Charcoal, clay and zeolite cleanses

1. Introduction

Version followed: consumer "detox" and "cleanse" products containing activated charcoal, edible clay (mainly bentonite) or zeolite (mainly clinoptilolite), as sold direct to the public and as US and UK regulators and clinical information services describe them. There is no founder, manual or originating organisation; these are commercial products, often used within wider detox programmes. The psychotherapist works with the client's choices and never performs, sells, prescribes or recommends these products.

What is sold. Activated-charcoal capsules and charcoal added to juices, foods, toothpaste and face washes; powdered bentonite clay sold to be mixed with water and drunk or applied to skin and hair; zeolite powders and liquids sold as supplements. [source: CU Anschutz/Medscape 2019; FDA 2016; STAT 2016; MSKCC Zeolite]
Core idea as marketed. The substance binds (adsorbs) "toxins", heavy metals, alcohol or gas in the gut so they pass out of the body; clay is promoted to "aid in colon and detox cleansing" (label wording reported by STAT); zeolite is promoted to remove heavy metals, "balance body pH" and modulate immunity, and has been marketed for cancer, autism, diarrhoea, herpes and hangover. These are the sellers' claims. [source: STAT 2016; MSKCC Zeolite; CU Anschutz/Medscape 2019]
Distinct medical use. Hospitals give activated charcoal as an emergency treatment for some poisonings and overdoses; that clinical use is separate from consumer cleanses and is decided by medical staff. [source: CU Anschutz/Medscape 2019]
How change is supposed to happen (as sellers frame it). Removing an internal "toxic load" is said to restore wellbeing. UK advertising regulators note that the liver and kidneys detoxify the body and that they have seen no evidence that toxins can be removed by other means. [source: ASA/CAP Detoxing: General]

For the psychotherapist, change happens in the client's relationship to the cleanse: understanding what it means to them, making an informed decision, keeping medical care coordinated, and recognising risk early. [synthesis]

2. Framework

2a. The method as sold

What a client experiences. Buying a product online or in shops and taking it by mouth (capsules, powders mixed into liquid, charcoal-coloured drinks or foods), sometimes alongside other detox components such as fasting, juice-only or restricted diets, laxatives, enemas or colonic irrigation, herbs or saunas. Clay may also be used as a face or hair mask. No doses, schedules or preparation are given here. [source: NCCIH Detoxes and cleanses; FDA 2016; STAT 2016]
Who provides it. Retailers, online marketplaces and product brands; some products are promoted within wellness programmes or by individual promoters. [source: FDA 2016; STAT 2016] Which practitioner groups recommend them is not documented here [uncertain: not verified].
Regulation, United States. Sold as dietary supplements or cosmetics, not as approved drugs. FDA warned consumers in 2016 not to buy or use "Best Bentonite Clay" (Best Bentonite, Guthrie, Oklahoma) because of elevated lead, and earlier that year urged consumers not to use "Bentonite Me Baby" (Alikay Naturals) after testing found lead. Zeolite supplements have not been approved as safe or effective, and FDA has sent warning letters to distributors over misleading claims. FDA and FTC have acted against detox products with hidden ingredients, false disease claims or devices marketed for unapproved colon-cleansing uses. [source: FDA 2016; STAT 2016; MSKCC Zeolite; NCCIH]
Regulation, United Kingdom. For advertising, ASA/CAP treat general "detox" claims for foods as health claims; a specific claim such as colon detoxing is acceptable only if it is on the GB nutrition and health claims register. Medical claims would bring a product under MHRA medical-device or medicines rules. [source: ASA/CAP Detoxing: General]
Other jurisdictions. EU, Canadian and Australian status not verified [uncertain: not verified].
Regulatory status (one line). Unapproved consumer products; at least two US clay products were the subject of FDA lead warnings; advertising of detox claims is restricted in the UK.
Evidence status (one line). Detox programmes in general have few, low-quality human studies and no long-term data; zeolite has not been shown to treat cancer or other conditions in humans; evidence for charcoal capsules for gas and bloating is described as contradictory. [source: NCCIH; MSKCC Zeolite; CU Anschutz/Medscape 2019]

2b. The psychotherapist's work alongside it [synthesis]

No source sets out phases; the structure below is a working sequence. It runs inside ordinary therapy sessions; there is no separate session count.

