Dr. Teresa Diaz on Aging, Hormones, and the Importance of Pleasure

Bree Luck  0:00  
I decided to start the Pause to Go Podcast with a season on menopause because I have a lot of questions about this time of life. That means you should keep in mind that I am not an expert on perimenopause and menopause. So as you listen, remember, I'm inviting all kinds of real experts onto this show to give us a multi modal view of perimenopause and menopause. Please know that these conversations are reflecting a variety of opinions and are not meant as a substitute for medical or emotional care. Rather, they are to arm you with more information so that you can be better informed to seek the care you need when you need it. 

Today's conversation is with a truly remarkable human being. Dr. Teresa Diaz. Dr. Diaz has an undergraduate degree in psychology from San Francisco State, a medical degree from Rutgers University, and is an accomplished ob gyn surgeon. She's certified in age management medicine, a member of the Institute for Functional Medicine, and studied holistic nutrition at the Institute for Integrative Nutrition. She's also been through menopause, and she knows her stuff. But what sets Dr. Diaz apart from other doctors, is her incredible story. from growing up in the Bronx to attending medical school at age 35 to ditching it all and traveling the world. Dr. Diaz has a unique perspective on the aging process. And I hope you find her story as inspirational as I do. Enjoy. I am so happy to have you here today.

Dr. Diaz  1:52  
I'm delighted to hang out.

Bree Luck  1:54  
You are actually the first functional medicine doctor that I've been able to talk to about menopause. So I am just beyond delighted and so curious to hear what you have to say about this time of life. And I'd love to begin with a question that I'm asking all of the guests, which is how old are you? And where are you in relation to perimenopause and menopause?

Dr. Diaz  2:24  
Okay, so I am 62, about to be 63 in January, and I am in menopause. Technically, I have been on hormone therapy for 20 years. So I have not had to go through menopausal symptoms. Because I actually watched enough of my own patients do it that I was pretty clear. I didn't want to do it.

Bree Luck  2:51  
Mm hmm. And can you tell us well, I know that we're going to talk about hormones a little bit later. But what clued you in to it was it was time that you wanted to start with some hormone therapy?

Dr. Diaz  3:10  
Well, in my 40s, I started going through perimenopause. And being a gynecologist. I knew what that was. I knew that my ovarian function was starting to wax and wane. And so I started to bleed a lot more than I was used to bleeding during my periods. And I was having it more frequently. And at the time, I was a surgeon and sometimes in the operating room for six, seven hours, depending on the surgery, and I didn't want to be bleeding through my clothes. And so my first thing was to start with progesterone so that I could limit the amount of bleeding I was doing. Progesterone is what helped me do that. Because that's what was deficient. You know, at that time.

Bree Luck  3:54  
I think that one of the myths, certainly one of the myths that I held was that as we approach perimenopause, that our periods which is sort of gradually decline, like we would see just fewer and fewer periods, but hear from a lot of women that I've talked to that a lot of women are experiencing heavier and heavier periods, like you just described, 

Dr. Diaz  4:21  
Yes. And it's really disruptive like so it's a whole 10 year period where women's lives are disrupted by this intense bleeding. And sometimes I have even had to give women blood transfusions during that time. And then you know, oh my goodness, I'm on the progesterone. So really, I'm just replacing the deficiency that is happening during that perimenopausal time to ease that time. Yes. Which is what I do with myself because right the bleeding was too much and I didn't, I didn't want to become anemic

Bree Luck  4:52  
I'm asking all the questions I want to ask. So if you are on that hormone replacement therapy. Do you still have periods? Do you still have periods at 62?

Dr. Diaz  5:05  
No, no. Periods stopped when I started using hormones. Oh, so when I started because you know, I was bleeding heavily when I started using progesterone. I just decided to use enough not to have periods anymore because it was just fun not to have him wasn't like detrimental. So I just decided I'm taking hormones Why take a break just to bleed that I didn't really need to do that. So once I started hormones, I stopped having any periods. So I I don't know exactly when I actually shifted over into menopause, other than to test my own follicle stimulating hormone FSH. Uh huh. But when I got to about 50, I just decided to switch over into replacing my estrogen. And so it became progesterone and estrogen because the estrogen around once I go into menopause, the estrogen becomes deficient.

