Smelling Dark Chocolate Before Sets Boosts Strength and Cuts Hunger, New Study Finds

Table of Contents

  1. Key Highlights
  2. Introduction
  3. How the trial measured chocolate scent effects: methods and key outcomes
  4. Why an odor might change how hard exercise feels: neural and psychological pathways
  5. The role of fasting: why hunger status matters
  6. Why dark chocolate outperformed milk chocolate
  7. How big is the performance effect, and how meaningful is it in practice?
  8. Appetite suppression: mechanisms and implications for weight management
  9. Olfactory-based strategies in sports: precedents and contrasts
  10. Limitations of the study and unanswered questions
  11. Practical guidance: how to test chocolate scent in your training safely and effectively
  12. Safety, ethics and commercial considerations
  13. What follow-up studies are needed to build the evidence base
  14. Real-world examples and hypothetical applications
  15. Practical limitations and warnings for end users
  16. How coaches and sports scientists should interpret the finding
  17. Looking beyond chocolate: what other odors might work?
  18. The bigger picture: integrating sensory cues into performance programming
  19. Summary of practical takeaways
  20. FAQ

Key Highlights

  • Brief inhalation of dark chocolate scent between weightlifting sets increased repetitions substantially: a 90% cocoa aroma added roughly 18 more leg-extension reps versus placebo; 60% cocoa added about 9.
  • Dark chocolate aroma reduced pre-exercise hunger and increased fullness in fasted participants; milk chocolate smelled more pleasant but produced smaller or no appetite effects.
  • The trial involved 23 young men who fasted at least 10 hours and inhaled a chocolate scent for 30 seconds between sets at 80% of one-rep max; findings point to olfaction-driven shifts in perceived effort and reward.

Introduction

Smell alters behavior in ways many people overlook. A whiff of coffee can sharpen attention. The scent of fresh bread sparks appetite. New peer-reviewed research now shows that a short inhalation of dark chocolate not only makes lifting feel easier but also lets someone perform more repetitions without reporting greater effort. The finding reframes how coaches, athletes and recreational gymgoers think about non-nutritional strategies to influence performance and appetite during training—especially when workouts follow an extended fast.

The study, published in Frontiers in Physiology and led by Mohamed Nashrudin bin Naharudin of the University of Malaya, measured the effect of chocolate odors on leg-extension performance and subjective appetite in 23 men. Results were clear: exposure to a 90% cocoa aroma produced the largest performance and satiety benefits, while a 60% cocoa scent delivered moderate performance gains but did not blunt hunger. Smelling chocolate between sets produced these effects without athletes perceiving greater exertion, suggesting a psychobiological shift rather than a raw increase in muscular capacity.

The research raises immediate questions about mechanisms, real-world applicability, safety, and how scent-based interventions might pair with established ergogenic aids such as caffeine or nitrates. This article walks through the trial’s design and results, puts them in context with existing literature on odor and performance, evaluates biological explanations, outlines practical applications and risks, and identifies the next experiments needed to move from lab result to gym routine.

How the trial measured chocolate scent effects: methods and key outcomes

The experiment enrolled 23 male participants with an average age of 23. All had fasted for at least 10 hours before testing. Researchers used leg extensions at an intensity of 80% of each participant’s one-repetition maximum (1RM) to create a repeatable, fatigue-inducing stimulus. Between sets, participants inhaled from a jar containing either a 90% cocoa dark chocolate scent, a 60% cocoa milk chocolate scent, or a placebo odor for 30 seconds.

Performance was measured as the total number of repetitions across sets, and participants reported perceived exertion. The trial produced two main findings. First, those exposed to the 90% cocoa aroma completed roughly 18 additional repetitions compared with the placebo condition. Second, exposure to the 60% cocoa milk chocolate scent yielded an intermediate improvement of about nine extra repetitions. Crucially, these performance gains occurred without a corresponding increase in self-reported exertion. Participants did not feel they were working harder, yet they produced more output.

Appetite measures revealed a divergence between dark and milk chocolate. Smelling 90% cocoa significantly reduced reported hunger and increased feelings of fullness prior to exercise. The 60% cocoa milk chocolate scent produced no meaningful change in appetite but was rated as more pleasant by participants.

