Why Acne & Eczema Could Be Signs of a More Serious Health Issue | Dr. Mark Hyman

Coming up on this episode of the Doctor's Pharmacy. A leaky gut also impairs the absorption of really important nutrients that you need for healthy skin, like vitamin A, vitamin D and E, vitamin K and zinc. And the main driver of skin conditions is inflammation, right? So it's all connected. If you're a long time listener, you might know that I've been drinking AG1 for a while now. I gave it a try one day and noticed right away how easy it is to drink and how much better it made me feel, unlike a routine involving multiple pills and powders, which can be inconvenient and hard to maintain. AG1 makes it easy. Just adding one scoop to a glass of water each day gives you what you would normally get from multiple individual supplements and provides comprehensive support for your brain, gut, and immune systems. I trust AG1 because they take a methodical approach to science. Their formula isn't just backed by studies, but over 14 years of innovation. AG1 isn't about quick fixes, but about a nutrient-dense blend that complements a healthy diet. They've even conducted third-party, double-blind, placebo-controlled studies so when you're drinking AG1, you know you're getting a product that's been thoroughly vetted and by experts. Try AG1 and get a free one-year supply of vitamin D3, K2, and five AG1 travel packs with your first purchase at drinkag1.com slash Hyman. That's D-R-N-K-A-G1-Number1.com slash Hyman. Check it out today. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hymen Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products. Welcome to the Doctor's Pharmacy and another edition of Health Bites. Hi, I'm Dr. Mark Hyman. Today we're peeling back the layers literally and figuratively on what your skin reveals about your health. It's often where underlying health issues become visible and most people don't realize that skin health comes from the inside out and can't be fixed by expensive lotions and potions. They may be helpful, but not if you don't get the foundations right. Did you know that your skin is not just a protective shell? It's actually your body's largest organ making up about 10% of your total body weight. Your skin says a lot about your overall health and it's like a window revealing what's going on beneath the surface. There's a lot of common skin problems, things like acne, psoriasis, eczema, and rosacea, and they're not just bad luck or random or just some unfortunate occurrence. They're signals from your body that something deeper needs attention. In functional medicine, we're in the business of the medicine of why. We ask why is this happening? Not what disease you have, but why now conventional medicine focuses on what? What's the diagnosis? What's the disease? And what do you need to give to fix it? What disease, what drug? It could be steroids or topical agents that sometimes might be necessary, but mostly can be avoided with diet and lifestyle changes. And of course you can avoid their troubling side effects that sometimes come from the treatments. So if you're struggling with different skin issues like acne, rosacea, eczema, psoriasis, and you're curious about what they might be telling you about your internal health, what's going on inside your body. I want you to stay tuned to this podcast because we're about to uncover how the best skin care starts from within and why understanding the why behind your skin's condition is the key to achieving lasting and radiant health. Here's the deal. The doctor often will say, okay, you have dry, scaly, itchy white patches on your skin. I know why you have those. It's because you have psoriasis. Well, psoriasis is just a name that we give to people who have those symptoms. It doesn't tell you about the cause. And psoriasis can have multiple causes. We're gonna go down and dig deep into that and you have to treat the right cause or patient won't get better. Now in functional medicine, we wanna understand the full picture by looking at all the relevant signs and symptoms and your medical history. And we do a bunch of diagnostic tests to help figure out what's going on at the root of the problem. And we then address the root causes by optimizing nutrition, healing your gut, removing toxins, optimizing your nutritional status for the right supplements, getting the root cause. And you're going to learn that the root causes today are not the same for each individual with exactly the same diagnosis. If you have 10 people with eczema or 10 people with psoriasis, they may each have different causes and need different treatments. And not just a one size fits all prescription, which is what we get in traditional medicine. In fact, no two people have the same cause for the same skin condition. The good news is there's a lot you can do to optimize your skin health from the inside out. I always say beauty comes from the inside out, not the outside in. Now, the inside out approach to skincare