiovascular disease (Blanchard, 2004; pp. 74-75).
Etiology (Is It In the Air?)
No one has yet pinpointed the exact causes of Hashimoto’s, but research has shed some light on contributing and possibly causative factors. The available research points to a combination of genetics and environmental triggers as cofactors. Both Hashimoto’s and Grave’s disease — autoimmune hyperthyroidism — cluster in families with a history of autoimmune disorders, and several different genes have been identified that confer susceptibility to both (Chistiakov, 2005). But genetically susceptible people also require one or more environmental triggers to initiate the disease process. And, as Edward Bauman, M.Ed., Ph.D. (in Shomon, n.d.) explains, it is most likely a variety of factors, not just one, that contributes to the onset of hypothyroidism. Some of the possible triggers are:
- Viral, bacterial, or Candida infections as a trigger or as a direct cause
- Ongoing stress, sufficient to cause adrenal insufficiency that hampers conversion of T4 to T3 and weakens the body’s immune defenses
- Pregnancy, wherein hormonal and immune system shifts can trigger Hashimoto’s in susceptible women either during pregnancy or postpartum
- Trauma, such as surgery or an accident
- Nutrient deficiencies, in particular of iodine and/or selenium
- Foodborne bacteria, most notably Yersinia enterocolitica, though this is more common outside the U.S. (Shomon, 2001)
Toxins are of particular concern, especially those created from petrochemicals. Many plastics (all those bottles of water we drink), pesticides, fertilizers, dioxin, body care products, not to mention what’s in the air and tap water we ingest, all contain substances that mimic our own body’s estrogen. These xenoestrogens are powerful endocrine disruptors, affecting the balance of all our hormones, and are thought to contribute to the rise in autoimmune conditions in general (Plapp, 2002) and to Hashimoto’s thyroiditis specifically (Shames, private conversation; May, 2007). Mercury (from fish and dental amalgams) and fluoride (in toothpastes and water) are also endocrine disruptors. Mercury amalgams, especially, since they sit so close to the throat, can pose a serious threat to the thyroid gland, making mercury detoxification imperative (Bauman, in Shomon, n.d.).
Medical, Clinical, and Home Testing
Other hormone imbalances, especially of the adrenals and the sex hormones, can produce symptoms identical to those of hypothyroid, making screening very important. But standard medical testing, which often checks TSH only, may not reveal asymptomatic or subclinical Hashimoto’s. In addition, the reference values used by most physicians for TSH are too broad, though some doctors now recognize that a TSH level >2 often leads to the development of hypothyroidism. A TSH >3 is now often considered subclinical and deserving of treatment, especially with a finding of autoantibodies, since treatment can stop the progression of the autoimmune attack (Aksoy et al., 2005). Finding a good doctor or other healthcare practitioner is essential if one suspects hypothyroidism.
The first step may be to answer a questionnaire to determine if symptoms could be due to low thyroid function. Several of these tests are available in the books and websites listed at the end of this article.
Basal Temperature Test
Take a thermometer to bed. Because some people feel analog thermometers are more accurate, if you have one, use it, and shake it down prior to going to sleep. Digital thermometers, however, will work just fine, too. Immediately upon awakening, place it under an armpit. Leave it there for 10 minutes and move as little as possible during that time. A reading below the normal range of 97.8–98.2 indicates lowered metabolic function, which may indicate lowered thyroid function. It should be noted that this test is not definitive and must be used in conjunction with other assessment methods. Men and menopausal women can perform this test any day of the month (Barnes & Galton, 1976, pp. 47–48). Menstruating women should perform it during their periods. Do this test for 5 days to obtain an average reading.
Serum testing for TSH, Free T3, Free T4, and for thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb) is available. Testing for these antibodies is necessary to uncover the autoimmune component, which is indicative of Hashimoto’s even in the absence of symptoms.
Signs of hypothyroidism can include hypercholesterolemia, hypertension, and chest pains. In the elderly, these can be present even though thyroid hormone and TSH levels are normal. In fact, normal TSH levels are not at all unusual in older people with hypothyroidism (Urban, 1992). Seeing a cardiologist to rule out cardiovascular disease may be a wise idea.
If Hashimoto’s is confirmed, the following tests will prove useful:
- Thyroiditis is an inflammatory condition. Determining food reactivity can help people eliminate reactive foods to help quench the inflammation (Bauman, Shomon, n.d.; Ross, 1999; p. 173).
- Anemia is common among those with HT. Check for both iron- and B12-deficiency anemia. Serum ferritin is a better measure of iron status than iron, alone, and methylmalonic acid is considered a better marker for B12 deficiency than serum B12.