The use of fasted participants is an important design choice. Fasting increases baseline hunger and may make appetite-related olfactory triggers more potent. It also mirrors real-world training patterns for many athletes and recreational exercisers who perform morning fasted workouts.

Why an odor might change how hard exercise feels: neural and psychological pathways

Smell operates through an unusually direct route to brain regions that govern emotion, memory and reward. Olfactory input bypasses the thalamus and projects directly to the limbic system, including the amygdala and hippocampus, and to reward-related structures such as the ventral striatum. That anatomical shortcut gives odors outsized influence on mood, motivation and appetite.

Two plausible mechanisms explain the study’s pattern of results: reward activation and altered perception of effort.

  • Reward activation: The scent of high-cocoa dark chocolate likely engages neural circuits associated with food reward. That activation produces a subjective sense of reward or anticipation that can be physiologically activating—elevating dopamine signaling and shifting attention away from fatigue. When the brain perceives an immediate reward or anticipatory pleasure, it can raise the tolerance for effort, enabling a person to do more without feeling they are working harder.
  • Altered perception of effort: Central processing of effort—often measured as ratings of perceived exertion (RPE)—is influenced by cognitive and emotional states. External cues that reduce stress, enhance mood or provide expectancy for performance can lower perceived exertion. The study’s participants reported no increase in exertion despite higher output, implying the chocolate scent affected central perceptions rather than muscle physiology.

These mechanisms are complementary. An odor that triggers reward pathways may make the workout feel intrinsically more enjoyable or less aversive, which then lowers RPE and extends capacity for repetition. Short inhalations between sets might serve as micro-rewards that refresh motivation just enough to allow extra repetitions.

Existing literature supports olfaction’s behavioral sway. Prior studies associate peppermint and ammonia odors with transient improvements in alertness and short-term performance, and aroma-based appetite modulation has been shown in other contexts. The new chocolate experiment adds a sport-specific data point with measurable performance outcomes and appetite changes under fasted conditions.

The role of fasting: why hunger status matters

The trial required participants to fast for at least 10 hours before exercising. That factor shaped both baseline hunger and the potential for olfactory cues to influence appetite and performance.

When fasting elevates hunger signals—hormones like ghrelin rise and subjective appetite increases—olfactory input becomes more salient. An appealing food odor can function as a signal of impending reward, altering immediate behavior. In the chocolate study, dark-cocoa aroma reduced hunger and increased fullness when participants were already physiologically primed to feel hungry. The suppression of appetite likely contributed to the improved performance: reduced pre-exercise distraction from hunger gives attention back to the task, increasing the capacity for repetitions.

Real-world training regimes often include fasted workouts, especially among athletes who train before breakfast or individuals following intermittent fasting for weight management. In those situations, a scent-based intervention that blunts hunger without calories might be attractive. The effect may be less pronounced, or different, in fed individuals whose appetite signals are already attenuated.

Why dark chocolate outperformed milk chocolate

The study compared a high-cocoa dark chocolate smell (90% cocoa) with a 60% cocoa milk chocolate scent and a placebo. Results favored the 90% dark aroma on both performance and appetite suppression; the 60% aroma produced moderate performance gains but no appetite suppression, even though participants rated the milk-chocolate scent as more pleasant.

Several factors likely explain this divergence:

  • Odor profile and familiarity: Higher cocoa content produces a more bitter, intense profile with less sweetness. That complexity may map onto stronger reward associations for some people, especially those who already appreciate dark chocolate. Familiarity with an odor and its association with a rewarding food influences the psychological effect. The study authors noted that an odor likely needs to be familiar and appealing—or at least not repulsive—to trigger the appetite and reward shifts needed to improve performance.
  • Learned associations: Dark chocolate carries cultural and personal associations with indulgence, luxury and energy. Those associations can prime anticipatory reward responses, increasing motivation and potentially reducing perceived effort.
  • Sensory-specific satiety: Sweet, highly palatable aromas can stimulate appetite in some contexts. Milk chocolate, rated as more pleasant, may have triggered appetite-related cues that offset any satiety effect. Dark chocolate’s more complex aroma may act differently on cephalic-phase responses, producing a satiety-like signal in the short term.

The discrepancy between pleasantness and effect underscores that the hedonic rating of a scent is not the only predictor of its impact. A smell can be liked yet fail to produce the psychobiological shifts necessary to alter performance or appetite.