Ask and record (first contact, then periodically). Goal: know what the client takes. Move on once use, products and context are recorded.
Understand meaning (one or more sessions). Goal: the client's hopes, explanatory model and what draws them. Move on once both of you can state what the cleanse is for in the client's own words.
Check risk (same or next session). Goal: screen for eating-disorder patterns, medicine use, pregnancy, children, wider detox components and commercial or group pressure. Any red flag goes straight to 4 or to urgent action.
Coordinate (with consent). Goal: the client's doctor or pharmacist knows about the use, especially where medicines are taken.
Support the decision and follow up. Goal: an informed choice that fits the client's values, revisited as circumstances change.
Report where a product harmed someone, was misleadingly marketed, or a child is at risk.

3. Guiding principles

Never perform, sell, prescribe or recommend. You do not supply, endorse, dose or advise on these products, or on stopping or starting them. [synthesis]
Never advise on medicines. Interaction questions go to the prescriber or pharmacist; your role is to make that conversation happen. [synthesis]
Curiosity without judgement. Clients disclose more when asking feels safe; disclosure is what makes coordination possible. [synthesis]
Attribute claims. Say "the seller says it removes toxins" rather than affirming or mocking the claim. [synthesis]
The client decides. Your task is to support an informed, values-based choice, not to win an argument. [synthesis]
Medical risks are stated as clinical and regulatory sources give them, not from your own opinion. [synthesis]
Watch the eating behaviour around the product, not just the product: cleanses can sit within restriction, purging or orthorexic patterns. [source: NICE NG69 as reproduced; synthesis]
Children and pregnancy raise the threshold for action because lead and other contaminants pose particular risks to them. [source: FDA 2016; STAT 2016]
No disease-treatment framing. These products are not treatments for cancer or any other physical disease; claims to that effect are the seller's. [source: MSKCC Zeolite]
No conflicts of interest. You never sell products or courses to clients. [synthesis; uncertain: not verified against the APA Ethics Code]

4. Intervention inventory

All interventions below are the psychotherapist's own work alongside the client's use of a charcoal, clay or zeolite cleanse. Steps are [synthesis] unless a source is tagged.

4.1 Routine, non-judgemental inquiry and recording

Purpose / when: At intake and at reviews, and whenever the client mentions detoxing, gut symptoms, "toxins", weight or new supplements. NCCIH advises people to tell their health care providers about any detox or cleanse they use. [source: NCCIH]
Steps: (1) Ask about complementary products as a routine category, alongside medicines and alcohol. (2) If yes, record product type (charcoal, clay, zeolite, other), brand if known, how often in general terms, how long, where bought, who suggested it, and whether it is part of a wider programme (fasting, juice-only eating, laxatives, enemas, colonic irrigation). (3) Ask whether their doctor or pharmacist knows. (4) Record without evaluative language; note the client's own words for the purpose. (5) Set a reminder to ask again at review.
Example language (illustrative): "Lots of people use supplements or cleanses alongside their usual care. Is there anything like that you're taking at the moment, such as charcoal, clay or a detox product?" / "I'm not asking to judge it; it helps me understand your health as a whole."
Watch for: Hesitation or embarrassment (normalise), minimisation, use that is hidden from family or doctors. Working: the client volunteers changes at later sessions without prompting.

4.2 Exploring meaning, hopes and the explanatory model

Purpose / when: Once use is known, to understand why the cleanse matters: control, hope, purity, distrust of medicine, identity, belonging to a community or following an influencer. [synthesis]
Steps: (1) Ask what the client hopes the product will do and how they will know. (2) Elicit their model: what "toxins" are to them, where they come from, how they affect body and mood. (3) Ask what led them to it (an event, a symptom, a person, a group). (4) Ask what it would mean to stop or not to start. (5) Reflect themes back (e.g. wanting to feel clean, in charge, or protected). (6) Link, if relevant, to presenting problems such as anxiety, trauma, body image or grief.
Example language (illustrative): "When you take it, what do you imagine it's doing inside you?" / "What would you notice if it were working?" / "It sounds like feeling clean on the inside gives you a sense of control when a lot else feels out of control."
Watch for: Beliefs of contamination that are rigid, distressing or spreading to other areas (consider health-anxiety, OCD or eating-disorder formulation; see 4.5 and 4.9). Working: the client can name needs the cleanse is serving and consider other ways of meeting them.