- Hypothyroid is almost always associated with some degree of adrenal fatigue, and since adrenal hormones are necessary for the conversion of T4 to T3 (Blanchard & Brill, 2004; p. 48), and for the uptake of hormone into peripheral tissues, it is advised to do an Adrenal Stress Index — a salivary hormone assessment — to determine the extent of adrenal involvement.
- Checking estrogen (for women) is also important, as excess estrogen can reduce the effect of thyroid hormone and lock it out from receptor sites on tissue cells (Blanchard, 2004, p. 16)
- Richard Shames, M.D. considers selenium deficiency to be one of the critical factors in the onset of Hashimoto’s (Shames, private conversation, May, 2007). Selenium is necessary for the conversion of T4 to T3. A hair mineral analysis is useful to determine if this deficiency exists. Hair mineral analysis can also help determine the copper: zinc ratio, which is also critical to good thyroid function (Shames, private conversation, May, 2007).
Eating for Health, Eating to Heal
Once a diagnosis of Hashimoto’s is obtained, the dietary goals are to cool the inflammation, work to balance all hormones, and help the thyroid gland produce hormones — and the body to convert them — properly. Since thyroid hormone medication is indicated when antibodies are detected, the dietary recommendations are meant to be in addition to medical therapy, not in place of it.
Adopting a diet rich in high-quality proteins and fats, with lots of fresh, seasonal, and organic vegetables, fruits, nuts, seeds, whole grains and nutrient-dense booster foods is the shortest, straightest path to nutritional thyroid support. An emphasis on building, through an increased amount of protein, is recommended, since lowered thyroid function reduces the body’s ability to benefit fully from the protein foods eaten (Ross, 1999; p. 170). However, Richard and Karilee Shames (2006) differentiate between people whose metabolisms are driven primarily by their adrenals, thyroids, or sex glands and have slight dietary modifications for each, despite a Hashimoto’s diagnosis. (See the Resources section for their book). Also consider eating three meals and two to three snacks per day to keep energy levels more even throughout the day.
Foods to Increase
Julia Ross, M.A. advises 20 grams of protein (3–4 oz) at each meal and stresses animal protein foods (Ross, 1999; p. 170). Also, shoot for 1–2 oz at snack time. Cold-water fish is a good choice, as it also contains omega-3 fatty acids. Tempeh is a good source of vegetable protein, and whey protein, though more processed, can be very useful. It contains immunoglobulins and L-glutamine that can help heal a distressed digestive tract.
“Push the antioxidants,” says Richard Shames, M.D. (private conversation, May, 2007). Antioxidant-rich foods are necessary to combat free radical damage caused by the inflammatory process. Emphasis on vitamin-A containing foods is especially helpful, since vitamin A is often deficient in people with any type of autoimmune condition (Plapp, 2002), whose bodies are often inefficient at converting beta-carotene to actual vitamin A. Other nutrients with antioxidant qualities often deficient in Hashimoto’s thyroiditis include vitamins C and E, iodine, zinc, and selenium. (A more complete listing of foods and their nutrient content is available at www.whfoods.org.):
- Vitamin A and beta-carotene-rich foods: carrots; cooked calf’s liver; cod liver oil; eggs; pastured dairy; lightly cooked spinach, kale, collard greens and Swiss chard; winter squashes; red bell peppers; apricots; cantaloupe; sweet potato
- Vitamin C-rich foods: red bell peppers, parsley, broccoli, citrus fruits, romaine
- Vitamin E-rich foods: lightly steamed mustard greens and Swiss chard, sunflower seeds, almonds, avocado
- Iodine-rich foods: seaweeds, especially dulse and kelp (be sure it’s very high quality), seafood (free of mercury and wild, not farmed)
- Zinc-rich foods: oysters, crab, beef (organic and/or grass-fed), sesame and pumpkin seeds
- Selenium-rich foods: Brazil nuts, crimini mushrooms, cod, shrimp, halibut, snapper, oats, sunflower seeds, brown rice
4–6 tablespoons per day of the good fats found in avocados, nuts, and seeds (especially pumpkin, chia, and flax), organic pastured butter and ghee, olive oil, and coconut and its oil. Coconut is very thyroid-friendly. The lauric acid it contains is soothing to the endocrine system (Bauman, Shomon, n.d.) and its medium-chain fatty acids digest quickly and provide a superior energy source for the body. It can also be helpful for weight loss (Calbom & Shilhavy, 2003). The milk from the coconut can be used in place of other milks.
At least 4 cups per day (Ross, 1999; p. 171). Choose a wide variety of colorful veggies and eat them lightly cooked or raw. NOTE: Avoid eating the brassica family raw, as these inhibit thyroid function. Brassicas include broccoli, cauliflower, turnips, etc. Don’t overdo these, in general, though they should be fine in moderation (Shames, private conversation, May, 2007).