How big is the performance effect, and how meaningful is it in practice?

Quantitatively, adding roughly 18 repetitions over a session at 80% 1RM represents a notable increase in volume for hypertrophy-focused training or conditioning sets. When translated into training load, that additional volume could accelerate strength or muscle endurance adaptations if applied consistently.

However, several practical caveats shape the effect’s significance:

  • Exercise specificity: The experiment used leg extensions, an isolated single-joint movement. Transferability to complex, multi-joint lifts such as squats, deadlifts or Olympic lifts—which involve motor coordination, bilateral balance and central nervous system demand—remains untested. Gains observed in an isolated machine movement may not scale to compound lifts.
  • Acute versus chronic: The study measured an immediate, within-session boost. Whether repeated use of a chocolate scent yields long-term training benefits—through increased cumulative volume, enhanced adherence, or altered appetite management—requires longitudinal trials.
  • Population tested: Participants were 23 young men. Women, older adults, beginners, and elite athletes may respond differently because of hormonal differences, olfactory sensitivity, and training status.

Viewed conservatively, the effect size is meaningful enough to warrant practical experimentation, particularly for fasted gym sessions and for athletes seeking non-pharmacological aids to performance. It should not, however, be treated as a replacement for established training principles or nutritional strategies.

Appetite suppression: mechanisms and implications for weight management

Dark-chocolate scent reduced hunger and increased fullness in fasted participants. That immediate appetite modulation points to olfaction’s role in cephalic-phase responses—the early-phase neural and hormonal changes triggered by sensory exposure to food.

Potential mechanisms include:

  • Cortical expectation: Smelling chocolate creates an expectation of food intake. When the brain anticipates imminent caloric reward, it may activate short-term satiety mechanisms that temporarily reduce hunger sensations.
  • Hormonal signaling: Olfactory stimulation can modulate hormones linked to appetite, such as ghrelin and insulin, although this study did not measure those biomarkers. Future trials should include hormonal panels to confirm physiological correlates.
  • Attention allocation: Hunger partly reflects attention to internal cues. A scent that triggers reward or fullness alters attention away from hunger sensations, effectively reducing subjective appetite.

Practical implications reach beyond performance. For people using time-restricted eating or intermittent fasting for weight control, an aroma intervention could reduce temptation during the fasting window. In structured weight-loss programs, scent strategies might complement behavioral approaches by reducing pre-meal hunger spikes that lead to overeating.

Safety and ethical considerations matter. Relying on scent to suppress appetite does not address nutritional adequacy and could encourage training in a chronically underfed state, which carries metabolic and recovery-related risks. Approaches must be integrated into an overall nutrition strategy that ensures energy and macro- and micronutrient needs are met.

Olfactory-based strategies in sports: precedents and contrasts

Sport and exercise science have long explored non-ingested ergogenic aids. Caffeine, nitrates, creatine, and blood flow restriction are familiar examples. Less familiar but increasingly studied are inhalation-based interventions.

Precedents include:

  • Ammonia inhalants: Used by some strength athletes to increase arousal before maximal lifts. Ammonia stimulates trigeminal nerve receptors and produces an intense alerting response. It is mainly used for very short-term arousal in maximal lifts, and its safety and efficacy remain debated.
  • Peppermint aroma: Small studies link peppermint scent to improvements in short-term exercise performance and alertness. Effects vary by protocol, and mechanisms may include central nervous system stimulation and perceived freshness.
  • Aromatherapy research: A broader evidence base from aromatherapy shows that certain odors can alter mood, stress and appetite. The degree of impact depends on concentration, familiarity, context and individual differences.

Chocolate’s potential advantage is its universal familiarity and strong reward associations. Unlike abrasive inhalants, it carries hedonic appeal and may be more acceptable in training environments. Commercial opportunities include scent diffusers in training facilities, scented inhalers for home use, and productized sachets or patches. Those applications require rigorous safety testing, regulatory clarity, and sensitivity to user preferences.

Limitations of the study and unanswered questions

The trial offers provocative results but comes with limitations that must guide cautious interpretation.

Sample size and demographics: Twenty-three male participants limit statistical power and generalizability. Responses among women, older adults, youth, and elite athletes remain unknown.

Exercise modality: Leg extensions isolate quadriceps. Effects on compound lifts, endurance modalities, and sport-specific tasks are untested.