4.3 Medicine-interaction prompt and coordination with doctor or pharmacist

Purpose / when: Whenever a client who takes any prescribed or over-the-counter medicine (including oral contraceptives) uses charcoal, clay or zeolite. Clinical sources state that charcoal can bind many medicines, including painkillers, antidepressants, arthritis, diabetes and epilepsy medicines, beta-blockers, antiarrhythmics, bronchodilators and oral contraceptives, and that timing matters. Zeolite's chelating and pH effects may reduce absorption of many prescription drugs (including some antibiotics and iron) and may cause early release of enteric-coated medicines; transplant patients and people on immunosuppressants are advised to avoid it. [source: CU Anschutz/Medscape 2019; MSKCC Zeolite] Interactions for clay were not verified [uncertain: not verified].
Steps: (1) Ask whether the client takes any medicines, including the pill and psychiatric medicines. (2) Say plainly that you cannot advise on medicines or timing, and that this is a question for their pharmacist or prescriber. (3) Offer to help them prepare: write down the product name and how they use it in general terms. (4) With written consent, contact the doctor or pharmacist yourself, or support the client to raise it. (5) Record the consent, the contact and the outcome. (6) If the client is on psychiatric medicine you jointly monitor (e.g. with a psychiatrist), make sure that prescriber knows.
Example language (illustrative): "Charcoal and some minerals can stick to medicines in the gut. I can't tell you what to do about that, but your pharmacist can. Would you be willing to ask them, or would you like me to contact them with your permission?"
Watch for: Reduced effect of medicines the client relies on (e.g. a return of depressive symptoms, seizures or contraceptive concerns) reported in sessions: pass this to the prescriber promptly. Never suggest stopping or spacing medicines. Working: the prescriber or pharmacist has been informed and the client follows their advice.

4.4 Product contamination and physical-risk awareness

Purpose / when: When a client uses or plans to use edible clay or zeolite, or gives these products to others.
What sources state: FDA found elevated lead in a bentonite clay sold to be drunk or applied to skin; lead can damage the nervous system, kidneys and immune system, and in children long-term exposure even at low levels is linked to lower IQ and behaviour problems. FDA told consumers not to buy or use it and said anyone who had used it, or given it to a child, should see a health care professional right away. [source: FDA 2016] A separate 2016 FDA alert concerned another bentonite clay labelled for colon and detox cleansing. [source: STAT 2016] MSKCC reports a European zeolite product contaminated with arsenic, lead, mercury, cadmium and other metals; inhalation of zeolite dust is linked to lung disease, and the fibrous form erionite is carcinogenic when inhaled. Charcoal can cause nausea and vomiting, constipation and faecal impaction, intestinal obstruction, and may bind vitamins and nutrients. [source: MSKCC Zeolite; CU Anschutz/Medscape 2019]
Steps: (1) Share, without alarm, that regulators have issued lead warnings on some clay products and that the client may want to check with their doctor. (2) Encourage the client to bring the product name to their GP or pharmacist. (3) If the client reports symptoms (abdominal pain, vomiting, constipation, new neurological symptoms) advise prompt medical review. (4) Record what was discussed.
Example language (illustrative): "I'm not a doctor and I'm not telling you what to take, but I want you to know the FDA has warned about lead in some clay products. Would you be willing to show the label to your GP?"
Watch for: Use by children or during pregnancy (go to 4.7 and 4.8). Working: the client has a medical contact who knows what they take.