Bree Luck  5:57  
So this is a great time, I think to just do a quick medical review of what perimenopause is, and what menopause is. Can you walk us through that?

Dr. Diaz  6:11  
Yeah, so perimenopause happens when the ovaries start to atrophy. And it's really in the very beginning stages where the ovulation doesn't happen. So when that happens, we don't produce progesterone, we're not ovulating in the second half of our cycle, a 28 day cycle. So the second the last two weeks of that 28 day cycle, after we've ovulated and we should be producing progesterone. Right? So then if we don't ovulate, that progesterone doesn't get produced. And when we don't ovulate, our brain doesn't see those hormones, right. So it starts to try to stimulate the ovaries more producing more estrogen. So that's why they call it estrogen dominance. Because the estrogen can be normal or high, but the progesterone is low. So they call it estrogen dominance, because it's the dominating hormone in the system. So that's what the estrogen dominance is. So that's what happens in perimenopause. And that's when people will start to have symptoms, like anxiety, because progesterone dampens anxiety and even depression. The anxiety and the angst and the nervousness and jitters and all these things that women experienced in perimenopause is because the progesterone is becoming deficient, which is why I have an issue when doctors prescribe antidepressants to treat this. And they do that frequently, rather than going to the hormones -- because they don't know a lot about hormones in menopause. What happens is that now the the ovaries now stop ovulating. So the ovaries stop ovulating  then we become estrogen deficient as well.

Bree Luck  7:58  
 I mean, there's just so much our hormones do so much for us. I'm starting to really understand that and living in a world where our medical information has been dominated by understandings of men, right? Because for so long, women were not even included in medical studies, which just blows my mind.

Dr. Diaz  8:25  
Right? So there's a lot of mixed messaging around the effects. Well, actually, hormones are protective of our heart, you know, so there's a lot of mixed messaging and lots of misinformation I'm learning. But hormones actually are protective of our heart is protective of so many things. It's protective of our vaginal health, it's protective of our bones. It's protective of our skin elasticity, right? So hormones are so protective, which is why you know, everyone is like, wow, you're 62 my energy, it protects my energy, right? So like, I hear women, I feel so fatigued, and I feel hot flashes and you know, vaginal dryness, and I have low libido. And all of that is deficiency of these hormones.

Bree Luck  9:13  
And there are brain shifts that happen as our hormones fluctuate, too, right? I mean, that's a huge part of it.

it's Yeah, so they don't like what conventional medicine often doesn't recognize is that it isn't just about our uterus and our vaginas. It's also about our brains. It's also about our sugar metabolism. Another thing that people don't recognize even before perimenopause and menopause, is the effect our diets have on our hormone balance. So if we have insulin resistance, the whole polycystic ovaries is caused by insulin resistance, pre diabetes, right so if I have a woman walk in during the pre menopausal stagefrom like, you know, from our teens to early 40s and she's not ovulating regularly, then I know it's really about changing lifestyle and diet.

Can we change that lifestyle and diet at any point and see results? I ask this because I'll be really honest, I eat a pretty clean diet. Now I'm mostly plant based, but not solely plant based, because I do love fish and I love really good grass fed beef. That's just my, it's what I like. It's what I'm drawn to. It's what works for me. But I have to say, I feel like that from the age of 18 to 22, I lived off of jelly beans, and Twizzlers. And, and sometimes I wonder, did I do irreparable damage to myself? So for those of us who have not always been healthy, or have not always had a nutrition rich diet --