doesn't just mask the problems, it addresses the root causes. I mean, if you have terrible skin, you can put a lot of makeup on, but that doesn't fix your skin, right? Now, if you've got a lot of inflammatory stuff, you can put a bunch of steroids on your skin, but that's not going to get rid of the cause. And I'm going to share a case with you in a little bit, but it's pretty impressive. Functional medicine is really about addressing the root causes. And the side effect is that the rest of your health gets better too. It's kind of a good side effect. What's the conventional medicine approach to inflammatory skin issues? Well, it's not taking care of all these issues. You get to a dermatologist, right? And most of these treatments are aimed at reducing inflammation or suppressing the immune system to help calm symptoms, but they don't address the root cause of the inflammation. So for acne, what I'll do, I'll give you benzoyl peroxide, which is a topical treatment to kill bacteria, use retinoids like Retin-A or Accutane to reduce inflammation. They give you antibiotics, which may change the gut flora, like erythromycin, clindamycin, which can be problematic and really cause more long-term problems. And one of the stories I often see is when kids are in their teenage years, they'll often get antibiotics for years for acne. Later on, they'll have secondary effects, even if they've stopped the antibiotics. from the damage they've done to their gut, which then causes leaky gut, dysbiosis, and that leads to autoimmune diseases. So it's often a common story to sort of start out with gut issues, skin issues, get antibiotics, and then get autoimmune disease. We'll also do a lot of hormonal treatments with oral pills like birth control pill. They use something called spironolactone, which is often regulating testosterone that contributes to acne. There's side effects from these. You can get burning, dryness, irritated skin, flaky skin, gut so not a great idea for a lot of these drugs. What about eczema? How did doctors treat that? Well, they use steroids, topical steroids, immune suppressants, biologics, which are very serious, they're very expensive and suppress your immune system. They'll use antihistamines, moisturizers, emollients, all that stuff is fine. They use UV therapy, phototherapy, which is fine, but it doesn't really deal with the cause. What about psoriasis? What do they treat that with? Well, again, steroids, immune suppressants like methotrexate. Cyclosporine, Biologics, these TNF-alpha inhibitors, interleukin inhibitors, PD inhibitors, PD-4 inhibitors, and they don't really cure the problem, they just manage it. What about rosacea? Well, again, they'll use antibiotic treatment, anti-inflammatory creams, they'll use metronidazole, as I mentioned, or flagyl, tetracycline, but again, they don't deal with the cause. So how do I think about treating skin issues using the model of functional medicine? Well, the way I handle these skin issues is basically the same way I deal with anything else. Get to the root cause, right? Identify the imbalance, I address the cause. It's usually diet and lifestyle. Help the body repair, regain balance, fix the gut, get rid of toxins, balance hormones. It's basically following the functional medicine foundational principles of how you treat somebody. And then the body's natural intelligence basically takes care of the rest. If you're working with a functional medicine doctor, or you come see us at the UltraWellness Center, we'll take care of you. It's important to start with comprehensive lab testing to look at the root cause. Like we mentioned, for example, the fungal overgrowth or bacterial overgrowth or deficiencies in nutrients or increase in risk of thyroid issues with certain problems or other factors like gluten, which may be tested on lab testing. So you need to kind of look at these things, heavy metals. Now, sometimes you may not need them, but probably you mostly need to figure out what's going on. And the other thing I look at are some of these sort of specialty tests like food sensitivity testing, allergy testing, testing the stool microbiome, testing for bacterial overgrowth. We'll call it SIBO test, which looks at methane, hydrogen, and sulfide in the gut. We look at food sensitivities with Cyrex testing. We'll look at H. Pylori if you have rosacea through either a breath test, stool test, or even antibodies. We'll do food allergy, IgE profiles, and you can really look at a lot of this stuff. Now, I co-founded a company called Function Health to help you identify stuff, and there's ways you can check for indoor and outdoor allergies on that with IgG testing. You can look at a celiac panel and you can go to an independent lab, but you need to find someone who's gonna work with you to do this or you can be autonomous and do it on your own and checks gluten and food allergies and nutritional deficiencies. Many things I talked about thyroid, omega-3s, heavy metals, insulin