4.5 Eating-disorder awareness and screening

Purpose / when: When the cleanse sits within restrictive eating, compensatory behaviour or rigid "clean" eating, or when the client is in a higher-risk group (NICE highlights ages 13 to 17 and people in sport, dance, fashion and modelling). [source: NICE NG69 as reproduced by Medical Dialogues]
Signs clinical sources list: restrictive eating or worrying dieting; social withdrawal from food situations; disproportionate concern about weight or shape; compensatory behaviours such as laxative or diet-pill misuse, vomiting or excessive exercise; unexplained gastrointestinal symptoms, electrolyte imbalance or hypoglycaemia; dizziness, palpitations or fainting; difficulty managing diabetes or coeliac disease. Orthorexic patterns include fixation on ingredient purity, cutting out food groups, extreme anxiety about how food affects health, avoiding eating outside the home and distress when self-imposed rules are broken; orthorexia is not a DSM-5 diagnosis but overlaps with recognised eating disorders. [source: NICE NG69 as reproduced; Eating Recovery Center]
Steps: (1) Ask how the cleanse fits with the rest of their eating: what they eat, skip, or "make up for". (2) Ask about laxatives, vomiting, fasting and exercise used to compensate. (3) Ask how they feel when they cannot follow their routine. (4) A brief screening questionnaire may be used, but NICE says screening tools such as SCOFF should not be the only basis for deciding whether someone has an eating disorder, and a single measure such as BMI should not decide access to treatment. (5) If an eating disorder is suspected, refer promptly to the GP and an age-appropriate eating-disorder service; NICE advises immediate referral after initial assessment. (6) Because compensatory behaviours can disturb fluids and electrolytes, which NICE says should be assessed medically, ask the GP to check physical health. [source: NICE NG69 as reproduced; synthesis for steps 1–3]
Example language (illustrative): "Some people find a cleanse becomes part of a wider set of food rules. Does that fit for you at all?" / "What happens inside you if you miss a day?"
Watch for: Rapid weight change, fainting, palpitations, secrecy, guilt or shame about food, cleanses repeated after eating perceived as "bad". Severe electrolyte imbalance, malnutrition or dehydration need urgent medical care. [source: NICE NG69 as reproduced] Refeeding syndrome after prolonged restriction is a recognised medical risk that requires medical management [uncertain: not verified]. Working: the client accepts medical review and eating-disorder assessment if indicated.

4.6 Wider detox programmes: medical-risk recognition and medical supervision

Purpose / when: When the charcoal, clay or zeolite product is one part of a programme that also includes fasting, juice-only or limited-food diets, laxatives, enemas or colonic irrigation.
What sources state: NCCIH lists diarrhoea, dehydration and malabsorption from laxatives and colon cleansing; dangerous electrolyte imbalance from taking only water or herbal tea without food; headaches, fainting, weakness and dehydration from fasting; higher risk of harm from colon cleansing in people with gastrointestinal disease, previous colon surgery, severe haemorrhoids, kidney disease or heart disease; and advises people with diabetes to follow their care team's plan. [source: NCCIH]
Steps: (1) Map all components of the programme in general terms (no quantities or schedules needed). (2) Identify conditions in the list above, plus pregnancy and eating-disorder history. (3) Encourage the client to discuss the full programme with their GP before or during it, and say that a doctor can monitor safety. (4) Agree what symptoms would mean seeking urgent care (fainting, palpitations, severe abdominal pain, persistent vomiting, confusion). (5) Record the plan.
Example language (illustrative): "Can we write down everything the programme involves, so you can take the whole picture to your doctor?" / "If you felt faint or your heart raced, what would you do?"
Watch for: Escalation (longer, stricter or more frequent cleanses), symptoms reframed as "detox reactions" or "toxins leaving" so that medical help is delayed. Working: the client keeps medical contact and seeks help for warning symptoms.

4.7 Pregnancy, breastfeeding and clay eating

Purpose / when: When a pregnant or breastfeeding client uses clay or zeolite products, or describes eating clay or earth (geophagia, a form of pica), which in some communities is a culturally established practice in pregnancy.
What sources state: Lead is especially dangerous in pregnancy and breastfeeding; STAT reported CDC's warning that lead poisoning in pregnancy can cause birth defects, developmental problems or miscarriage. A 2020 study of clay eaten as pica by pregnant women in Ghana found arsenic, lead, nickel and other metals at levels the authors judged to carry health risk, concluding the clay was not safe for pregnant women to eat. [source: STAT 2016; Kortei et al. 2020]
Steps: (1) Ask with cultural respect: what the practice means, who taught it, what it does for them (cravings, nausea, tradition). (2) Share that health agencies have raised concerns about metals in some clays. (3) Encourage the client to tell their midwife or obstetric team and to ask whether testing is advised. (4) With consent, inform the maternity team. (5) Do not shame; address cravings and stress within therapy.
Example language (illustrative): "In many families eating clay in pregnancy is a tradition. Can you tell me what it means for you?" / "Some clays contain lead, which can affect a baby. Would you be willing to talk to your midwife about it?"
Watch for: Secrecy from the maternity team, cravings linked to distress. Working: the maternity team is aware and the client feels respected.