Dr. Diaz  11:05  
Yes, I love this is why I do menopause. Right?  I get women right around 40 to 50. And it's not just about hormones, obviously, you know, and although hormones is what brings women to me, I'm definitely about changing lifestyle. So I was 300 pounds in my 40s, in medical school, 300 pounds. So I did the gummy bears. And I mean,  I was studying non stop, and I had a six month old, right? And my  husband died during medical school. So it was a lot of stress. And, you know, I had grown up responding to stress with sugar. So I was at my maximum, I had also quit smoking, like probably, I don't know, I would say like 10 years prior. So all of that combination eventually led me to about 300 pounds. And so I had to take a look at my own diet, and I had to turn to functional medicine to begin to understand how I could be healthy. You know, I started to notice that probably 80% of people who walk into a hospital probably didn't have to walk into a hospital if they could change their lifestyle. And when that realization hit me, I was like, wow, I need to do that for me, too. I'm seeing that in my patients. And I'm seeing it at every age. The bird's eye view I have as a physician is that I see women at every age, from birth until they're 100 years old. And I see the outcome of what the 20 year old is doing. In my 80 year olds, I began to see the big picture in a way that you know, not everybody gets to see. And so I feel like I want to share what I'm seeing. Right, what I'm seeing is that 40s and 50s are a great time to turn around your lifestyle. And so, I think I've shared this with some menopausal women earlier this week, that in our 40s and 50s, not only do we lose our hormones, but all of a sudden the impact of the last 20 years of mistreatment of our body -- not on purpose it's the way we've been conditioned. We're conditioned to eat fast food. And we're conditioned to eat things that are processed and manmade and not natural. By the time we hit 40s. We thought we were getting away with it, but but it's catching up with us now. So it's a perfect time to work with women.

Bree Luck  13:36  
I do think it is a transformational time. So it's really wonderful to hear that on the medical side as well. Yeah, that there's hope.

Dr. Diaz  13:48  
Yes, there is. Right like I'm in I'm in my 60s I have, I probably have as much energy as I had in my 30s 

Bree Luck  13:54  
Thank you for sharing your story or giving us a little glimpse into your story of medical school and all that you went through in that time. Knowing that you've moved beyond it to a healthy place is truly inspirational. So you were in medical school. You were a practicing ob gyn?

Dr. Diaz  14:21  
Yes. Yes, yes. I went to medical school at 35 years old. And then I did ob gyn for about 12 years before I walked away from it and decided I didn't know what I was going to do when I first walked away. Honestly, I just took a break from it. I didn't know becoming a doctor was so energy draining. You know, I think I was working 120 hours a week when I was a resident and I had a family and it was just really difficult. It was pretty traumatic, that whole system but you know and then working in it as an attending physician.  I worked at Haven Hospital in Oakland, a city hospital -- county hospital, I learned a lot there.

Bree Luck  15:02  
I bet. 

Dr. Diaz  15:04  
I mean, you know, I come from the South Bronx of New York. So that's the group of people I felt like I could connect with easily. And why not, there's such a lack. And that's where I like to work anyway. So it was, it wasn't not a hard choice. But there's a lot of trauma and lots of things that, you know, I got to work with, drug and alcohol and domestic violence and lots of stuff that needs attention, you know, so and all of which affect our health and affect how we do our menopausal years, right? So these are all important things to take a look at and turn around. This is nothing I did overnight. It's been a journey from the time I left home at 19, right? And I've never stopped doing the journey and I'm still doing the journey, there's still things you know, that I have to adjust that I have to address another layer I have to work on.

Bree Luck  16:00  
I think that goes for all of us. I think it's a fallacy to feel like, at some point, we're fully baked,

Dr. Diaz  16:07  
right? Like there's some goal, you know? It's like, try to put your attention on the journey, like what is the journey I'm going through? How am I living my life today? How is what I'm doing today gonna get me to wherever I think I want to be tomorrow.

Unknown Speaker  16:26  
And that's the exciting part is that journey, I think about taking a vacation. It's really nice to sit on the beach and watch the waves and enjoy the sunshine and relax, no question about it. But also equally fun, and sometimes more fun is thinking about it, and planning for it. 

Dr. Diaz  16:48  
And absolutely, I've never thought of it that way. Yes, 

Bree Luck  16:51  
Dreaming about it, and making it come to fruition and feeling that satisfaction, I think of the little dopamine hit that I get when I buy the plane tickets. I was in a women's circle this weekend and an image that emerged in that circle is that of the snake shedding its skin and emerging from that and part of the snake wriggling out of the old skin is a recognition that old skin doesn't fit anymore. Yes. And so with that comes some natural discomfort. But it doesn't have to be painful, you are finding ways to take some of the agony out of this transition so that we can be aware. Oh, I'm I'm shifting, I need to make changes. Not need -- need is the wrong word. It's here's an opportunity to make some changes that can really serve me. And, and I know that menopausal hormone therapy is is part of that for you. You talked a little bit about the estrogen dominance and the lack of progesterone. But I think that there's a lot of confusing information out there about hormones. I mean, I'm terrified. I have a history of breast cancer in my family, a lot of women I know have similar situations. And I think on one hand, we're being told, oh, you can get hormones  to make you feel better. And on the other hand, we're told, don't take hormones because you'll get cancer. And on the other hand, we're told if you don't take hormones, you're going to get cancer. I know you probably don't have all the answers for that. But if you could just shed your perspective. I would love it.

