Citrulline Malate is an amino acid also known as L-Citrulline and is taken for many different medical conditions. There is some research that shows that the amino acid may help improve performance while exercising by reducing fatigue. What does that mean for you? In your muscle building efforts, you can use this supplement to help you make it through longer, harder workouts. This will spur more muscle building in response to the trauma your muscles experience in a tough workout. Not only that, but Citrulline Malate can also help reduce soreness after a workout. Who doesn’t want to avoid feeling sore? Reduced soreness means you can get back to the gym the next day with renewed enthusiasm.

The other two, the medius and minimus, work together to aid your gluteus maximus in raising your leg to the side. Plus, those smaller glute muscles help rotate your thigh outwards when your leg is straight, and inwards when your hips are bent. Talk about a dream team! (To learn more about the workings of your glutes, check out The Women's Health Big Book of Exercises!)
It has also been noted that supplementing creatine (which reduces internal synthesis of creatine and methylation requirements) preserved folate and tetrahydrofolate status (42% and 23%),[312] which acted to preserve methyl groups for other processes. Despite this effect, global DNA methylation decreases by 22% (assessed by the 5-methylcytosine/cytosine ratio) following creatine supplementation, which is usually seen as an anti-cancer effect in developed mammals.[461] This study was unable to demonstrate why this reduction occured[461] and opposing effects have been noted in females with Rett syndrome supplementing 200mg/kg creatine for 1 year, during which global methylation increased, secondary to preserving other methyl donors.[462]
Having a strong butt will get you far—literally. Our glutes are responsible for powering us through everything from long runs to tough strength workouts to a simple jaunt up a flight of stairs. Strong glutes that can take on the brunt of the work can help us avoid overcompensating with smaller muscles during lower-body exercises. Plus, beyond just helping us move, the glutes play an important role in "stabilizing our entire lumbo-pelvic-hip complex," says Cori Lefkowith, NASM-certified personal trainer and owner of Redefining Strength in Costa Mesa, California. That translates to better form, more efficient movement, and a reduced risk of straining your lower back and hips.

Eating the right carbs is important too. Carbohydrate is stored in your body in the form of glycogen. Glycogen in the muscles is an important fuel reserve during intense physical exercise or in times of energy restriction – protein sparing. It is best to restrict or to keep away from junk carbohydrates such as sweets, cakes, and biscuits, and stick to foods like porridge, pasta (wholemeal), rice (brown), bread (wholegrain), and cereals (try to choose the versions with low or reduced sugar and salt). For more on carbohydrate and the effect of sugar on the body, click here.


Kidney damage (from anything) will cause high levels of creatinine in blood, and creatine can also increase blood creatinine levels in a manner that is not due to damaging the kidneys. This results in a false positive when trying to diagnose kidney damange when the subject also supplements creatine, and does not signify any actual damage to the kidneys.

Whey, the liquid remaining after milk has been curdled and strained, is rapidly digested and absorbed and has a remarkable ability to stimulate muscle protein synthesis (Hayes & Cribb, 2008). Whey is available in three varieties — whey protein powder, whey protein concentrate, whey protein isolate — and all provide high levels of the essential and branched chain amino acids, vitamins and minerals.
Anti-depressive effects have been noted in woman with major depressive disorder when 5g of creatine monohydrate was supplemented daily for 8 weeks in combination with an SSRI. Benefits were seen at week two and were maintained until the end of the 8-week trial.[253] The improvement in depressive symptoms was associated with significantly increased prefrontal cortex levels of N-acetylaspartate, a marker of neuronal integrity,[254] and rich club connections, which refers to the ability of nerons to make connections to one another.[255]

At the end of the day, yes, strength training does impact your metabolism, but any boost you get will be minimal and completely secondary to all of the other health benefits of strength training. Any change in metabolism or increase in calorie burn will vary widely from person to person, and depends on so many factors: your genetics, eating habits, health conditions, what workout you do that day, how much sleep you’re getting, and even how stressed you are on any given day. But incorporating a couple of strength training sessions into your fitness routine is worth doing no matter what—you’ll feel yourself get stronger, and put yourself in a position to say healthier throughout life. Those are the best, most promising benefits to work for.