Go easy on the fruit, grains, and starchy vegetables. Two 1/2 cup servings of fruit per day, plus 1/2 to 1 cup, one or two times per day, of whole grains or starchy vegetables (Ross, 1999; p. 171).
NOTE: Soaking or sprouting grains prior to cooking will make them more digestible — an important consideration for those with impaired digestion, which is common with hypothyroid. However, unsoaked is fine occasionally; just be sure to chew well.
At least 8 cups pure, filtered water daily. Avoid water with chlorine and fluoride, as these are halogens and compete with iodine, the halogen the body uses. This can disrupt thyroid function. And remember: it is not wise to purchase water in plastic bottles.
To support people with a wide variety of health issues, a dietary food supplement powder is a great ally. A therapeutic combination can include undenatured whey protein concentrate (or other protein powder for those intolerant of dairy), a blend of algae, cereal grasses, and sea vegetables; a blend of fibers, including flax meal and apple pectin; extracts of highly anti-inflammatory organic fruits and vegetables; and other therapeutic elements such as aloe vera, detoxifying herbs, ionic minerals, probiotic bacteria, and digestive enzymes.
This combination provides easily digestible protein and, with whey, is rich in sulfur amino acids that support detoxification, healing chlorophyll, and anti-inflammatory nutrients to cool an overheated immune system and cleanse impurities from the blood, thyroid and its hormones, and to improve thyroid hormone sensitivity. It can be used as a meal replacement in a shake or just added to warm or cool liquids. Making it with coconut water is a very healthful and refreshing application.
Dietary “tricks” can help hypothyroidism, too. The first is to reduce caloric intake by about 30 percent. Essentially, stop eating before getting full, while still taking in adequate nutrients. Calorie restriction, as it is called, has been shown to improve both immune and thyroid function (Moore, 2006). The second technique, from Dr. Ken Blanchard, is to “eat breakfast like a king, lunch like a prince and dinner like a pauper” (Blanchard, 2004; p. 200). This prevents the body from being overloaded with food at night, when it is converting fat to muscle with growth hormone, and to fuel it well during the day to accommodate energy needs.
Things to Avoid
Gluten: Hashimoto’s, as mentioned above, occurs at a greater rate in those with celiac disease than in the general population. The gluten molecule is very similar to thyroid tissue, and it is thought that the immune system identifies the thyroid gland as gluten and attacks it.
Aspartame: Aside from its other known toxic effects, Aspartame appears to be particularly problematic for the thyroid gland (Bauman, in Shomon, n.d.).
Iodized Salt: Even though the thyroid gland depends on iodine to produce hormones, this is not the way to get it. It is not possible to eat enough salt, in the first place, to get the daily recommended dosage of iodine (150 mcg). Nor is it advisable to consume such a highly processed product, the grocery store versions of which often contain aluminum and dextrose (Bauman, Shomon, n.d.). Sea salt, unprocessed and containing trace minerals, is a far better choice.
Unsaturated Oils (including canola oil): There is speculation that these contribute to hypothyroidism. Whether it is because they contain so much inflammation-promoting omega-6 fatty acid, or because they are generally rancid even before they are bottled (or go rancid in their clear bottles) is not known.
Soy: Also disruptive to the endocrine system, and considered a toxin by some, though it is the isolated and concentrated isoflavones that pose the greatest risk, according to Ken Blanchard, M.D. (2004; p. 190). He points out that infants fed soy formulas are more likely to develop autoimmune conditions later in life than those who are not. Depending on soy as a primary source of protein is not recommended. Even small amounts have been shown to have powerful hormone disrupting powers and can lower concentrations of T3 (Ross, 1999; pp. 204–205). The exception to this is fermented soy foods, such as tempeh, natto, and miso.
Because Hashimoto’s thyroiditis can result in reduced digestive capabilities, it is a good idea to support digestion with enzymes, HCl and probiotics when necessary, and to supplement with extra quantities of the nutrients most often found lacking with this condition.
Whole foods-based multi-vitamin and mineral: Take as directed.
Extra antioxidants: Take as directed daily (Shames & Shames, 2005; p. 97).
Extra essential fatty acids: From fish or flax;
1,000–2,000 mg per day, two divided doses (Shames & Shames, 2005; p. 97; Ross, 1999; p. 245).
Extra B vitamins: Either in supplement form or, preferably, use nutritional yeast.
Calcium: 250–300 mg (1–2 at bedtime) (Ross, 1999; p. 245). Calcium and iron need to be taken two hours before or after thyroid medications so as not to interfere with their absorption.
Magnesium: 200 mg 2 times daily (Ross, 1999; p. 245; Shames & Shames, 2005; p. 97).
Selenium: Supplementation with selenium (200 mcg) for a period of 3 months has been found to significantly reduce thyroid peroxidase autoantibodies (TPOab) titers and significantly improve well-being and/or mood (Toulis & Anastasilakis et al., 2010).