Yes, yes. So let's do that. You know, before the 1990s it was pretty routine that doctors prescribed hormones for women. One of the issues with it is that it was not bioidentical hormones. It was pharmaceutical hormones that were changed. It was patentable, so things like Premarin and Prempro Medroxyprogesterone -- like these are all hormones that are not the same as what's in our body. And then what happened was they did a study -- WHI. You know, a lot of people may have heard that, but it's called the Women's Health Initiative, WHI and they tested hormone therapy, and they put out a lot of fears about breast cancer and stroke risk and maybe other kinds of cancers. You know, I'm trying to pinpoint all the different what I call myths out there about hormones, and there is actual evidence that if you use a bioidentical estrogen, estradiol. If you use bioidentical estradiol, you actually improve your breast cancer risk, and even breast cancer mortality. Right? So that's so contrary to what's out there in the myths, right? Well, all doctors know - well I shouldn't say all doctors know because I don't know. You know, when women have, they'll hear this when you have it a uterus still you haven't had a hysterectomy, then you should have progesterone. But if you've had a hysterectomy, you don't need progesterone, which is not true. That's another myth, right? Because progesterone protects many things. Also, it has added benefit in protecting against breast cancer. It also has added risk in protecting against osteoporosis, which estradiol also does. It protects you against osteoporosis. So it's really important to distinguish between bioidentical. And I think in places like the UK, they call it biological, or biology, identical, they call a little different because we've been going back and forth about that. But it's the same hormone that you have in your body, you want chemically the same hormone with nothing added nothing adjusted, no molecule that's twisted in a different direction. You want the same hormone that's in your body.

So do they, how do they make it the same hormone that's in your body?

Dr. Diaz  21:29  
No, they do they synthesize it. It is a synthesized hormone. But it just needs to be identical.

Bree Luck  21:37  
So does that vary from person to person, then?

Dr. Diaz  21:42  
Minimally, if any, I mean, minimally, if any, because you know, when you do a lab, you're testing for the same molecule, right? So this minimally,

Bree Luck  21:53  
I just wasn't sure if they were taking some kind of sample and then matching that sample. But it sounds like bio identical means generally bio identical to estradiol

Dr. Diaz  22:08  
in your system. So there are three estrogens. So this is another thing that's super important. And this is the reason why, no matter what I always test, I don't guess I test right? So if I'm treating somebody with hormones, I test them every six months, I won't renew them without testing them, because I want to stay out of the risk zones for one and I want to have the benefits right? So I don't want people being too over or under replaced.

Bree Luck  22:39  
So there are three different types of estrogen

Dr. Diaz  22:42  
estradiol, estrone, and estriol. So as to die off. Basically it's it's it's just slightly chemically different, right? So the active form of estrogen in the body estradiol, I mean and it's di all because it has two hydroxyl groups Oh h right. So it's di all right estrone has one at the end is one -- estrone is one hydroxy and estrial is three hydroxy --  three different estrogens that are in our body, the estrial is really a weak estrogen and you know, sometimes I measure it but oftentimes I don't even measure it because it's really weak and I don't really worry about the level of the estriol the estrone is  like a metabolite that the body needs to then clear in the liver -- which goes back to lifestyle because if we're not eating a clean lifestyle, our bodies get clogged up with toxins and we don't clear our estrogens because there's like a line going to the liver you know gets all banged up and it's crowded. You know, if you're drinking alcohol and if you're eating too much sugar, and you're creating oxidative stress in your body and you have a really high stress, lifestyle, all those things our body has has to clear and repair. And the liver is one of the major detox organs in our body. And so when we have estrone in our body, and we don't clear it through the normal channels because we don't have enough detox chemicals - one of the ways that I teach women is --  you want to make sure you have plenty of vegetables and I literally, I eat two pounds of vegetables at least a day. And and you know people said what two pounds of vegetables is a lot! And understand that we are so far veered off of a normal human diet that it appears a normal, unnatural, right? But it's very natural for us to graze on plant foods. So I eat at least two pounds of vegetables a day green vegetables with other things like carrots and beets and things. Because this not only is a great for our menopausal status, it's great for cancer prevention, which is what everybody's worried about, right? So it's great for cancer prevention. And even if you've had a cancer, the way you want to not get it is to change these lifestyle factors, especially what we're eating, 