To meet the demands of a high-intensity exercise, such as a sprint, muscles derive their energy from a series of reactions involving adenosine triphosphate (ATP), phosphocreatine (PCr), adenosine diphosphate (ADP), and creatine. ATP, the amount of which is relatively constant, provides energy when it releases a phosphate molecule and becomes ADP. ATP is regenerated when PCr donates a phosphate molecule that combines with ADP. Stored PCr can fuel the first 4-5 seconds of a sprint, but another fuel source must provide the energy to sustain the activity. Creatine supplements increase the storage of PCr, thus making more ATP available to fuel the working muscles and enable them to work harder before becoming fatigued [1].
At the end of the day, you have to focus on how you feel. “Listen to your body,” says Davis. “It tells you when it needs a day off.” As a rule of thumb, take a rest day if your perceived pain is above a seven on a scale of 10, Davis advises. Or, focus on a different body part (say, if your legs are sore, focus on upper-body moves). Can't stop, won't stop—at least, till your next rest day.
Bodybuilding supplements are dietary supplements commonly used by those involved in bodybuilding, weightlifting, mixed martial arts, and athletics for the purpose of facilitating an increase in lean body mass. The intent is to increase muscle, increase body weight, improve athletic performance, and for some sports, to simultaneously decrease percent body fat so as to create better muscle definition. Among the most widely used are high protein drinks, branched-chain amino acids (BCAA), glutamine, arginine, essential fatty acids, creatine, HMB,[1] and weight loss products.[2] Supplements are sold either as single ingredient preparations or in the form of "stacks" – proprietary blends of various supplements marketed as offering synergistic advantages. While many bodybuilding supplements are also consumed by the general public the frequency of use will differ when used specifically by bodybuilders. One meta-analysis concluded that for athletes participating in resistance exercise training and consuming protein supplements for an average of 13 weeks, total protein intake up to 1.6 g/kg of body weight per day would result in an increase in strength and fat-free mass, i.e. muscle, but that higher intakes would not further contribute.[3] The muscle mass increase was statistically significant but modest - averaging 0.3 kg for all trials and 1.0–2.0 kg, for protein intake ≥1.6 g/kg/day.[3]

Stand on your right foot and lift your left foot off the ground. Inhale as you step your left foot backward into a lunge, so that your left knee hovers above the ground. Exhale as you drive through your right heel to rise to a single-leg stance, bringing your left leg forward and up to hip height. Do 10-12 reps. Switch sides. Optional: Load this move by holding a kettlebell at your chest or a dumbbell in each hand.
Furthermore, because creatine can help restore ATP levels, increasing energy, it can lead to reduced amounts of heart muscle stress. More energy in your life will result in less pain, stress, and boost morale in everyday life which has a significant role in improving heart health. The increased capacity to exercise is also crucial in maintaining and improving heart health.
Athletes in ancient Greece were advised to consume large quantities of meat and wine. A number of herbal concoctions and tonics have been used by strong men and athletes since ancient times across cultures to try to increase their strength and stamina.[5] In the 1910s, Eugen Sandow, widely considered to be the first modern bodybuilder in the West, advocated the use of dietary control to enhance muscle growth. Later, bodybuilder Earle Liederman advocated the use of "beef juice" or "beef extract" (basically, consomme) as a way to enhance muscle recovery. In 1950s with recreational and competitive bodybuilding becoming increasingly popular Irvin P. Johnson began to popularize and market egg-based protein powders marketed specifically at bodybuilders and physical athletes. The 1970s and 1980s marked a dramatic increase in the growth of the bodybuilding supplement industry, fueled by widespread use of modern marketing techniques and a marked increase in recreational bodybuilding.
Cornelissen et al [80] analyzed the effects of 1 week loading protocol (3 X 5 g/d CM) followed by a 3 month maintenance period (5 g/d) on cardiac patients involved in an endurance and resistance training program. Although CM supplementation did not significantly enhance performance, markers of renal and liver function were within normal ranges indicating the safety of the applied creatine supplementation protocol.

Creatine is used up as energy during high intensity exercise. Due to this usage, the amount of glucose required from glycogen is decreased a bit. This both preserves glycogen concentrations in skeletal muscle and reduces lactate production, which is produced when glucose is oxidized for energy. There do not appear to be any alterations in the bioenergetic status of muscle cells during low to moderate intensity exercise.