resistance, all these things are in the basic function health initial set of tests that you get when you're a member. Then you can go to functionhealth.com/mark. There's a lot of people on the waiting list, but that allows you to jump the waiting list of 200,000 people. and it'll help you get those tests at a very reasonable cost, including hormones that we're gonna talk about. So, what else you need to test? Well, hormones, testosterone and other hormones like dihydrotestosterone, androstenedione, IGF, stress hormones like cortisol, toxins like lead and mercury, looking at your white count, whether you have high levels of neutrophils or lymphocytes, eosinophils can tell you a lot about what's going on with your gut microbiome, with what's reacting in your body. We look at nutritional deficiencies like omega-3, zinc, iron, vitamin D, magnesium, all part of the panel. We look at your metabolic health like insulin glucose. So basically you get a full assessment of what's going on. And most people are pretty surprised by what they find because people have stuff. If you don't look, you won't find it. There's a long time between often diagnosis and the onset of problems because doctors don't look. So what do you do if you want to treat this? How do you approach this? And how do I think about this as a functional medicine doctor? Well, the first step is to get rid of the bad stuff and put in the good stuff. That's basically all functional medicine is. It's being a detective, find all the bad stuff, right? Gut issues, food sensitivities, toxins, hormonal dysregulation, whatever, get rid of it, and then add in the good stuff, the right food, nutrients, et cetera. So the first thing is to get rid of the foods that potentially can be triggering inflammation in the skin. The most common cause is food. So I would try an elimination diet, and that's usually three or four weeks. and you get rid of the most common allergens and the potential triggers including dairy, gluten, soy, eggs, peanuts, tree nuts, shellfish, corn, processed food, sugar, caffeine, alcohol, nitrates. Now, you can do a more limited one. It's a little easier. I call it the 10-day detox diet. You can have eggs in that and nuts, but it takes out most of the grains and dairy, gluten, all the ultra-processed food, and it usually works for most people. So you can check that out, 10-day detox diet. is the book and lots of resource on that. What you can eat though is as important as what you don't eat, right? You need lots of anti-inflammatory foods, whole unprocessed foods, veggies, fruit, nuts, seeds, good quality protein, healthy fats, some gluten-free grains might be helpful. The second phase is the reintroduction and you want to do it slowly, one food at a time every three days, no more. For example, eat dairy for three days and see if you react and then eat gluten for three days and see if you react. you don't want to add everything back at once by going and have a pizza, which is going to cause a problem because you don't want to know what's what. And then you might feel like crap and don't know what was causing it. The challenge phase is after you've identified food reactions, you can actually sort of wait a little longer, maybe another few months, try to heal your gut, and then try to rechallenge your body to see how much you can tolerate. And if you're really having a reaction, like if you have dairy and you get eczema, well, just don't eat it, right? You're not going to be able to eat it. or you might try sheep or goat. So that'll really help you identify what's working. Now there's some tests that you can use to help track which foods are reacting, but almost the gold standard is what we call elimination provocation testing. And that'll allow you to know which to take in your back in your diet and which to keep away. I had one patient who was really quite amazing. She was a young woman in her 30s who was literally allergic to her boyfriend because of his sweat. And she would have these horrible rashes all the time anyway. Her face was all red, she had itching everywhere, she was reacting to everything. And it was really horrible that she was struggling so much. And so when I said, just do an elimination diet, let's get your gut sorted, give her probiotics, give her zinc, give her fish oil, give her vitamin D, give her good resources to help sort of heal her gut, and see what happens. And it was quite amazing. She basically quit all the inflammatory foods. She got off gluten and dairy, sugar, She went on the 10 day detox diet. She had a complete resolution of her symptoms and she has no more reactions and she's doing great. So the body can't heal. First thing you have to do is quit all the bad foods, right? Get rid of not just the food sensitivities, but all the inflammatory foods, all the ultra processed food. Gluten and dairy are like the number one and two culprits when it comes to inflammation in the diet. Of course, besides sugar, refined sugar, flour, all that