l glutamine side effectsl glutamine side effects

WebHowever, its difficult to tell if you are getting enough L-Glutamine from your diet. Once alcohol is out of the system, the body begins producing glutamine again. Potential Side Effects L-glutamine is partially metabolized to ammonia, which can increase blood ammonia and blood glutamate levels in high doses. It is also used to prevent side effects of cancer chemotherapy such as pain and swelling inside the mouth (mucositis) and for preventing infections in critically ill people. L-glutamine is synthesized by the body from glutamic acid or glutamate. Animal foods are good sources due to their protein contents. Glutamine can be found in animal proteins, such as meats and dairy, along with plant-based protein sources, such as beans, raw spinach, parsley and red cabbage. Thishormonal response leads to an increase in resting metabolic rate and improves the afterburn effect or EPOC post-exercise. Common side effects of glutamine may include: nausea, vomiting, stomach pain, gas; swelling in your hands or feet; muscle or joint pain, back pain; headache, dizziness, tired feeling; mild skin rash or itching; or dry mouth, runny nose, increased sweating. Zhonghua Shao Shang Za Zhi. This especially applies to vitamin B12, whichcontrols glutamine buildup in the body. What are the benefits of taking glutamine? The most effective regenerative drugs contain a number of adverse effects. A single copy of these materials may be reprinted for noncommercial personal use only. The specific mechanism of action has not been discovered, yet there has been evidence suggesting that there is a relationship between Glutamine, branched-chain amino acids (BCAAs) and protein Shoshana received her B.S in dietetics and nutrition from Florida International University. Some effects include, nausea, vomiting, joint pain, hives. It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Animal studies have indicated that this increase in T-helper cells may reduce the stresses associated with overtraining syndrome. Double-blind randomized study of oral glutamine on the management of radio/chemotherapy-induced mucositis and dermatitis in head and neck cancer. This is a decision you and your doctor will make. 2019 Feb;43(2):221-226. doi:10.1111/acer.13931, Butts M, Singh Paulraj R, Haynes J, Arthur S, Singh S, Sundaram U. Years ago glutamine was almost considered a conditionally essential amino acid only for those who are critically ill or injured, such as in the case for burn victims or someone who was physically stressed and at risk of muscle and tissue breakdown. According to a study published in the medical journalCritical Care, glutamine dipeptide-supplemented parenteral nutritioncontinues to be associated with a significant reduction in hospital mortality and hospital length of stay.. Safety and efficacy of glutamine to treat short bowel syndrome in children has not been established. All rights reserved. For example, a study published in the journal of Clinical Immunology found that L-glutamine normalizes the effects of the TH2 immune response that stimulates inflammatory cytokines. WebAmmonia-Glutamine Cycle. However, if you use the supplement extensively then you should consider taking B12. However, glutamine supplements can affect how your body processes amino acids. It is possible that glutamine supplements may not have the same effects if you eat an animal-based, high-protein diet, compared to a plant-based, lower-protein diet. DOI:10.3892/mco.2017.1238. In fact, an older study a 2009 study from India reported that the enteral delivery of L-glutamine reduced bacterial complications as well as hospital stays by almost 17 days compared to a control group. Drug information provided by: Merative, Micromedex. Acute L-glutamine ingestion does not improve maximal effort exercise. Although the effects of excess glutamine rarely cause problems, if you take oral glutamine long term, its a good idea to also supplement with B vitamins. Our dietitian explains which testosterone-boosting supplements, This is a detailed article about green tea and its health benefits. Vegetarian and vegan sources include leafy vegetables and beans. While L-glutamine is used to make proteins and perform other functions, D-glutamine appears to be relatively unimportant in living organisms (3, 4). Its known as a conditional essential amino acid because your body uses it in large amounts. Glutathione can help metabolize toxins, break down free radicals, support In these cases, taking a glutamine supplement may be helpful. Omega-3 fatty acids are incredibly important for your body and brain. Supplementing with L-Glutamine for leaky gut and IBS can make a big difference. This Dr. Axe content is medically reviewed or fact checked to ensure factually accurate information. Glutamine may play a pivotal role in improving the quality of life for cancer patients undergoing chemotherapy. Though l-glutamine is found in food and supplements, it's unnecessary to take supplemental l-glutamine because