Any type of running will help strengthen your glutes, but sprinting at a very fast speed is even more effective. You can perform sprints as part of a HIIT workout or simply increase your speed while running or briskly walking for a short distance. Start out with about 15–20 minutes of HIIT intervals and work your way up to 25–30 minutes if you’d like.  To perform intervals alternate slower running or resting for 1–2 minutes with 30–90 seconds of sprinting as fast as you can. Most experts recommend practicing HIIT workouts 2–3 times per week.

If you are somebody that is tired of not getting results, wants to avoid trial-and-error, or you just want to be told exactly what to do to reach your goals, check out our popular 1-on-1 coaching program. You’ll work with our certified NF instructors who will get to know you better than you know yourself and program your workouts and nutrition strategy for you.
Knowledge – When it comes to building the best physique possible, you have to be willing to experiment and learn from your body. No one will be able to tell you what’s the most effective nutrition or training split for your individual genotype. Not only that, they don’t know your personal preference, injury history, asymmetries, experience level, or current work capacity.
This test measures a participant's ability to stand up from a seated position as many times as possible in a thirty-second period of time.[2] Testing the number of times a person can stand up in a thirty-second period helps assess strength, flexibility, pain, and endurance,[2] which can help determine how far along a person is in rehabilitation, or how much work is still to be done.
This test measures a participant's ability to stand up from a seated position as many times as possible in a thirty-second period of time.[2] Testing the number of times a person can stand up in a thirty-second period helps assess strength, flexibility, pain, and endurance,[2] which can help determine how far along a person is in rehabilitation, or how much work is still to be done.
^ Jump up to: a b Lazaridis I, Charalampopoulos I, Alexaki VI, Avlonitis N, Pediaditakis I, Efstathopoulos P, Calogeropoulou T, Castanas E, Gravanis A (2011). "Neurosteroid dehydroepiandrosterone interacts with nerve growth factor (NGF) receptors, preventing neuronal apoptosis". PLoS Biol. 9 (4): e1001051. doi:10.1371/journal.pbio.1001051. PMC 3082517. PMID 21541365.
Do standard squats with a weighted bar. Place enough weight on a bar and rack so that it's a little lower than shoulder height. It should be heavy enough that doing a squat is difficult, but not impossible. If you're a beginner, this may mean using a bar without any weight to start with. Duck under the bar and stand up so that the bar rests comfortably on your trapezius muscles, just below the neck. Keep your knees slightly bent and your legs slightly wider than shoulder width. Lift the bar up off the rack and move backwards one step.
In summary, creatine salts have been show to be less stable than CM. However the addition of carbohydrates could increase their stability [62]. The potential advantages of creatine salts over CM include enhanced aqueous solubility and bioavailability which would reduce their possible gastrointestinal adverse effects [63]. The possibility for new additional formulation such as tablets or capsules is interesting for its therapeutic application due to its attributed better dissolution kinetics and oral absorption compared to CM [63]. However more complete in vivo pharmaceutical analysis of creatine salts are required to fully elucidate their potential advantages/disadvantages over the currently available supplement formulations.
Even human studies can be misinterpreted or manipulated. A few years ago a then-esoteric trace mineral called boron was found to increase testosterone, but only in older women, as it turned out. When boron was tested in young men engaged in weight training, it proved worthless for increasing testosterone. That doesn't mean boron is useless; it helps the body use the minerals calcium and magnesium, and it appears to increase mental alertness.

Creatine, through its ability to act as an energy reserve, attenuates neuron death induced by the MPTP toxin that can produce Parkinson’s disease-like effects in research animals,[235] reduces glutamate-induced excitotoxicity,[236] attenuates rotenone-induced toxicity,[120] L-DOPA induced dyskinesia,[237] 3-nitropropinoic acid,[238] and preserves growth rate of neurons during exposure to corticosteroids (like cortisol), which can reduce neuron growth rates.[239] Interestingly, the energetic effect also applies to Alzheimer’s disease, during which creatine phosphate per se attenuates pathogenesis in vitro, yet creatine per se did not.[240]
The amount of testosterone synthesized is regulated by the hypothalamic–pituitary–testicular axis (see figure to the right).[133] When testosterone levels are low, gonadotropin-releasing hormone (GnRH) is released by the hypothalamus, which in turn stimulates the pituitary gland to release FSH and LH. These latter two hormones stimulate the testis to synthesize testosterone. Finally, increasing levels of testosterone through a negative feedback loop act on the hypothalamus and pituitary to inhibit the release of GnRH and FSH/LH, respectively.
High extracellular creatine concentrations induce the expression of a factor that inhibits the creatine transporter (CrT). To date, neither the identity of nor mechanism for this putative CrT-suppressing factor has come to light. Future studies that are able to identify this creatine transport-suppressing factor and how it works may provide valuable insight into possible supplementation strategies that might be used to increase creatine uptake into muscle cells.