stuff is really bad. All the inflammatory fats, refined oils we eat. You might be eating a low glycemic nutrient dense, whole foods, anti-inflammatory diet. I jokingly call it the Pegan diet. And what does that do? Well, it balances your blood sugar. It's higher in protein and micronutrients, phytochemicals, fiber, good fats, right? That helps you balance your blood sugar and your hormones so you don't get all the hormonal surges, you don't get the high androgens, it helps reduce inflammation in your body in general, and it makes your skin look better and makes you younger looking, right? And it also provides a lot of the essential nutrients we need for skin health. you also want a lot of polyphenols. These are really important. These are colorful plant compounds like phenolic acid, flavonoids, still being lignans, veratrol. These are just all these incredible medicines in food that help reduce inflammation and reduce oxidative stress. And a lot of the damage to skin is because of inflammation and oxidative stress. It helps repair damaged DNA and damaged lipids. It improves all your skin damage you might have had and reduces Skin Legions. It inhibits the growth. and the stimulation of T cells, which is good in psoriasis, and accelerates wound healing, which is awesome. These polyphenols can increase the benefit because they help decrease the expression of IgE receptors and we call toll-like receptors on mast cells. Mast cells are the cells that are releasing histamine that cause eczema. Mast cells are like the guards of the immune system. They help protect you from infections and allergies by releasing the things that you don't like, but they have a benefit like histamine. These mast cells have IgE and toll receptors that when they come into contact with an allergen like a pollen or pet dander or pathogen like some toxin, they cause them to release histamine and all these other inflammatory cytokines and nice itching. You've had a histamine reaction when you get a bug bite, for example. So if we decrease the expression of IgE and toll-like receptors on the mast cells, It helps prevent too many of these cells from releasing histamine, and it makes you feel better with less allergy symptoms. Hey everyone, it's Dr. Mark. Sleep is the foundation of wellness and happiness, but when you're sleeping on a so-so mattress, getting deep restful sleep can be difficult. Thankfully, my friends at Ascensia have solved the problem of less than stellar mattresses. 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So the big question is how do you eat for better skin health? what are the skin supporting nutrients and where do you get them? Both phytochemicals and polyphenols and good fats and all the stuff we need, right? So there's a lot of these things we need. And I created a table for you and I'm going to put in the show notes that lists all the phytochemicals, where to find them, all the fats, where to find them, all the nutrients, where to find them in your food, and how to start adding foods in your diet that can gradually include a lot of the things that are necessary for reducing inflammation in your skin, for reducing oxidative stress, for providing the right fats to have healthy skin. So check out that table in the show notes. I think you're gonna get a lot of benefit from it. All right, so what else do you need to do besides focusing on eating skin supporting nutrients? Well, focus on your gut health. And what we do in what I do in functional medicine is double down on the gut. So I basically do an elimination diet. and anti-inflammatory diet. So it's basically an addition diet, right? I eliminate the bad stuff and add in the good foods. And then I focus on gut health as the next step for fixing the skin, which is so counterintuitive, right? Your dermatologist probably not talking to you about your digestive system or your gut symptoms. Oh, am I bloating? Oh, go see the gastroenterologist. Well, no, that's the problem, right? That's why you're having skin issues. So you have to treat the bacterial overgrowth, the fungal overgrowth, all that stuff, and you can use Herbal products, I use oregano for example. I'll use something called Candibactin AR and BR, which are great natural antimicrobials, both antifungals and antibacterials that help. You can get those on DrHyman.com. I have a supplement store. I've sourced the best quality products or you can maybe find them somewhere else but be careful of the source. And it's also important to repair the gut lining and there's a lot of things that help do that like bone broth, the amino acid and glutamine. different kinds of colostrum. I use SBI protect from Orthomolecular. That's a great product that helps support the gut healing. In fact, in a 12-week double-blind placebo-controlled trial published in Nutrition, patients with acne who consumed lactoferrin-enriched fermented milk, like colostrum, basically, they showed significant improvements in their acne symptoms compared to those who