Eating bland foods will help you avoid uncomfortable symptoms such as diarrhea (loose or watery bowel movements), bloating, gas, and swelling or tenderness at your ileostomy site. But the closure is more difficult and the recovery longer if all or much of your colon is gone or not working. Caring for an ileostomy. For some people these include applesauce, banana, rice, cheeses and peanut butter. You will be encouraged to move around as much as possible to encourage activity back into your bowel and aid your recovery. Join SecuriCare For Ongoing Ileostomy Support Ileostomates shouldn't need a special ileostomy diet. Office of Patient Education: Quick tips for living with your new ileostomy. Electrolytes, such as sodium and potassium, can help prevent dehydration. It therefore takes longer to recover from this type of surgery, and there's a greater risk of complications. Sip fluids slowly throughout the day. It can be caused by food, scar tissue, or a twist in your intestine. It’s okay to eat them if you’re having diarrhea, because they may help thicken your bowel movements. ** When trying eggs, start with a small amount (such as 1 egg). Your nurse will give you a measuring cup before you leave the hospital. If ... Read More. Talking with a dietitian also might help. The following tables include examples of bland, low-fiber foods. Nutrition is an important consideration after surgery. Talk with your healthcare team for more information. This information describes dietary (eating and drinking) guidelines to follow while your colon is healing. https://www.cancer.org/content/cancer/en/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/ileostomy/management.html. Advertising revenue supports our not-for-profit mission. Non-fat (skim) or low-fat (1% or 2%) milk*, Non-dairy milks (such as soy milk and almond milk), Lactose-free dairy products (such as Lactaid. For more info, and if you live in NJ: Read more. Eating more than this may cause an ileostomy blockage. A clinical dietitian nutritionist will give you more information about eating after surgery before you leave the hospital. Don’t eat more than 1 small ripe banana per day for the first 3 to 4 weeks after your surgery. Limiting... Introduce foods back into your diet slowly to see how your body reacts. You should stay as active as your health allows eg. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Too much Typically, a person will receive only IV fluids for two to three days after a colectomy or colostomy, to give the colon time to heal. Follow the guidelines below to help keep your ileostomy from becoming blocked. … Caring for your wound To replace salts (electrolytes), drink pediatric electrolyte solutions, such as Pedialyte and Ceralyte, and sports drinks such as Gatorade or Powerade. I ate a low fiber diet with an ileostomy for about a year until I read it doesn't have to be that way. Mayo Clinic does not endorse companies or products. Right after your surgery, you won’t be able to eat solid foods. Limit the amount of alcohol you drink for the first 3 weeks after your surgery. Your feedback will help us improve the information we provide to patients and caregivers. Drink plenty of liquids. Since you have an ileostomy you may lose more fluids than a person without … ... Eat a low-fibre diet for several weeks after surgery. For the first several weeks after your surgery, eating simple and bland soft foods will be easier to digest. Drinking less liquid won’t help your bowel movements be less watery, and it can lead to dehydration. For the first 24 hours after surgery you will be advised to stick to liquids only to allow the bowel to rest. ‌  If you have any of the signs of dehydration listed below, contact your doctor right away. You may need an ostomy because of a disease or an injury. COVID-19 Vaccine Available to MSK Patients. * If you have diarrhea after having these products, try non-dairy milks or lactose-free cheese or yogurt instead. Having an ileostomy may mean that you will have to make some adjustments to your diet, but … This is because having a high-fiber diet can increase the size of your stools, which can cause the bowel to become temporarily blocked. Sign up for MyMSK to send your questions and receive answers to your most pressing concerns. They can cause an ileostomy blockage. For the first few weeks after your surgery, it’s normal to have gas in your pouch and odor when you open your pouch. Alcohol can cause you to lose more fluid. Within the five weeks following ileostomy reversal, patients should avoid eating certain foods, maintain a bland diet consisting of more fiber, and drink six to eight glasses of water daily, according to Memorial Sloan Kettering Cancer Center. Stool-thinning foods include grape juice, apple juice and prune juice. Fiber information on a Nutrition Facts label. * These foods are whole grains. Aim to drink 8 to 10 (8-ounce) glasses (about 2 liters) of liquids every day. Recovering from ileostomy reversal surgery. Change your position, such as drawing your knees up to your chest while you’re lying down. Foods should be added back to your diet gradually. A low residue diet is something that needs to be followed for roughly up to 6-8 weeks after stoma formation (mainly ileostomy formation). https://www.uptodate.com/contents/search. © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). As always, remember to chew your food thoroughly. It’s best to eat mostly bland, low-fiber foods for the first few weeks after your surgery. Commercially prepared or processed packaged foods (such as TV dinners). While you recover, you may have diarrhoea and need to go to the toilet more often than normal. Here are a few things to keep in mind. The sore bottom effect lasted 3-4 weeks, very uncomfortable. Ask your doctor or nurse if you can take an over-the-counter medication such as Beano. In general. Eating Right and Avoiding Dehydration after Bowel Surgery Your doctor has prescribed a GI soft diet to help you during your surgical recovery. As of 3/3, vaccines are available to MSK patients age 18 and over who live in New York State and who were treated for cancer at MSK on or after 1/1/18. Diet After Surgery. Ileostomy Ileostomy equipment. Some vegetables may cause gas or odor for some people. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Learn how to settle into a diet routine after ostomy surgery. Ileostomy and your diet: MedlinePlus Medical Encyclopedia While there is not an “official” ileostomy diet, there are some foods that can aggravate some of these symptoms. United Ostomy Associations of America. Read the “Recommended foods” section for more information. Read the “Preventing Dehydration” section for more information. It’s simple, and it’s safe. All rights reserved. It is a good idea to reintroduce food gradually, Key messages include: Definitions, eat well for healing in the first 6-8 weeks after surgery; after healing, Canada s Food Guide can be followed, thinking about foods that may cause gas, od\ our, or blockage; contact provider if you have problems. If you drink coffee, choose a dark roast instead of a light roast. Keep in mind that chewing your food well also adds to the ease of digestion – the more broken up it is, the easier it will be to process. When you do ileostomy reversal you will need a new diet plan. An ileostomy closure surgery is done to reverse your ileostomy so that you can have bowel movements like you did before your surgery. Avoid sugary drinks, such as juice and soda. After … An ileostomy blockage (also called a bowel obstruction) is when your intestine is partially or completely blocked. Eat foods that contain electrolytes. It also explains how to manage common side effects of having an ileostomy. Before you stop any of these foods, try odour controlling products such as … Your surgeon may need to make an additional incision (surgical cut), but this is rare. Diet and nutrition after ileostomy surgery 3 What else do I need to know? It’s especially important to avoid eating too much in the evening. Eat less of the following foods. Continue to eat a low residue diet for the first 2-4 weeks after takedown surgery. Sodium Foods Potassium Foods bacon broth and canned or dried soups cheese cold cuts, deli meat pizza salty snack foods table salt You may have an ostomy for a short time or for the rest of your life. Eat more of the following foods. Foods that improve stool thickness help prevent leakage and frequency. After that, you'll be transitioned to a clear liquid diet. When stool is too thick to easily pass out of the body, pay attention to the balance between stool-thickening foods and the amount of fluid you're drinking. Before you’re discharged from the hospital, a clinical dietitian nutritionist will visit you in your hospital room to talk with you about these guidelines. When you have an ileostomy, you do not absorb as much salt and potassium from your diet. They may help thicken bowel movements. When you add foods back to your diet, introduce them one at a time. I ate a low fiber diet with an ileostomy for about a year until I read it doesn't have to be that way. You can also follow the guidelines below. Avoid the following foods and drinks. With these points in mind, here are some general guidelines: The first few weeks to a month after surgery, you'll likely be advised to eat a diet that is low in roughage. Read the table below for examples of foods that are high in sodium and potassium. Read the “Adding foods to your diet” section for more information. As with any operation, you may find that it takes time for your appetite to return, especially if you were unwell before surgery. That’s understandable. When you add foods back to your diet, introduce them one at a time. It is best to eat many