Dymatize Nutrition maximizes the benefits of protein in ISO-100 through its use of hydrolyzed 100% whey protein isolate. Designed to increase the absorption of protein, this fast-acting protein provides 25 grams of protein and 5.5 grams of BCAAs per serving, with no gluten or lactose. With a formula that aids in the instantaneous delivery of effective and advanced protein forms straight to the muscle, ISO-100 is able to repair and build muscle faster, resulting in the ability to reach fitness goals sooner rather than later. Keep Reading »
It's OK to be a little sore. Your muscles might feel achy or tired the day after a tough training session thanks to DOMS, or delayed onset muscle soreness. When you strength train you're causing microscopic damage to the tissue that will be repaired, that's how you build stronger lean muscle. Speaking of repair and recovery, though, rest days are important. "If you constantly break down muscle without a recovery period, you won’t give the muscle fibers a chance to repair and build back stronger,” explains Davis.
The 100% Grass-Fed Whey Protein Isolate comes in the form of powder and can be mixed with any liquid. While the protein powder can be mixed well with water, try mixing it with milk for added calories and protein. You can even add this to smoothies and baked goods to increase the protein profile. Recommended protein intake for adults is 0.8 grams per kilogram. Some athletes may need as much as 1.2-2 grams protein per kilogram. For your specific needs, always consult a registered dietitian.
I'm 6'1" 175 pounds 27 years old. I would like to increase my general muscle mass and reduce my stomach fat. I would consider myself and ectomorph (hard gainer) as I have never really developed much muscle while I've always been very active in sports and periodic weight training. Over the past year I lost about 30 pounds (nearly all fat) by reducing my caloric intake effectively and regular whole body exercises. I was on my way to my ideal body composition until I became a bike courier. I've been a bike messenger for 9 months and recently my stomach fat has started to return. I'm riding 50+ miles each weekday riding for 9 hours a day. How many calories should I be eating? I've tried everywhere between 2400-3,500 cal/day. Is it possible for me to be eating too few calories while still accumulating stomach fat? Is it realistic for me to be able to maintain or even build muscle mass in this scenario? Please help, thanks.
We’ll be talking more about this later, but for now, just give it a shot! In strength training you can see your progress so clearly that as you can do more and more, you’ll also be rewarded by seeing your strength progress from level 1 to level 50! If you aren’t a fan of the downtime, put on a book on tape or throw on your favorite playlist while circuit training to ensure you’re always moving (instead of sitting and waiting in between sets).
In the last week leading up to a contest, bodybuilders usually decrease their consumption of water, sodium, and carbohydrates, the former two to alter how water is retained by the body and the latter to reduce glycogen in the muscle. The day before the show, water is removed from the diet, and diuretics may be introduced, while carbohydrate loading is undertaken to increase the size of the muscles through replenishment of their glycogen. The goal is to maximize leanness and increase the visibility of veins, or "vascularity". The muscular definition and vascularity are further enhanced immediately before appearing on stage by darkening the skin through tanning products and applying oils to the skin to increase shine. Some competitors will eat sugar-rich foods to increase the visibility of their veins. A final step, called "pumping", consists in performing exercises with light weights or other kinds of low resistance (for instance two athletes can "pump" each other by holding a towel and pulling in turn), just before the contest, to fill the muscles with blood and further increase their size and density.
These effects were noted before in a preliminary study of depressed adolescents (with no placebo group) showing a 55% reduction in depressive symptoms at 4g daily when brain phosphocreatine levels increased.[231] Other prelimnary human studies suggest creatine might lessen unipolar depression[256] and one study on Post-Traumatic Stress Disorder (PTSD) noted improved mood as assessed by the Hamilton Depression Rating Scale.[232]
How to do it: Begin with one foot firmly planted in front of you with your other leg extended back. Keep balance by putting your weight in the ball of your front foot and the back heel of your back foot. Hold a dumbbell in either hand, arms at your sides. Or, place a resistance band under the foot of your working leg, up, and around the same shoulder. Stand tall and bend your front working leg to approximately 90 degrees, keeping your knee directly over your ankle so it doesn’t over-extend. Return to the start position and repeat. Do both sides.
On top of this, you’ll need to consume more calories than you’re burning. Burning more calories each day than you eat is a great way to lose weight, but if your goal is to put on muscle mass, this can make the process much harder. Your body requires calories to build new muscle tissue, but this can’t occur if all the body’s energy is being used up for daily processes. Because of this, some bodybuilding supplements include weight gainers to help you get more healthy calories in your diet.
I know this goes against the recommendations you often see in stereotypical bodybuilding routines (i.e. the ones that involve having a single “chest day” or “arm day” or “shoulder day” once a week), but that’s just one of the many reasons why those types of routines suck for us natural, genetically-average people, and work best for steroid users with great genetics.
Beta-alanine is a naturally occurring non-essential amino acid that comes into the body through foods that are rich in protein. The performance-enhancing aspect of beta-alanine (BA) is due to its ability to increase intra-muscular levels of carnosine. Increasing beta-alanine through supplementation may raise carnosine levels by over 60 percent in as quickly as four weeks.[6]
In males, the testosterone test can help find the reason for sexual problems, like reduced sex drive or erectile dysfunction. If you’re having a hard time getting your partner pregnant, the test can tell if your blood testosterone level is low. It can also screen for problems with the hypothalamus or pituitary gland. This controls how much testosterone your body makes.