4.8 Children: assent, consent and safeguarding

Purpose / when: When a parent gives or plans to give charcoal, clay or zeolite products to a child, or a young person uses them independently. Zeolite has been marketed for autism. [source: MSKCC Zeolite]
What sources state: FDA advised that anyone who had given the warned clay product to a child should see a health care professional right away, and that lead exposure in children is linked to lower IQ and behaviour problems. [source: FDA 2016]
Steps: (1) Explore the parent's hopes and fears without blame. (2) Share the regulator warning and encourage review by the child's doctor. (3) With a young person, seek their view and assent, and their consent where they have capacity under local law. (4) Screen a young person's use for eating-disorder patterns (4.5). (5) If a child is being harmed, deprived of necessary medical care or adequate nutrition, or given products after medical advice to stop, follow your local safeguarding procedures and consult your safeguarding lead. [synthesis]
Example language (illustrative): "I can see how much you want to help your child. The FDA has warned about lead in some clay products. Could we think together about checking this with your child's doctor?"
Watch for: Withdrawal of a child from medical care, restricted feeding, a child's distress. Working: the child's doctor is involved and the child is safe.

4.9 Health anxiety, somatic symptoms and fear of "toxins" (cross-ref Domain II)

Purpose / when: When cleansing is driven by persistent fear of contamination or illness, unexplained bodily symptoms attributed to "toxins", or symptoms attributed to environmental exposures (idiopathic environmental intolerance).
Steps: (1) Formulate with established psychological approaches as set out in Domain II (cognitive-behavioural models of health anxiety and persistent physical symptoms). (2) Identify the cycle: bodily sensation, threat appraisal ("toxins are building up"), safety behaviour (cleansing, checking), short-term relief, increased preoccupation. (3) Treat cleansing as a possible safety behaviour to be understood, not attacked. (4) Use behavioural experiments and attention work as Domain II describes, coordinated with the GP so that medical assessment is not duplicated or skipped. [synthesis; cross-ref Domain II]
Example language (illustrative): "After a cleanse, how long does the relief last before the worry comes back?" / "What would it be like to notice the sensation without doing anything about it, just for now, and see what happens?"
Watch for: Escalating cleansing, avoidance of medical tests or, conversely, repeated testing. Working: less time preoccupied and more flexibility around bodily sensations.

4.10 Informed, values-based decision support

Purpose / when: When the client is deciding whether to start, continue or stop a cleanse, or how to involve their doctor. No published decision aid specific to these products is cited here [uncertain: not verified]; the steps are [synthesis].
Steps: (1) Clarify the decision and who makes it (the client). (2) Help the client gather information from regulators and their doctor or pharmacist, not from you. (3) Elicit values: what matters most (feeling in control, safety, money, family, faith in the community). (4) Weigh the client's hoped-for benefits alongside the risks clinical sources state (4.3–4.6). (5) Check for pressure from sellers, family or groups (4.11). (6) Respect the decision and keep the door open for review.
Example language (illustrative): "This is your decision. My part is to help you make it with the information you want and in line with what matters to you." / "What would you want to know before deciding?"
Watch for: You pushing your own view; the client deferring to you. Working: the client can describe their reasons and the risks in their own words.

4.11 Commercial, multi-level-marketing and group pressure

Purpose / when: When the product is bought through a seller relationship, a subscription, a programme with tiers, or a group or influencer the client is attached to.
Steps: (1) Ask how they came to the product, how much they spend and whether they also sell it. (2) Explore financial strain and debt. (3) Explore social pressure: what happens if they question or stop. (4) Notice high-control features (shaming for doubt, discouraging medical care, isolation from critics). (5) Never sell or recommend products or courses to clients; declare and manage any conflict of interest. [synthesis]
Example language (illustrative): "How did you first hear about it? Are you also selling it?" / "What would happen in the group if you decided to stop?"
Watch for: Debt, recruitment of family members, loss of other relationships. Working: the client can talk freely about doubts.