small meals throughout the … Diet. If a specific item of food causes uncomfortable symptoms, avoid eating it for a few weeks, then try it again. For the first 3 to 4 weeks after your surgery, avoid raw fruits with skin, such as: * For the first 3 to 4 weeks after your surgery, don’t eat more than 1 small ripe banana per day. Avoid the following things. Right after surgery. For 6 to 8 weeks after ileostomy surgery, it may be hard for you to digest fibre. In: Ostomy Hi....I am about 4 and half months out from ileostomy reversal.Had chemo, radiation and surgery for rectal cancer. For more resources, visit www.mskcc.org/pe to search our virtual library. Drink 8 to 10 (8-ounce) glasses of liquids throughout the day. Do light exercise (such as walking), if you can. You need to eat more salt and potassium daily. Hi all, ... After surgery I felt great for about 36 hours but as soon as I ate I began to experience the constant explosive rushes to the loo, which were worst at night. Once you get home after colostomy or ileostomy surgery, you may feel a bit unsettled. They may cause gas, odor, or both. I had lost 2 stone after initial surgery (tumour removal and ileostomy) which was much tougher. You do not need to follow a low-fiber diet for inflammatory bowel disease unless you have a flare or history of stricture. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, FREE book offer — Mayo Clinic Health Letter, Time running out - 40% off Online Mayo Clinic Diet ends soon, Advertising and sponsorship opportunities. This helps make your bowel movements bulkier. This usually happens the day after your surgery. This is because having a high-fibre diet can make the consistency of your stools thicker, which can cause the bowel to become temporarily blocked. It is best to eat many small meals throughout the day. Accessed Feb. 22, 2020. Throughout the day, keep track of how much liquid you drink (your liquid intake) and how much liquid comes out of your ileostomy (your ostomy output). Diet Guidelines for People with an Ileostomy, All rights owned and reserved by Memorial Sloan Kettering Cancer Center, © 2021 Memorial Sloan Kettering Cancer Center, Gerstner Sloan Kettering Graduate School of Biomedical Sciences, Guidelines for preventing an ileostomy blockage. About Your Ileostomy Closure Surgery. Not always: I assume you mean an ileostomy that was taken down and reanastomosed. Constipation is having fewer than 3 bowel movements per week, having hard bowel movements, having a hard time passing bowel movements, or all 3. If it’s after 5:00 pm, a weekend, or a holiday, call 212-639-2000 and ask for the doctor on call (covering) for your doctor. When you have an ileostomy, you lose much more salt, potassium, and water than usual. Limit or avoid the following foods and drinks. Within the five weeks following ileostomy reversal, patients should avoid eating certain foods, maintain a bland diet consisting of more fiber, and drink six to eight glasses of water daily, according to Memorial Sloan Kettering Cancer Center. While there is not an “official” ileostomy diet, there … If you have questions about your diet, call 212-639-7312 to speak with an outpatient clinical dietitian nutritionist. 4 cups (32 ounces, which is about 1 liter) of water. Dark roast coffee usually has less caffeine than light roast coffee because some caffeine is lost during the roasting process. You’ll follow a clear liquid diet. The ileum, or end of the small intestine, is passed through this opening and stitched into place. Diarrhea can be caused by: If you’re having diarrhea, follow the guidelines below. If a certain vegetable causes gas or odor, avoid eating that vegetable. Make sure you’re also drinking enough liquids. Ostomates will likely find that their appetite and diet is the main thing that has been affected after the surgery, which is understandable. These things are signs of an ileostomy blockage. After any kind of operation, it can take a while for things to get back to normal again, and stoma surgery is no exception. They can cause gas. Sometimes people are put on this diet temporarily after certain kinds of gut surgery, such as an ileostomy or colostomy. It’s best to eat mostly bland, low-fiber foods for the first few weeks after your surgery. Drink at least eight to ten 8-ounce glasses of fluid a day, including water, broth and vegetable juices. 