consumed fermented milk without the lactoferrin, which is beneficial compound from from colostrum. The Lactoferrin Group experienced a 38% reduction in inflammatory lesion count, a 23% reduction in total lesions, and a 20-point reduction in the acne grade, which is a way to categorize acne severity. That's pretty impressive. And even further, the sebum content went down by 31% in the Lactoferrin Group. So really, really awesome. Now, you want to eat prebiotic and probiotic-rich foods. those are important. You want to have the right bacteria. There's a lot of versions of these bacteria, but I'm just going to name a few. And we need a diverse array of bacteria to help support our gut health. I'm just going to name a few probiotics like Lactobacillus rhamnosus GG, Lactobacillus casei, Paracasei, Lactobacillus acidophilus, Bifidobacterium longum, Bifidobacterium lactis, Lactobacillus plantarum. So there's a lot of different strains, all of which are available in a multi strain probiotic that we use. I like seed, for example. They modulate the immune system and they help reduce inflammation. You can get them also from food, right? Fermented foods like yogurt, kefir, sauerkraut, kimchi, miso, tempeh, all great. And the probiotic supplements are in capsules, powders. I would encourage higher doses like 5 to 10 billion even more. And other supplements also important for your skin health. Vitamin D is essential, right? It helps maintain skin barrier function and immunity and helps regulate the cells. that produce keratin in the skin. It also is effective for improving psoriasis and eczema too. Quote, normal vitamin D in labs is said to be over 20 nanograms per deciliter. Some labs say 30, but it should be 45 or more. And that's not gonna be enough for psoriasis flares, and we really should aim for higher concentrations. In fact, higher levels of over 100 may not be harmful and actually are protective against psoriasis flare-ups, and more might be better. you have to watch your levels, make sure you don't get toxic. But anybody can take 5000 units a day. My favorite is vitamin D supreme from Designs for Health. You can take vitamin D3 from pure encapsulations. They have up to 10,000 a day from that can be helpful. But you have to test. You have to know what your levels are. Test before, test after a few months, get the dosing right. Vitamin A also really important. It promotes skin growth and renewal. particularly in the form of retinol. It helps regulate the production of sebum, the growth and shedding of your skin cells. It's really important for your gut lining integrity, prevent a leaky gut, and it's also essential for your immune system functioning. When you have enough vitamin A, it enhances turnover of your cells, allows the new cells to replace the old ones, and that leads to smoother and more even skin. That's why retin-A is used for, you know, wrinkles. A lot of food sources, retinol is the preformed version of vitamin A, which you can get from only animal foods like liver, it's the best source, fish, egg yolks. Carotenoids are a pro-vitamin A. They're not an active vitamin A. They can be converted into vitamin A, but some people don't do that well. But they're obviously in the orange and yellow vegetables, carrots, sweet potatoes, pumpkin, butternut squash, red bell peppers. They're also in leafy greens, spinach and kale. But the conversion rate from carotenoids to vitamin A is low, maybe anywhere from 8 to 60 something percent. People eat a lot of carrots or sweet potatoes can develop carotenemia, which can turn their skin an orange yellow color. I had that once. I decided to drink a lot of carrot juice at one point in my life, and all of a sudden my skin turned orange. I had to stop that. But that doesn't get converted to vitamin A as well. Now, you might want a supplement. You might actually need vitamin A as a supplement between 2,000 to 5,000 units a day. You don't want to take overdose of that. Cod liver oil is great. It's a good source of vitamin D, omega-3s, and even vitamin A. My favorite Omega-3 is really important because Omega-3s are so important for skin health. They make your hair lustrous, your skin nails strong, your skin clear and shiny and moisturized. And the one I like is Big Bold Health Omega-3 Rejuvenate. It's got extra anti-inflammatory compounds and it's really great for you. It's one I take every day. I usually do about 2000 milligrams a day, which is two capsules. Zinc Picolinate is really good for your skin too. Zinc is really important. You can do thorn zinc to colonate about 30 milligrams a day. If you have acne, you might need more up to 50 milligrams. Zinc can sometimes interfere with the absorption of other minerals like copper. So if you're taking zinc supplements for a long time, you might want to think about adding a little copper or have a multi that includes copper. What else is good for your skin? Well, there's something called evening primrose oil that has a very special fat called