NOTE: Selenomethionine form preferred. Do not exceed 400 mcg daily if pregnant!
Iodine: If the multiple doesn’t contain 150–200 mcg iodine, kelp supplementation — 2–3 g daily — should provide adequate amounts (Balch, 2000; p. 451). Dr. Mercola (in Shomon, N.D.) recommends 5 g daily. (Supplementing directly with high-dose iodine is very controversial, with physicians obtaining erratic results, and should be either avoided or done with extreme caution until more is known about it.) Daily low-dose iodine supplementation (200 mcg a day) has been shown to reduce antibody levels in people with Hashimoto’s (Rink, Schroth, Holle, & Garth, 1999).
Vitamin D3: Often low in those with autoimmune conditions, it is necessary for optimal immune function (Hayes, Nashold, Spach, & Pedersen, 2003). It is also required for thyroid hormone production (Shames, in Shomon, 2007). 1,000–5,000 IU daily to bring up levels. Maintenance doses will vary.
L-Tyrosine: One of the thyroid’s hormone building blocks. Many sources recommend 500 mg twice daily, but others feel that levels of this amino acid are rarely low enough to warrant supplementation (Shames & Shames, 2005; p. 108).
Chromium: 200 mcg daily, if it’s not included in the multiple (Ross, 1999; p. 245)
Iron: If testing shows a deficiency. Calcium and iron need to be taken two hours before or after thyroid medication so as not to interfere with its absorption.
Zinc: If testing shows a deficiency. 50 mg daily (Balch, 2000; p. 452).
Thyroid glandulars: These have been shown to be very effective; 50–100 mg twice daily. They are made from desiccated thyroid glands of either pigs or cows (use those from non-BSE cow-raising countries), from which most of the hormone has been removed. Dr. Shames likens them to decaffeinated coffee: there’s still a little bit in there (private conversation, May, 2007). Because of this, they also contain T1 and T2, other thyroid hormones that may exert a physiological effect.
Additional supplements, recommended by Dr. Shames, are extra free-form amino acids daily (two 500 mg capsules), taurine (two 500 mg daily), and proteolytic enzymes on an empty stomach for inflammation (Shames & Shames, 2005; p. 97).
Vegans may have to add the nutrients commonly missing in adequate amounts from an animal-free diet: extra B12, D, some L-Carnitine, zinc, and selenium (Ross, 1999; p. 244).
Many herbs are available (often combined in one supplement) to support overall endocrine function and the thyroid gland particularly. These include:
- Ashwagandha (Withania somnifera)
- Asian Ginseng (Panax ginseng)
- Bladderwrack (Fucus vesiculosus)
- Coleus forskholii root
- Guggul (Commiphora mukul)
- Holy Basil Leaf (Ocimum sanctum)
- Maca root (not raw, as it’s a brassica). No research exists to date about its effect on the thyroid, but anecdotal evidence from www.thyroid.about.com (Shomon, 2007) and from some of the producers of maca products suggest it has a beneficial effect on the thyroid. Since it is an adaptogenic, endocrine-balancing herb (Walker, 1998), this would not be surprising.
- Rosemary (Rosmarinus officinalis)
- The Shames’ recommend a Tibetan herbal product called Padma Basic (Shames & Shames, 2005; p. 122)
- Thyroidinum 6x or 6c, three pellets under the tongue 3 times daily for one week, may be helpful to initiate thyroid balance (Shames & Shames, 2005; pp. 122–123)
- Calcarea carbonica may increase thyroid function (Balch, 2000; p. 452)
- Acupuncture may be very effective to support the thyroid (Ehrlich, 2006)
- Lymph massage (Bauman, Shomon, n.d.) or exercise that includes gentle jumping
- Contrast hydrotherapy (hot and cold applications) to the neck and throat may stimulate thyroid function (Ehrlich, 2006)
- Stress reduction
- Overall detoxification
- Good sleep
- Exercise, to tolerance
Hashimoto’s thyroiditis can be well managed in many instances with nutritional and lifestyle interventions. It takes all of the following to have a successful outcome: individualized clinical assessment, a treatment plan that integrates detoxification, thyroid glandular support, improved conversion of T4 to T3, and improved receptor site sensitivity. A person who receives excellent care and follows a hypoallergenic diet with appropriate supplemental nutrients will improve gradually.
There is no one-size-fits-all treatment plan. It is a long-term recovery program that is exciting to undertake with the support of health professionals and family members. Clean up the diet, clean up the blood, and clean up the environment and the immune system will calm down. Peace will be restored. Sage advice to all.
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The Diet Cure by Julia Ross, M.A.
Nourishing Traditions by Sally Fallon and Mary Enig
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