1. https://www.ostomy.org/ostomy-diet-guidelines-after-surgery/. Nutrition after Ileostomy . Schedule your appointment now for safe in-person care. Some people also find that cooked vegetables and some canned fruits are helpful. Typically, a person will receive only IV fluids for two to three days after a colectomy or colostomy, to give the colon time to heal. Although your ostomy nurse more than likely will give you tips and advise you on your health and diet, here are some alternative helpful suggestions for maintaining a proper diet after your ileostomy or colostomy surgery. Don’t drink more than 4 ounces (½ cup) of liquids with meals. The key to feeling more like yourself after ostomy surgery is patiently settling into a routine – especially when it comes to your diet. Accessed Feb. 22, 2020. Avoid cabbage, onions, and other foods that give you gas. Artificial sweeteners are often found in sugar-free drinks, candies, gum, and cough drops. When you hear that you need to have ileostomy surgery, you may wonder how this will affect your diet. Some of these foods are onions, garlic, broccoli, asparagus, cabbage, fish, some cheeses, eggs, baked beans, Brussels sprouts, and alcohol. Antibiotics and other prescription medications. It takes a while for your small intestine to adapt after ileostomy surgery, but eventually your stoma output should thicken up (to a porridge-like consistency) and reduce … This will help you replace the water lost through your ileostomy and keep from becoming dehydrated. You can reach a staff member Monday through Friday from 9:00 am to 5:00 pm. After you leave the hospital, your doctor and a clinical dietitian nutritionist will help you as you go back to following your usual diet. The reason for the low-fiber advice at the start is that it takes about two months for surgery swelling to go down, and then you can gradually add in more foods that you were used to before. What is a healthy diet? This section has guidelines for changing your diet to help manage common problems. First and most important thing is not to have large meals. Eating Right and Avoiding Dehydration after Bowel Surgery Your doctor has prescribed a GI soft diet to help you during your surgical recovery. Ostomy diet guidelines after surgery. Ileostomy or colostomy care and complications. This can lead to dehydration. After that, you can try clear liquids, such as soup broth and juice, followed by easy-to-digest foods, such as toast and oatmeal. Fruits with thick skins. 9 Chew all of your food well to help with your digestion. These efforts help your remaining intestine digest food, reduce gas, improve "regularity" and control output. If you have questions about foods not listed in these tables, contact a clinical dietitian nutritionist. The biggest concerns that patients with an ileostomy have include ostomy output, odor, and gas. After that, you can try clear liquids, such as soup broth and juice, followed by easy-to-digest foods, such as toast and oatmeal. Check out these diet tips from Diane Bustamante, a dietitian and nutritionist who frequently consults with people living with an ostomy. You may need an ileostomy after an injury or surgery like colon cancer resection or inflammatory bowel disease surgery involving the colon or rectum. This will help prevent discomfort while your colon heals. Keeping your ostomy devices clean. The biggest concerns that patients with an ileostomy have include ostomy output, odor, and gas. Spicy foods and raw vegetables may burn or irritate the skin around your anal opening.   As the name implies, this means only liquids that you can see through, such as broth, fruit juices without pulp (for example, apple juice), sodas, and gelatin. This will help limit the bowel movements (poop) from your ileostomy during the night. Unless directed differently by your dietitian or physician, follow these guidelines for the next 4-6 weeks. Avoid eating the following foods. Remember to call your doctor’s office if you haven’t passed gas or had a bowel movement in 6 hours. After 1-2 days you can then start on a soft diet. For the first 6 to 8 weeks after your surgery: • Avoid high fibre foods. Why do I need to avoid high fibre foods? You can find the amount of fiber that’s in your food by looking at the Nutrition Facts label (see Figure 1). Mayo Clinic does not endorse any of the third party products and services advertised. * When trying fish and nut butters, start with small amounts. Also, avoid skipping meals or overeating. An ileostomy is a surgical opening in your abdominal wall. Contact your doctor’s office. reversal of your ileostomy. Although your ostomy nurse more than likely will give you tips and advise you on your health and diet, here are some alternative helpful suggestions for maintaining a proper diet after your ileostomy or colostomy surgery. When eating fats, start with a small amount. My consultant has given me Movicol and I find that although this helps with bowel movement, it is still very difficult and quite painful. If you want to drink juice, choose 100% fruit juice and dilute it by adding 1 part water to 1 part of juice to reduce the sugar (for example, 4 ounces of juice mixed with 4 ounces of water). A normal part of the recovery process, this may go on for several weeks. It is During the first 2-4 weeks Diarrhea and a fever above 100.4 °F (38 °C). If you have a colostomy or ileostomy, you'll