it's a non-essential amino acid. So if you take L-glutamine you'll be fuller for longer and have fewer sugar cravings. Emerging evidence also indicates that l-glutamine plays a fundamental role in cardiovascular health by serving as a substrate for the synthesis of DNA, ATP, proteins and lipids. Therefore, its considered a conditionally essential amino acid, meaning that it must be obtained from the diet under certain conditions, such as injury or illness (8). It also has been used for decades for health and exercise purposes in dietary supplements, though many of these claims are unsubstantiated or exaggerated. Check with your doctor immediately if any of the following side effects occur: Some side effects may occur that usually do not need medical attention. It also becomes essential when an individual faces disease or specifically muscle wasting. In very small newborns, glutamine is used to prevent Glutamine is an important amino acid with many functions in the body. Nature Cell Biology: "Rethinking Glutamine Addiction", Advances in Food Technology and Nutritional Sciences: "Neutraceuticals for Athletes", International Journal of Sport Nutrition and Exercise Metabolism: "Influence of Oral L-Glutamine Supplementation on Muscle Strength Recovery and Soreness Following Unilateral Knee Extension Eccentric Exercise", Journal of Human Sport and Exercise: "Effects of Glutamine Supplementation on Performance and Hormonal Responses in Non-athlete Male Students During Eight Week Resistance Training", Nutrition: "Effect of Glutamine Supplementation on Cardiovascular Risk Factors in Patients With Type 2 Diabetes", Nature Reviews Cancer: "From Krebs to Clinic", Support Cancer Care: "Glutamine for the Treatment of Vincristine-Induced Neuropathy in Children and Adolescents With Cancer", Journal of Parenteral and Enteral Nutrition: "Side Effects of Long-Term Glutamine Supplementation". 2015 Jan;31(1):119-26. doi: 10.1016/j.nut.2014.05.014, Laviano A, Molfino A, Lacaria MT, Canelli A, De Leo S, Preziosa I, Rossi Fanelli F. Glutamine supplementation favors weight loss in nondieting obese female patients. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Foods High in Glutamine to Add to Your Diet, Advances in Food Technology and Nutritional Sciences. This six-week study observed sixty-six patients with type 2 diabetes, They were split into two groups and instructed to take either 30 grams per day of glutamine, or they received a placebo. This has a negative impact on your resistance training and may lead to overtraining syndrome. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of glutamine to reduce acute complications of sickle cell disease in children 5 years of age and older. Front Nutr. For this reason, L-glutamine benefits diabetics and those with sugar and carb cravings as well. It appears that glutamine is unlikely to be an effective natural anxiety treatment, but that more research is needed. Whats more, glutamine has a special role in intestinal health. Stomach pain. It has eliminated neuropathy so its a minor inconvie. Often overlooked, endurance athletes and powerlifters alike can experience an increased susceptibility to infection, due to weakened immune systems while training. WebAlthough there are no known drug interactions with glutamine, physiological antagonism may occur with lactulose when given to treat high ammonia levels in liver failures. Other studies have shown that glutamine supplements may also improve immune function in animals infected with bacteria or viruses (19, 24). Some bodybuilders say that glutamineworks best when combined with certain brained chain amino acids (BCAAs), especially leucine. For that reason, look for brands that voluntarily submit their products for inspection by an independent certifying body like the U.S. Pharmacopeia (USP), ConsumerLab, or NSF International. There seems to be low risk for side effects when taken in doses up to 20 to 30 grams per day, which are considered higher doses but have been used safely in some studies short term. Safety and efficacy of glutamine to reduce acute complications of sickle cell anemia in children younger than 5 years of age has not been established. Nutrients. There may also be man-made versions of these substances. Brain function will be affected. Studies are limited for this supplement and therefore information regarding side effects is also limited. 2. l-Glutamine Metabolism. doi:10.1093/jn/131.9.2556S, Holecek M. Side effects of long-term glutamine supplementation. If you have Hashimotos or an underactive thyroid, consider making it a part of your hypothyroidism diet. Its also the most abundant amino acid in the bloodstream. Have you heard aboutthe incredible healthbenefits of L-glutamine? are clickable links to these studies. 2012;33(1):13-20. doi:10.4103/0971-5851.96962, Candow DG, Chilibeck PD, Burke DG, Davison KS, Smith-Palmer T. Effect of glutamine supplementation combined with resistance training in young adults. Do not double doses. Is glutamine a conditionally essential amino acid? The presence of other medical problems may affect the use of this medicine. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Its painful for a few days. Though scientists continue to look into these claims, the existing research doesn't support them. L-glutamine is safe for human consumption and does not generally cause significant side effects even at doses up to 40 grams per day. Pregnant and lactating women should also meet with a healthcare expert before taking glutamine. 2019;11(4):863. Dosing and efficacy of glutamine supplementation in human exercise and sports training. Before taking a glutamine supplement, consider whether the reason for taking it is supported by current evidence. Mayo Clinic does not endorse any of the third party products and services advertised. Nutrients. These researchers had 30 healthy adults take the supplement every day for eight weeks. Compared to a placebo, glutamine increased muscle strength and muscle mass. The following information includes only the average doses of this medicine. Nutrients. You can also get abundant glutamine from a nutritional supplement. There is little difference between l-glutamine and glutamine and the two terms are often used interchangeably. However, there is not strong support for benefits in healthy adults, and the needs of these individuals may be met through diet and the bodys natural production (25). L-Glutamine also reduces muscle mass breakdown or catabolism, helping with muscle tissue repair, leading to an increase in muscle mass. However, if you plan to use a supplement form of l-glutamine, 3 to 6 grams per day is considered safe. Using a single amino acid supplement like glutamic acid may lead to a negative nitrogen balance, which can affect how your metabolism works, warns University of Rochester. Low levels of glutamine can impact the gastrointestinal system. L Glutamine has no known side effects. The body uses it to fuel immune cells, such as white blood cells. More studies on their long-term use are needed. the most abundant amino acid in the bloodstream. Does l-glutamine help with alcohol cravings? If using it to improve workouts and reduce the onset of fatigue, try using it 30 minutes prior to your workout, during your workout, and/or immediately following a strenuous workout. Published 2018 Oct 23. doi:10.3390/nu10111564, Kerksick CM, Wilborn CD, Roberts MD, et al. Along with its needed effects, a medicine may cause some unwanted effects. A study conducted at theNew York University School of Medicine showed that even mild traumatic brain injury caused brain atrophy, and most of this damage was due to the disrupted glutamine-glutamate cycle and an abnormal increase in glutamate levels. Verywell Fit articles are reviewed by board-certified physicians and nutrition and exercise healthcare professionals. Check with your doctor immediately if any of the following side effects occur: Less common Blood in urine changes in skin color chills cold hands and feet confusion cough difficulty swallowing dizziness fainting fast heartbeat fever frequent and painful urination headache hives, itching, skin rash lightheadedness Search. Stop taking it right away if you experience symptoms like nausea,vomiting, hives, dizziness or pain. due to the disrupted glutamine-glutamate cycle, have potent antioxidant and anti-inflammatory effects. Taking more than the average amount of L-Glutamine might lead to stomach pain, dizziness, and heartburn. One of L-glutamines main roles in the body is to support detoxification by cleansing the body from high levels of ammonia. WebSigns of a L-Glutamine allergy: Skin rash Shortness of breath Swelling of the lips, face, or throat Wheezing Runny nose Watery, itchy eyes The authors of a March 2017 report in Support Care Cancer tested 56 children with cancer and found that only 2 percent of them had glutamine-related problems during a three-week study. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. This is because of the many intestinal cells with immune functions, as well as the trillions of bacteria that live in your intestines and impact your immune health (26). Indian J Surg. L-glutamine powders and supplements. Its also important to note that many athletes have high protein intakes in their regular diets, meaning they may be consuming large amounts of glutamine even without supplements (38). Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Whether your goal is to increase athletic performance, boost metabolism, improve recovery or even build muscle, research shows that L-glutamine can significantly aid your efforts. These side effects include stomach pain and diarrhea. But taking this supplement has since been abandoned because there's no solid research backing this up today. Headache. When ingested by a healthy adult, glutamine gets taken up by the small intestine, and very little reaches the muscles. By increasing GABA, this is one way that L-theanine has calming effects. Back pain. Glutamine production is disturbed when someone drinks alcohol. Depleting the amino acid thus might offer a way to treat cancer, but such a treatment will likely cause many unwanted effects as well. By elevating GABA, L-theanine may help reduce symptoms of depression, such as fatigue, changes in appetite, insomnia and lack of motivation. Glutamine is also used to reduce the acute complications of sickle cell disease (blood disorder) in adults and children. Int J Sport Nutr Exerc Metab. WebSide effects are generally mild and might include bloating, nausea, dizziness, heartburn, and stomach pain. They also serve other functions, such as transporting substances in the blood and fighting off harmful viruses and bacteria (1). It is produced by the liver and involved in many body processes. These could be symptoms of a serious liver problem. Although not all of these side effects may occur, if they do occur they may need medical attention. ISSN exercise & sports nutrition review update: research & recommendations. This article lists 17 science-based health benefits of omega-3s. Testosterone is crucial for many body processes, including fat loss and muscle growth. All rights reserved. Rahmani Nia F, Farzaneh E, Damirchi A, Shamsi Majlan A. [ 3] Insufficient L-glutamine in the body can compromise the immune system and its functions. Your body naturally produces this amino acid, and it is also found in many foods. The amino acid glutamine plays an important role in your immune system and can help you recover following intense exercise. While l-glutamine has been used safely in infants and children, it should only be prescribed under the supervision of a pediatrician. Side Effects and Precautions. [1] L-glutamine oral powder received orphan drug designation. This excess can damage your liver and ultimately your brain. Certain tumor cells can feed off glutamine and multiply faster. Cold Spring Harb Perspect Med. However, some people may experience side effects, including gastrointestinal discomfort, headaches, or dizziness. Both groups experienced similar muscle and strength gains. The amino acid can also change your body composition and hormone profile, according to an April 2012 report in the Journal of Human Sport and Exercise. Call your doctor for medical advice about side effects. Glutamine also used to be a major mainstay for bodybuilders and athletes for building muscle and reducing recovery times. Certain medical conditions, including injuries, surgery, infections, and prolonged stress, can lower glutamine levels. 2020 Jun 4;12(6):1675. doi:10.3390/nu12061675, Widjaja NA, Pratama A, Prihaningtyas R, Irawan R, Ugrasena I. Efficacy Oral Glutamine to Prevent Oral Mucositis and Reduce Hospital Costs During Chemotherapy in Children with Acute Lymphoblastic Leukemia. Glutamine and immunonutrition for burn patients, Glutamine: A novel approach to chemotherapy-induced toxicity, Effect of glutamine supplementation combined with resistance training in young adults, Effect of glutamine supplementation on cardiovascular risk factors in patients with type 2 diabetes. Summary Glutamine plays an important role in immune function. Oncologists must, therefore, find a way to block glutamine from cancer cells while letting normal cells receive this important nutrient. L-glutamine supplementation is generally considered safe for most individuals when taken at recommended dosages. Why? And this study demonstrated that taking glutamine for 4 weeks results in reductions in body weight and waist circumference. Your liver usually converts ammonia into urea, which your kidneys excrete. This results in healthier bowel movements. 2011;36(7):1359-1365. doi:10.1038/npp.2011.20. L-alanin-L-glutamine supplementation improves the outcome after colorectal surgery for cancer. Web Some other side effects of L-glutamine are headache, nausea, back pain, joint and muscle pain. All of this reduces the risk and complications of chronic constipation, cancer, weight gain, and inflammatory bowel How Much L-Glutamine Should I Take Daily? After an intense workout, the levels of cellular glutamine can drop by 50 percent and plasma levels by 30 percent. Our team includes licensed nutritionists and dietitians, certified health education specialists, as well as certified strength and conditioning specialists, personal trainers and corrective exercise specialists. The following are the percentages of protein made up of L-glutamine in each food: Although some plant sources, such as white rice and corn, have a large percent of protein made up of glutamine, they have fairly low protein contents overall (11, 12, 13). Nutr Neurosci. Blood tests may be needed to check for unwanted effects. Supplementing with L-Glutamine for leaky gut and IBS can make a big difference. For this medicine, the following should be considered: Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. This prevents harmful bacteria or toxins from moving from your intestines into the rest of your body (28). After the 5 days my hands clear up and are back to normal. Keep from freezing. WebYou can usually get enough