Many people are looking for magic bullets in their efforts to fuel their bodies, sharpen their minds, and hold on to their youth. As a result, some spend a small fortune on novel dietary supplements, hoping that the promising results of studies exploring the effects of these compounds in other animals translate to humans. Unfortunately, however, this is rarely the case. But every now and then a supplement is proven to actually help lots of people. Creatine has been around for decades, so it’s easy to overlook it amidst hype over newer pills and powders. Yet I think it might be the most beneficial, underappreciated, and cost-effective supplement there is – if I could only recommend one supplement for everyone to take (an absurd scenario, I know), it would be creatine monohydrate. That’s a bold statement, so in this post I’ll support my stance. As a result, I hope that you too get to experience the diverse benefits of creatine supplementation.
In an article entitled Active Seniors Enjoy Life More, the American Council on Exercise reports, “As you grow older…regular exercise can help boost energy, maintain your independence, and manage symptoms of illness or pain. Exercise can even reverse some of the symptoms of aging.” Wow! Are you sold yet? But wait, there’s more. While taking your daily walk remains a crucial piece of this exercise pie, getting in your strength training reps is the part that will truly make the difference in your well-being. The Center for Disease Control and Prevention (“CDC”) recommends strength training for most older adults to help lessen the symptoms of the following chronic conditions:
A loading phase of 10g creatine monohydrate for two weeks and 4g for the final week in subjects with MELAS (Mitochondrial Encephalomyopathy Lactic Acidosis and Stroke-like episodes) has been noted to increase physical strength relative to baseline, although the poor VO2 max seen in these subjects was not affected.[549] A case study exists in which a patient with a relatively novel mutation in their mitochondrial function (affecting cytochrome B) experienced benefits from creatine at 10g daily.[550] Researchers examining another case of MELAS found both cognitive and physical benefits with 5g creatine supplementation,[551] while four controlled case studies of 100-200mg/kg daily in children with myopathies found improved muscular endurance (30-57%) and muscular power (8-17%) after 100-200mg/kg daily for at least three months.[552]
Rice Protein: An alternative protein powder for muscle gain, rice protein is ideal for people who are lactose intolerant or have a milk allergy. As far as muscle gain and body composition when taken post-workout, this study showed that there was zero difference in outcomes when comparing taking whey protein and rice protein. So, if you prefer using rice protein, you can take it with confidence knowing that you’ll be able to achieve the same results you’d achieve if you were taking whey protein.
Furthermore, because creatine can help restore ATP levels, increasing energy, it can lead to reduced amounts of heart muscle stress. More energy in your life will result in less pain, stress, and boost morale in everyday life which has a significant role in improving heart health. The increased capacity to exercise is also crucial in maintaining and improving heart health.
If you're serious about putting on some muscle, then the most efficient way to do it is with three intense resistance training sessions and two lighter intensity workouts per week. “You need to have consistency in a workout program, hitting at least each muscle group two times a week to build muscle,” explains Lovitt. If you’re looking to switch up exercises, Olson suggests swaps such as sumo squats instead of traditional squats; step-ups on a bench instead of lunges; and then rotating back to the former. “These types of variation can be very effective in developing muscles, but the weights must still be fairly heavy that you’re using,” she says.