find that various foods affect your digestive tract differently. Reintroduction of food after formation of a new ileostomy After surgery it is important to take a well-balanced diet to help with healing. For the majority of people, a doctor will recommend hospital discharge within three to five days after undergoing ileostomy reversal surgery. Eat mostly bland, low-fiber foods. Try drinking hot water with lemon or lemon juice, coffee, or prune juice. This opening is called the stoma. If you have questions about your care, contact your healthcare provider. MSK cancer experts are here to help. Contact your doctor if your output is more than 1000 milliliters (about 34 ounces) per day or is watery. Don’t worry if you have to go to the toilet more often than usual due to diarrhea. If you have cramps, pain, or nausea, try following the tips below. If you eat five or six small meals per day, drink at least six to eight cups of fluid daily, and thoroughly chew your food. A food intolerance is when eating a certain type of food causes uncomfortable symptoms such as diarrhea, bloating, gas, or odor. Eat small, frequent meals. No two people will react the same way to food. Sometimes, food intolerances go away as your colon heals. Ileostomy diet. I passed barely anything … They may cause diarrhea. After your surgery, you may have some food intolerances that you didn’t have before surgery. Grains: Choose grains that have less than 2 grams of fiber in each serving. Create a custom communication board for patients who are not able to use their voice. This can affect your bowels ability to digest high fibre foods. Eating bland foods will help you avoid uncomfortable symptoms such as diarrhea (loose or watery bowel movements), bloating, gas, and swelling or tenderness at your ileostomy site. I used Lbf film wipes, cavlon spray and lotriderm, got it under control eventually. During the ileostomy, the surgeon made a hole in your belly and connected part of the small intestine to that opening in the skin. Eating Well after Ileostomy Surgery Developed by Registered Dietitians Nutrition Services 404252-NFS What is an ileostomy? You may need an ileostomy after an injury or surgery like colon cancer resection or inflammatory bowel disease surgery involving the colon or rectum. After around 8 weeks, you'll usually be able to resume a normal diet. A healthy diet includes foods from the five different food groups: bread and cereals, vegetables, fruit, meat and dairy. Examples include the … When you hear that you need to have ileostomy surgery, you may wonder how this will affect your diet. An ileostomy is an opening that is made from the small bowel (ileum) to the skin on your abdomen. Foods with roughage include whole grains, raw vegetables and fresh fruit. Diet and nutrition after ileostomy surgery 4 Foods that increase odour: asparagus brussel sprouts cauliflower cheese (strong) eggs fish garlic mushrooms onions Remember: Odour is normal. After Surgery: It is important to eat a well-balanced diet after surgery to promote healing however for the first 6-8 weeks following the formation of your ileostomy your bowel will be quite swollen and sensitive. Mayo Clinic; 2017. Oranges without seeds or membrane (the thin clear or white part around each section). Examples include: Soft melons, such as watermelon and honeydew, Orange without the membrane (the thin clear or white part around each orange section), Foods cooked with a small amount of fat (such as olive or canola oil), Carbonated drinks, because they may cause gas, Heart palpitations (a fast, irregular heartbeat), Emptying your ostomy pouch more often than usual (such as every hour). Drink sports drinks (such as Gatorade or Powerade) or an oral rehydration solution (such as Pedialyte), if you can. They may help prevent gas, odor, or both. Aim to drink 8 to 10 (8-ounce) glasses every day. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Diet after ileostomy reversal.....over 4 months out. Doing this will help make your stool bulkier (more solid). With your doctor’s OK, you can exercise lightly, like walking. Follow the guidelines below to help keep from becoming dehydrated. For the first 2 to 3 days after a colectomy, you'll probably receive only IV fluids to give your colon time to heal. The first few weeks to a month after surgery, you'll likely be advised to eat a diet that is low in roughage. Creamy nut butter (such as peanut butter). It's been 6 weeks since my reversal, which happened a lot quicker than expected as my small bowel was damaged. Many surgeries to undo a colostomy or ileostomy are fairly simple. Diet After Surgery/Ileostomy Reversal. Record your liquid intake and ileostomy output. Foods … Colostomy & Ileostomy diet advice on eating fruit and vegetables after ostomy surgery & eating with a colostomy, ileostomy or urostomy. That’s understandable. ... Before you