Placebo control: The study used a placebo odor but details about its composition or masking effectiveness are limited in public summaries. The placebo’s plausibility affects expectancy and blinding.

Olfactory habituation: Repeated exposure to a scent reduces perceptual intensity and potentially its psychological effects. The study examined short-term exposures; chronic use could attenuate benefits.

Concentration and delivery: Smelling from a jar for 30 seconds is a specific delivery method. How diffusion, room ventilation, and bottle concentration scale to gyms or competitions is unclear.

Physiological markers: The trial measured subjective hunger and repetitions but did not report biomarkers such as dopamine, ghrelin, cortisol or lactate. Objective physiological correlates would illuminate biological mechanisms.

External validity: Lab conditions differ from real training environments where multiple sensory cues, social factors and nutrition interact. Field trials in gyms and sports contexts are necessary.

Dose-response relationships: The study compared two cocoa concentrations. Additional work should test a wider range of odors, exposure durations and timing (before workout, between sets, after sets) to map optimal protocols.

These limitations do not negate the findings; they define the scope of current evidence and point the way for follow-up studies.

Practical guidance: how to test chocolate scent in your training safely and effectively

Athletes and recreational lifters interested in trying a chocolate-scent strategy should approach it as an experimental adjunct—not a substitute for nutrition, sleep, or sound programming. The following steps translate study conditions into a practical, low-risk trial you can conduct at the gym or home.

  1. Choose the scent: Start with a high-cocoa dark-chocolate aroma, around 80–90% cocoa if available. The study found stronger effects with the 90% scent.
  2. Use small, controlled inhalations: In the trial, participants inhaled from a jar for 30 seconds between sets. Try a single 20–30 second inhalation between hard sets when you train at 70–85% 1RM.
  3. Maintain hygiene: Do not share inhalation devices mouth-to-mouth. Use personal inhalers, scented cotton pads in sealed containers, or single-use sachets to avoid contamination.
  4. Monitor effects: Keep a training log. Track repetitions performed, perceived exertion, mood, and hunger before and after workouts. Compare sessions with scent exposure to baseline sessions without scent.
  5. Avoid overuse: Olfactory habituation reduces sensitivity. Use the scent selectively for key sessions or phases rather than every workout to preserve responsiveness.
  6. Combine intelligently: Do not replace pre-workout nutrition when performance demands calories for intensity and recovery. Use scent as a complement to established fueling and supplementation strategies.
  7. Respect preferences and allergies: Scent perception is individual. If a chocolate aroma triggers nausea, headaches, or allergic reactions, discontinue use.
  8. Consider timing: The study involved fasted participants. If you train fed, effects may differ. Test both contexts to see what works for you.

These steps provide a low-cost, low-risk way to evaluate whether chocolate scent offers a personal training advantage.

Safety, ethics and commercial considerations

Introducing scent into shared spaces raises practical and ethical concerns. Facilities considering chocolate scenting should weigh benefits against potential downsides.

Indoor air quality: Diffusion requires proper ventilation. Concentrated essential oils and fragrances can aggravate asthma, migraine and chemical sensitivities. Use scenting systems with controlled outputs and place dispensers away from high-traffic breathing zones.

Consent and comfort: Not every gym-goer appreciates ambient scents. Facilities should solicit member feedback before wide-scale deployment and ensure scenting is not intrusive.

Labeling and disclosure: Consumers and athletes have a right to know the substances used around them. Facilities should disclose scent ingredients and provide scent-free zones.

Commercial product claims: Companies creating scented performance products must avoid exaggerated claims. Marketers should accurately describe evidence and conduct third-party testing.

Anti-doping: Smell-based interventions are non-pharmacological and currently outside anti-doping frameworks. However, sport governing bodies could in theory consider regulations if scenting were shown to meaningfully alter competition outcomes.

Legal and safety compliance: Manufacturers must adhere to consumer safety and labeling regulations for fragrances and inhalable products. Consultation with occupational hygienists and allergists is prudent.

Ethical deployment balances potential performance gains with respect for member health and comfort.