GLA. GLA can reduce inflammation. It helps different skin conditions like eczema, psoriasis and dermatitis. that helps your skin look great, helps elasticity and firmness, makes you look younger. You can get it from Evening Primrose Oil, from Hemp Oil, Spirulina Borage Oil. Actually, one of my tricks was there's a oil that contains both flax oil and borage oil. I think it's called Barlean's Omega Twin. When people have dry skin in the winter, I have them put it on their skin and it's amazing to clear everything up and make your skin look great. And what other nutrients are good for your skin? Well, selenium is important. about 55 to 2000 micrograms a day. I like selenomethionine. Vitamin C also important for collagen and inflammation is a great antioxidant. I like liposomal vitamin C from Designs for Health, about a thousand milligrams a day. Vitamin E also really important. It's great antioxidant. It helps skin healing, repair, moisturize your skin. My favorite is Metagenics E Complex. And it has a mixture of tocopherols, not just alpha tocopherol, which is the main one in most vitamin E's, but also Delta and Gamma, which are more anti-inflammatory and antioxidant. There's some herbs that can help like curcumin, designs for health, curcumin is great. Curcumin Veal, it's called curcumin Veal. 400 milligrams a day is great. And again, you can order these online, but you know, I also go where I curated the best products. And I did a lot of work on finding the best in the market, mostly who are physician grade. And you can go to drhyman.com to learn more about them and check it out. Proper hydration is really important. A lot of people are dehydrated. Often I encourage people to use electrolytes with their water at least a couple of times a day. Use half your weight in ounces of water per day. So if your weight is, let's say, 180 pounds, you need 90 ounces. Also, light is great for your skin, right? Ultraviolet B phototherapy is very good. It helps with different skin disorders like psoriasis and eczema. there's narrow and broadband and you want to be careful, it can burn the skin, but it reduces generally inflammation and helps the skin barrier and decreases the overgrowth of cells like hyperplasia, which is called overgrowth of cells, and it can do that for psoriasis. So UV phototherapy is really good for reducing the abnormal thickening of the skin and by targeting the hyperactive immune pathways for psoriasis. The UVB also helps promote healing and can normalize the skin's immune response and that can help the healing process and reduce the severity and frequency of flare-ups. But I would just say that if you don't deal with the other causes, you can do all the UBB you want, it's just gonna basically make you symptomatically a little better but won't get rid of the problem. And if you do want to do it, you can try it in conjunction with everything else, but I wouldn't just do it alone. And you probably could do it two or three times a week. And the frequency depends on how severe it is and your response and so forth. But basically start with a low dose and you gradually adjust the frequency, duration, intensity of the sessions based on your progress. Now, there are home units. You can get UVB, phototherapy at home through lamps, bulbs, handheld devices. You can get natural sunlight. It's free, hard to control the dose. But bottom line is your skin is a window to your overall health. And things like acne, rosacea, eczema, psoriasis, they're not just random annoyances. They're signals that something deeper is going on. and thanks for joining me on this journey to uncover what your skin is telling you about your health. If you have questions and want to dive deeper into these topics, I encourage you to explore my related content, which is linked in the show notes. True skin care starts from within by embracing an inside out approach to skin care, focusing on gut healing foods and tackling the root causes. You can unlock lasting radiant health and beautiful skin. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman. And we'll see you next time on the doctor's Pharmacy. For more information on today's episode, please check out my new video and audio podcast, Health hacks. It airs every Tuesday and includes a more detailed breakdown of these Friday Health bites episodes. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com/markspicks I promise I'll only email you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my health journey and I hope they'll help you too. Again, that's drhyman.com/markspicks. Thank you again and we'll see you next time on the Doctor's Pharmacy. This podcast is separate from my clinical Practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorse the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice our services. If you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com if you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database. 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