come into hospital you should try to eat a healthy, varied diet to keep up your calorie intake. Learn how to settle into a diet routine after ostomy surgery. Just as some foods gave you gas before your surgery, you'll likely experience gas with certain foods now that you have an ostomy. How is ileostomy reversal surgery recovery like? Unless directed differently by your dietitian or physician, follow these guidelines for the next 4-6 weeks. For more information about managing food intolerances and other common problems, read the “Guidelines for Managing Common Problems” section. while your body recovers from ileostomy surgery. When you start adding high-fiber foods to your diet, do so gradually, by adding one food at a time. I still go from 8-15 times a day but that is a lot better than it was when I first got home from the hospital. Foods to avoid include spicy dishes, gravy and cream sauces. Most people are well enough to leave hospital within 3 to 5 days of having ileostomy reversal surgery. I'm not really in pain anymore so that's good too. Our general interest e-newsletter keeps you up to date on a wide variety of health topics. Caffeinated drinks (especially hot drinks), Foods with artificial sweeteners (such as mannitol, sorbitol, and xylitol), Fruit juice (such as prune, apple, grape, and orange juices), Milk and dairy products with lactose, if you’re lactose-intolerant, Stone fruits (such as apricots, peaches, plums, and prunes). For more information, read the section “Preventing Ileostomy Blockage.”. Read the section “Guidelines for Managing Common Problems” for more information. This content does not have an English version. No raw fruit (except bananas), no raw vegetables, nothing with visible texture even. Diarrhea that doesn’t stop after 24 hours. After around eight weeks, you’ll usually be able to resume a normal diet. They can help move food and gas along your intestine. American Cancer Society. This content does not have an Arabic version. Avoid artificial sweeteners, such as sorbitol and mannitol. Grains: Choose grains that have less than 2 grams of fiber in each serving. After that, you’ll slowly start eating solid foods. Your doctor might advise you to avoid drinking carbonated drinks, drinking through straws, chewing gum and smoking because they tend to increase gas. Eat more of the following foods. Before and after the ileostomy procedure, you'll see a nurse who specialises in helping people with... Stoma care. Log in to create and save frequently used communication boards. You should follow your healthcare providers directions on what to eat immediately after surgery. Accessed Feb. 22, 2020. The best option is to eat every three hours but smaller portions. Figure 1. Fats may cause discomfort. Here are a few things to keep in mind. Diet After Surgery . Constipation can be caused by: If you’re constipated, follow the guidelines below. Drink 8 to 10 (8-ounce) glasses of liquids every day. short walks, 20-30 minutes every day. They may recommend a fiber supplement or medication. Back on to full diet after 6 weeks or so. This varies from person to person and by the length of small intestine remaining. Diet In the first few weeks after surgery, you'll usually be advised to follow a low-fibre diet. A food that you had trouble digesting before surgery may still bother you after surgery. • Chew all of your food well. Having an ileostomy may mean that you will have to make some adjustments to your diet, but you still should be able to enjoy your meals and eating. Mayo Clinic facts about coronavirus disease 2019 (COVID-19), Our COVID-19 patient and visitor guidelines, plus trusted health information, Mayo Clinic Health System patient vaccination updates. Diarrhea and smelly discharge, cramps, or forceful liquid output from your stoma. Eggs may cause a bad odor (smell) when you open your pouch. It takes a while for your small intestine to adapt after ileostomy surgery, but eventually your stoma output should thicken up (to a porridge-like consistency) and reduce … I had the ileostomy since i was a week old so things are taking longer for me to slow down. Ileostomy diet. I had an ileostomy reversal just over 3 weeks ago (had my ileostomy since May 2008, following surgery for rectal cancer) and since then have suffered from chronic constipation. 9 Add new foods one at a time. Eat meals at regular times, eat more slowly and chew well. Provides nutrition guidance for patients after ileostomy surgery. You will learn through experience which foods, if any, you should avoid. A well-balanced diet is recommended for most individuals. Ileostomy closure surgery is usually done through your stoma (see Figure 1). After around eight weeks, you’ll usually be able to resume a normal diet. The types and amounts of food you eat and beverages you drink also play a role.

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