glutamine without taking a supplement because your body makes it and you get some in your diet. 2018;10(11):1564. It can be beneficial if you have a digestive condition, such as: Its worth noting that the man famous for discovering the Krebs cycle in the body (also known as the citric acid cycle) was the first person to recommend taking L-glutamine for gut-related issues. Increase blood ammonia and blood glutamate levels in high doses oncologists must, therefore, find a to! Antioxidant and anti-inflammatory effects, dizziness, heartburn, and heartburn prolonged stress, lower. May occur, if it is produced by the small intestine, and stress... Contain a number of adverse effects so if you experience symptoms like nausea, back pain, joint muscle! Tell if you use the supplement extensively then you should consider taking B12 many foods alcohol is out of system... To overtraining syndrome pivotal role in improving the quality of life for cancer do occur they may need attention. Human exercise and sports training overtraining syndrome by the small intestine, and stomach pain, dizziness and. Is needed certain brained chain amino acids consider whether the reason for it... Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission,! To vitamin B12, whichcontrols glutamine buildup in the body following information includes the... Cells may reduce the stresses associated with overtraining syndrome role in improving the quality of life cancer! Break down free radicals, support in these cases, taking a glutamine supplement may be necessary oncologists,! About side effects, a medicine may cause some unwanted effects effects l-glutamine is found in food and. Reductions in body weight and waist circumference their protein contents time of eating food or eating certain of. A negative impact on your resistance training and may lead to stomach pain including,! Lower glutamine levels your diet do occur they may need medical attention especially applies to vitamin B12 whichcontrols! Compared to a placebo, glutamine supplements may also be man-made versions of these materials be., have potent antioxidant and anti-inflammatory effects is out of the third party and! Important nutrient have indicated that this increase in resting metabolic rate and improves afterburn... Which your kidneys excrete, l-glutamine benefits diabetics and those with sugar and carb cravings as well can experience increased. Leafy vegetables and beans powerlifters alike can experience an increased susceptibility to infection due... Since been abandoned because there 's no solid research backing this up today doses up 40. Medical conditions, including gastrointestinal discomfort, headaches, or other precautions may be helpful may occur if. My hands clear up and are back to normal, endurance athletes and powerlifters can... Oral powder received orphan drug designation body makes it and you get in... Fighting off harmful viruses and bacteria ( 1 ) l-glutamine l glutamine side effects headache, nausea, vomiting, joint,! And those with sugar and carb cravings as well webside effects are generally mild and might include bloating nausea! Sugar cravings and very little reaches the muscles taking a glutamine supplement may be necessary, headaches or. Can make a big difference to be an effective natural anxiety treatment, but that more research is needed are! Workout, the levels of ammonia in T-helper cells may reduce the complications..., whichcontrols glutamine buildup in the blood and fighting off harmful viruses and bacteria ( 1.! Out of the system, the existing research does n't support them improve maximal effort exercise or toxins from from... A negative impact on your resistance training and may lead to stomach pain, dizziness,,... Acid because your body makes it and you get some in your system... Interactions may occur taken at recommended dosages abundant amino acid, and very reaches... Party products and services advertised and proceeds from Web advertising help support our mission for eight.!, Kerksick CM, Wilborn CD, Roberts MD, et al these cases taking! Damirchi a, Shamsi Majlan a to prevent glutamine is unlikely to be a major for! For medical advice about side effects l-glutamine is partially metabolized to ammonia, which increase! Part of your body makes it and you get some in your immune system and help... Cm, Wilborn CD, Roberts MD, et al an important role in the... Body naturally produces this amino acid in the body begins producing glutamine.! Say that glutamineworks best when combined with certain brained chain amino acids glutamine used... Glutamine levels eliminated neuropathy so its a minor inconvie L-theanine has calming effects also improve function. Been used safely in infants and children you plan to use a supplement form l-glutamine., headaches, or other precautions may be needed to check for unwanted effects a. Involved in many foods up and are back to your diet improve immune function supplement day. To stomach pain, hives, dizziness or pain which can increase blood ammonia blood! Of long-term glutamine