Testosterone fluctuates according to age and life circumstance, often plummeting at the onset of parenthood, and spiking (for some) during moments of triumph. Romantic relationships, too, can impact a person’s testosterone production; though the reasons are still not fully understood, entering a relationship tends to increase women’s testosterone levels, while decreasing men’s. Since males produce significantly more testosterone than females—about 20 times more each day—females can be more sensitive to these fluctuations. High levels of testosterone, particularly in men, have been correlated with a greater likelihood of getting divorced or engaging in extramarital affairs, though a causal link has not been established.
Although creatine can be bought commercially as a standalone product it is often found in combination with other nutrients. A prime example is the combination of creatine with carbohydrate or protein and carbohydrate for augmenting creatine muscle retention [5] mediated through an insulin response from the pancreas [69]. Steenge et al [70] found that body creatine retention of 5 g CM was increased by 25% with the addition of 50 g of protein and 47 g of carbohydrate or 96 g carbohydrate when compared to a placebo treatment of 5 g carbohydrate. The addition of 10g of creatine to 75 g of dextrose, 2 g of taurine, vitamins and minerals, induced a change in cellular osmolarity which in addition to the expected increase in body mass, seems to produce an up regulation of large scale gene expression (mRNA content of genes and protein content of kinases involved in osmosensing and signal transduction, cytoskeleton remodelling, protein and glycogen synthesis regulation, satellite cell proliferation and differentiation, DNA replication and repair, RNA transcription control, and cell survival) [25]. Similar findings have also been reported for creatine monohydrate supplementation alone when combined with resistance training [71].
Related to exercise and fitness, BCAAs are taken to help reduce muscle breakdown, which is why they may be known as muscle building supplements. Leucine, in particular, is known for playing an important role in muscle protein synthesis, which can help with muscle gain and maintenance. Some also claim that BCAAs can enhance performance, although many studies also refute this claim.
Why it made the list: Whey tops the list of mass-gain supplements because it's the most crucial for pushing protein synthesis. Whey is a milk protein that has a high level of branched-chain amino acids (BCAAs, No. 4 on our list). Bottom line: Whey takes the crown because it digests fast and gets to your muscles rapidly to start building muscle. Whey also contains peptides (small proteins) that increase blood flow to the muscles. This is why we always recommend consuming whey protein immediately after training.
Studies conducted in rats have indicated that their degree of sexual arousal is sensitive to reductions in testosterone. When testosterone-deprived rats were given medium levels of testosterone, their sexual behaviors (copulation, partner preference, etc.) resumed, but not when given low amounts of the same hormone. Therefore, these mammals may provide a model for studying clinical populations among humans suffering from sexual arousal deficits such as hypoactive sexual desire disorder.[37]
Plyometrics exploit the stretch-shortening cycle of muscles to enhance the myotatic (stretch) reflex. This involves rapid alternation of lengthening and shortening of muscle fibers against resistance. The resistance involved is often a weighted object such as a medicine ball or sandbag, but can also be the body itself as in jumping exercises or the body with a weight vest that allows movement with resistance. Plyometrics is used to develop explosive speed, and focuses on maximal power instead of maximal strength by compressing the force of muscular contraction into as short a period as possible, and may be used to improve the effectiveness of a boxer's punch, or to increase the vertical jumping ability of a basketball player. Care must be taken when performing plyometric exercises because they inflict greater stress upon the involved joints and tendons than other forms of exercise.
You have to fuel your body with high-quality, real, wholesome food. Eating pizza, burgers, ice cream, and fast food just because it’s high in calories is a really bad plan. You’ll feel terrible, and while the extra calories will help muscle gains to an extent, most of them will turn to fat. It’s not worth it. Your recovery will be slower and you will be riddled with inflammation.
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