4.12 Reporting routes

Purpose / when: When a product may have caused harm, appears contaminated, or is advertised with misleading health or disease claims; and in any safeguarding concern.
Steps: (1) Encourage the client to see a health professional about any harm. (2) In the US, adverse events from bentonite products can be reported to FDA MedWatch (online form or fax), as FDA advised. [source: FDA 2016] (3) In the UK, misleading detox advertising can be raised with the ASA; medical claims fall under MHRA rules. [source: ASA/CAP Detoxing: General] Consumer-protection routes (FTC in the US, Trading Standards in the UK) are [uncertain: not verified]. (4) Concerns about a regulated practitioner who sells or recommends these products to patients go to their professional board. (5) Safeguarding concerns go through local procedures. (6) Record what was reported, by whom, with consent where required. [synthesis for 1, 4–6]
Example language (illustrative): "If you think the product made you ill, there is a way to tell the regulator. Would you like help with that?"
Watch for: Breaches of confidentiality; report with the client's consent unless safeguarding or law requires otherwise. Working: the report is made and recorded.

5. Handling problems

Sources do not address the therapist's side of these situations; all guidance below is [synthesis] unless tagged.

Client becomes defensive when asked ("you think I'm stupid"). Name the intention: you ask everyone, you are not judging. Return to their goals. Drop the topic for now if needed and note to revisit. (illustrative) "I'm asking because I want to understand all of what you're doing for your health, not to talk you out of anything."
Client asks you to recommend a product, dose or timing, or whether to stop a medicine. Decline clearly and warmly, and route: medicines and timing to the pharmacist or prescriber; product safety to the GP. Never advise on medicines. (illustrative) "That's outside what I can safely advise on. Your pharmacist can answer it; shall we plan how you'll ask?"
Client asks your opinion of the evidence. Give the one-line status from regulators and clinical information services (Section 2a) without debate, then return to what matters to them. [source: NCCIH; MSKCC Zeolite]
Client will not consent to contact with their doctor. Respect it unless risk overrides confidentiality. Explore the reluctance (fear of dismissal, past shaming). Offer alternatives: the client tells the pharmacist themselves, or brings a written list. Revisit at review.
Doctor dismisses or scolds the client, leading to rupture with medical care. Validate the hurt, then help the client find a way to keep essential care (a different clinician, a pharmacist, written questions). Avoid joining in criticism of the doctor or the client.
Rupture with you after you raised a risk (lead, interactions, eating disorder). Acknowledge impact, own your part, restate that the decision is theirs and why you raised it. (illustrative) "I may have come across as telling you off. That wasn't my aim; I raised it because your safety matters to me."
"Detox reactions" used to explain worsening symptoms. Do not argue the theory; ask what symptoms would make them seek medical help and agree a threshold. New neurological symptoms, fainting, severe abdominal pain or persistent vomiting call for prompt medical review. [source: NCCIH; CU Anschutz/Medscape 2019 for listed adverse effects]
Cleansing escalates or follows binges or "bad" eating. Treat as possible compensatory behaviour: assess for an eating disorder and refer as NICE advises; do not rely on a single screening tool. [source: NICE NG69 as reproduced]
Overwhelm about "toxins everywhere". Slow down, ground, and shift from content to process (the worry cycle); formulate as health anxiety or OCD where criteria fit; cross-ref Domain II.
Client stops therapy or medical care in favour of the cleanse programme or a group. Express care, leave the door open, give safety information in writing (who to contact for warning symptoms). If a child or adult at risk is affected, follow safeguarding procedures.
Non-adherence to agreed steps (e.g. not talking to the pharmacist). Explore barriers (shame, cost, access, belief it is unnecessary); problem-solve one small step; do not make therapy conditional on it.
Product marketed for cancer, autism or another disease. Do not frame it as treatment; attribute the claim to the seller and note MSKCC's statement that zeolite has not been shown to treat cancer or other conditions in humans. Support contact with the treating team; for psycho-oncology work see entry 172. [source: MSKCC Zeolite]
Your own reactions (frustration, rescuing, or wanting to agree). Use supervision; keep to the role of supporting an informed decision; never sell or endorse products.
Pregnant client continuing clay eating. Keep respect for the tradition, keep the maternity team informed with consent, and work on cravings and stress. [source: Kortei et al. 2020 for metal risk]

Sources

Uncertain points: regulation outside the US and UK; interactions for clay; refeeding syndrome specifics; FTC and Trading Standards reporting routes; APA Ethics Code provisions on conflicts of interest [uncertain: not verified].

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