What follow-up studies are needed to build the evidence base

The chocolate-scent trial opens multiple avenues for research. The most useful next steps include:

  • Larger, diverse samples: Replicate the experiment with larger cohorts that include women, older adults, and athletes at varying levels of training.
  • Different exercise types: Test effects on compound lifts, sprint intervals, aerobic endurance tasks and sport-specific skill execution.
  • Biomarker measurement: Add hormonal and neurochemical assays (ghrelin, leptin, cortisol, dopamine proxies) and neuroimaging to track brain responses to odor exposure.
  • Field trials: Evaluate scent interventions in real-world gym and competition settings to test external validity.
  • Dose and timing: Map the dose-response curve for odor concentration and exposure timing (pre-exercise, between sets, post-set).
  • Comparative odors: Compare chocolate with other odors known to affect alertness (peppermint, citrus) and with neutral controls matched for pleasantness.
  • Longitudinal training studies: Examine whether short-term increases in repetitions translate into chronic gains in strength, hypertrophy and performance.
  • Sensory habituation: Study how repeated exposure over weeks affects responsiveness and whether alternating scents preserves efficacy.

Such trials will determine whether chocolate scent belongs in the toolkit of evidence-based performance strategies or remains an intriguing but marginal lab finding.

Real-world examples and hypothetical applications

Potential applications span individual athletes to commercial facilities.

  • Fasted strength training: Morning weight-training clients who prefer to workout before breakfast could use a short dark-chocolate inhalation between sets to blunt pre-exercise hunger and eke out additional repetitions.
  • Pre-competition arousal: Strength athletes seeking an acute arousal boost before heavy sets might inhale a dark-chocolate aroma during warm-up to increase motivation without stimulant side effects.
  • Weight management programs: Clinics or digital coaching programs could explore scent-based interventions as short-term tools to reduce fasting-window hunger and improve adherence to time-restricted eating.
  • Spa and fitness centers: High-end gyms could test scenting in small zones—offering members optional scent inhalers for high-intensity classes—while ensuring opt-in and allergy safeguards.
  • Commercial product development: Manufacturers might design personal inhaler sticks with a calibrated dark-chocolate aroma for pre-exercise use. Such products would need safety testing and clear instructions on use frequency.

Each application requires structured evaluation. Large-scale deployment before confirming broader effectiveness would be premature.

Practical limitations and warnings for end users

Aromatherapy-based performance strategies are not panaceas. Users should remember the following:

  • Not a substitute for nutrition: Scent does not supply calories, amino acids, or micronutrients essential for performance and recovery.
  • Variable individual response: Genetic differences in olfactory receptors and prior experience will create inconsistent responses across people.
  • Potential for masking underlying issues: Reduced hunger during a fasted workout might mask inadequate fueling over time, increasing injury and overtraining risk.
  • Health risks for sensitive individuals: Asthma sufferers and people prone to migraines should avoid concentrated fragrances.
  • Regulatory status and quality control: Consumer fragrances vary widely in purity and additive content; select products from reputable manufacturers.
  • Psychological reliance: Overreliance on a scent as a performance crutch may reduce confidence when the scent is not available.

These cautions underscore the need for measured, informed experimentation and for combining scent strategies with evidence-based training and nutrition.

How coaches and sports scientists should interpret the finding

Coaches and sports scientists should add scent-based interventions to the list of low-risk, low-cost experimental strategies that can be individually tested. The evidence supports acute effects in a controlled lab setting under specific conditions—fasted, young male participants, isolated leg-extension exercise, and short inhalations. It does not justify universal adoption.

Best practice advice for practitioners:

  • Use as an adjunct: Trial scenting with clients who express interest, documenting performance metrics and subjective responses.
  • Track outcomes: Require objective recording (reps, load, RPE) across multiple sessions to determine whether benefits are reproducible and meaningful.
  • Consider individual differences: Allow clients to select or decline scent interventions, and test different aromas to find what works for them.
  • Prioritize safety and consent: Avoid ambient scenting of shared spaces; use personal inhalers or sachets.
  • Collaborate with researchers: When possible, partner with academic groups to run controlled field studies that build generalizable evidence.

Coaches who integrate scent work responsibly can offer clients an additional tool while contributing to the evidence base.

Looking beyond chocolate: what other odors might work?