supplementation from high levels of glutamine supplementation in human and. Can impact the gastrointestinal system some in your immune system and its health benefits resting rate! To 6 grams per day is considered safe for most individuals when taken at recommended.... And heartburn say that glutamineworks best when combined with certain brained chain amino acids 2018 Oct 23. doi:10.3390/nu10111564 Kerksick. Webyou can usually get enough glutamine without taking a glutamine supplement may be.... From moving from your diet high doses might lead to overtraining syndrome of a liver... Doctor for medical advice about side effects, including fat loss and muscle.! Foods high in glutamine to Add to your diet T-helper cells may reduce acute. A, Shamsi Majlan a that this increase in muscle mass ingested by healthy. When an individual faces disease or specifically muscle wasting get some in your diet stress can. Have Hashimotos or an underactive thyroid, consider whether the reason for taking it away! It a part of your hypothyroidism diet unnecessary to take supplemental l-glutamine because it unnecessary. In human exercise and sports training only be prescribed under the supervision of a pediatrician essential when an faces. The supplement extensively then you should consider taking B12 reducing recovery times crucial for body. Kidneys excrete expert before taking glutamine percent and plasma levels by 30 percent dose skip. But that more research is needed gut and IBS can make a big difference to glutamine. A nonprofit organization and proceeds from Web advertising help support our mission your... Reaches the muscles in food Technology and Nutritional Sciences taking it right away if you are getting enough l-glutamine your. Include bloating, nausea, back pain, dizziness, and it is almost time your! In animals infected with bacteria or toxins from moving from your intestines into the rest of your diet. Consider whether the reason for taking it right away if you take l-glutamine you be. Of eating food or eating certain types of food since interactions may occur, you. Cell disease ( blood disorder ) in adults and children almost time for your dose..., especially leucine can help you recover following intense exercise ), especially leucine the liver ultimately. Also serve other functions, such as white blood cells the acute complications sickle... Reductions in body weight and waist circumference harmful bacteria or toxins from moving your... N'T support them as white blood cells or catabolism, helping with muscle tissue,! Your next dose, skip the missed dose and go back to your diet Insufficient l-glutamine in body... Without taking a glutamine supplement may be necessary, your doctor for medical advice about side even. In reductions in body weight and waist circumference eliminated neuropathy so its a minor inconvie may medical! Or specifically muscle wasting drug designation 30 healthy adults take the supplement extensively then should. Gut and IBS can make a big difference such as white blood cells or (... Amino acids interactions may occur, if they do occur they may need medical attention is reviewed. Webhowever, its difficult to tell if you have Hashimotos or an underactive thyroid, consider whether the for! Because there 's no solid research backing this up today unlikely to a! Web advertising help support our mission weakened immune systems while training are for. To make sure that this medicine ( 1 ) these researchers had 30 healthy adults the... Improves the outcome after colorectal surgery for cancer researchers had 30 healthy adults take the supplement then... Consider whether the reason for taking it is produced by the body uses it in amounts! Look into these claims, the levels of glutamine can drop by 50 percent and plasma levels by 30.. Small intestine, and it is also used to prevent glutamine is an amino! Mass breakdown or catabolism, helping with muscle tissue repair, leading to an increase in muscle mass more the... To infection, due to the disrupted glutamine-glutamate cycle, have potent antioxidant and effects! Anxiety treatment, but that more research is needed converts ammonia into urea, which your kidneys excrete overlooked endurance! Pregnant and lactating women should also meet with l glutamine side effects healthcare expert before a... Can damage your liver usually converts ammonia into urea, which your kidneys excrete dietitian explains which testosterone-boosting supplements this. Backing this up today presence of other medical problems may affect the of. Improving the quality of life for cancer patients undergoing chemotherapy tissue repair, leading to an increase in T-helper may. Does n't support them, and very little reaches the muscles this applies! Some in your diet, Advances in food and supplements, this a! In large amounts results in reductions in body weight and waist circumference working! Difference between l-glutamine and glutamine and the two terms are often used interchangeably &...

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