Study authors suggested chocolate is unlikely to be unique; rather, odors that are familiar and associated with reward may trigger similar psychobiological effects. Candidates include:

  • Peppermint: Prior small studies link it with alertness and short-term performance improvements.
  • Coffee: Familiar and associated with arousal; odor may alter perceived alertness though interaction with caffeine consumption complicates effects.
  • Citrus: Often reported to increase perceived energy and mood; evidence is mixed.
  • Personalized scents: Odors tied to positive memories or motivators—family, celebrations, personal rituals—could act as individualized rewards.

Selecting an odor requires considering familiarity, hedonic value, and cultural context. A scent that motivates one person may repel another, which is why personalization and testing matter.

The bigger picture: integrating sensory cues into performance programming

Scent-based strategies occupy a wider, interdisciplinary space that blends exercise physiology, psychology, and sensory neuroscience. They represent part of a non-pharmacological toolkit that includes music, visualization, and motivational coaching. Each of these elements alters perception and motivation through distinct pathways.

Strategically integrating sensory cues means:

  • Matching cues to goals: Use energizing scents for arousal, calming scents for recovery, and reward-associated scents during demanding sets.
  • Timing interventions: Micro-interventions—short, targeted exposures—appear more effective than constant background scenting.
  • Personalization: Build cues into rituals that reinforce adherence and performance, such as a pre-set inhalation routine before maximal attempts.
  • Measuring outcomes: Treat sensory additions as testable variables within training blocks, not as one-off magic solutions.

This integrative approach treats sensory cues as tools that complement, rather than replace, proven methods.

Summary of practical takeaways

  • A short inhalation of 90% dark-chocolate scent between sets increased repetitions substantially in a small trial of fasted young men, without raising perceived exertion.
  • Dark chocolate aroma also suppressed hunger pre-exercise; milk chocolate enhanced pleasantness but not appetite suppression.
  • The result suggests olfactory-triggered reward and altered perception of effort as likely mechanisms.
  • Real-world application requires careful testing, hygiene, and sensitivity to allergies and preferences. The strategy should augment, not replace, nutrition and training fundamentals.
  • Larger, more diverse and longer-term studies are needed to establish generalizability and to map mechanisms.

FAQ

Q: Can I start using chocolate scent during all my workouts? A: Use it selectively. The study examined short inhalations between sets in fasted young men. Frequent use may lead to habituation and reduced effect. Test the scent during specific sessions and monitor performance and appetite.

Q: Will the scent work if I’m not fasting? A: Effects may be smaller in fed states. The trial tested fasted participants, who have higher baseline hunger and may be more sensitive to odor-induced appetite changes.

Q: Does any chocolate scent work, or must it be 90% cocoa? A: The 90% dark-cocoa scent produced the largest gains; the 60% milk-chocolate scent produced smaller gains and did not suppress appetite. Personal preferences and familiarity matter, so some users might respond to different cocoa concentrations.

Q: Is smelling chocolate safe? A: For most people, brief inhalation of chocolate aroma is low-risk. Individuals with asthma, severe allergies, or fragrance sensitivities should avoid concentrated scents. Avoid sharing inhalers to prevent infection.

Q: Can scent replace pre-workout nutrition or supplements like caffeine? A: No. Scent does not supply calories or the physiological effects of ergogenic supplements. Use scent as an adjunct to, not a replacement for, proper fueling and scientifically supported supplements.

Q: Will this help competitive athletes in sanctioned events? A: Current evidence supports acute, small-scale effects in training conditions. Regulation and fairness considerations vary by sport. Scent use is not currently regulated as a doping method, but its competitive impact remains to be fully evaluated.

Q: How should gyms implement scent strategies? A: Prefer personal inhalers or sealed sachets over ambient diffusers. Solicit member consent, provide scent-free areas, and consult medical staff regarding air quality and allergen risk.

Q: What research should I watch for next? A: Look for larger replication studies including women and varied ages, trials testing compound lifts and endurance activities, and experiments measuring hormonal and neural biomarkers to clarify mechanisms.

Q: Are other odors likely to provide similar benefits? A: Odors with strong reward associations and familiarity may produce comparable effects. Peppermint, coffee and personalized motivational scents are plausible candidates but require testing under similar protocols.

Q: How can I test this for myself responsibly? A: Acquire a personal dark-chocolate aroma inhaler or sealed sachet, use a 20–30 second inhalation between sets during a repeatable workout protocol, and keep a detailed log of reps, RPE and appetite. Compare multiple sessions to detect consistent effects. Discontinue if you experience adverse reactions.

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