Bree Luck  25:29  
if we have access to those vegetables, and access is an issue for a lot of people. Yeah. But if we do it is such a readily available -- if we have that access, it's so-- I hate to say easy, because it's not always easy to change habits. But it is. It is simple. It is a simple shift in theory. And it's funny because I have two teenage daughters. They're amazing. And I so that also means I have teenage girls coming in and out of my house all the time. And my poor husband. We're also all Leo's so you can just imagine the --

Dr. Diaz  26:15  
He probably  loves it. 

Bree Luck  26:17  
He loves it, he does love it. But a couple of years ago, I started putting out --  it was such a simple thing. And I just did it kind of as an experiment. I go through so many vegetables too. And I love vegetables. And I've grown to love them. Now I can't stand the fast food diet, it just tastes wrong, thank goodness. But I started putting out a big bowl of spinach, baby spinach, you know, it's still kind of sweet. And I would put out that bowl of spinach when they were coming home from school. And by dinner, that bowl of spinach is gone. They eat it like chips, they just grab a handful of spinach and go -- and it doesn't mean that they're not also eating snacky foods.  I know that they're not living off of Twizzlers, jelly beans and gummy bears. So anyway, I hear that two pounds of vegetables. And I do love that you have a variety that it's not just I mean, two pounds of spinach will be a lot that you also have beets and --

Dr. Diaz  27:28  
carrots and celery, like you know that the variety of vegetables. I was reading this somewhere, you should have 20 to 30 different types of vegetables in your diet on a regular basis.

Bree Luck  27:40  
Oh, that's a new challenge.

Dr. Diaz  27:44  
Right? So I started, you know, so I've been like, oh, let's see how many have I had today. So, you know, I've been doing a lot of work around cancer too, which is sort of new for me. And because of that research, I have been moving much more towards a plant based diet. And the thing that I'm going to say about you know, whether there's access to organic vegetables, I grew up in the South Bronx, okay, so  burnt down buildings, and, you know, chalk marks of somebody who got killed the night before in our school yard,  drugs and alcohol and etc, etc, right? But there's some mindset to staying and living in that environment. There's a certain mindset to it. And anyone can actually shift the mindset because there's a way in which there's a conditioning that we don't belong to the rest of the world is a conditioning that we're separate from other human beings, and we're not.  And so, for me to get up at 19, and just go venture the world. I mean, like, I couldn't have done what I've done if I just stayed in the South Bronx, right? So they had to open my mind. So what else is there besides what I've grown up with? I see things on TV that I don't see in my world, right? So I want to see what else there is out there.  And so it was an adventure, I didn't know where I would end up, I didn't even consider going to medical school till I was in my 30s -- that was not even on my radar at all. So I got there from a very, very different place from a very different path I took than many of the doctors that I have met. 

Bree Luck  29:22  
I think it's also a woman's way I love being a woman, let me just say that I love being a woman. And one of the many gifts that I see is that we have these clear biological shifts that require us to evolve. 

Dr. Diaz  29:37  
Yes, 

Bree Luck  29:38  
and we can rise to the challenge as you did at 19 and again at 35. And again recently when you move to functional medicine, that you do evolve and our bodies can remind us of that possibility and have that opportunity. So let's talk a little bit about your move from your hospital ob gyn life, then you left that and you took some time, and then you moved into functional medicine. And I'd love to, to hear more about what that is. And also, what's different about it that appeals to you.

Dr. Diaz  30:20  
So I would say the thing that got me to shift -- Oh, God, it was a lot of things. It was a combination of things that intersected all at once. I was not happy in my marriage because I had gotten remarried because I was pretty much struggling with a really young child when my husband died. So I got married a year later, which probably wasn't the greatest, but I did need help. And so that's that was the benefit. It was sort of a trade off. So I got married, and it was really not a good marriage. So I needed to leave my marriage. And I had this job that paid me a lot of money, more money than I had ever made. Probably was making like, close to $250,000 a year. I had a really nice house in Pleasanton, California. And I put the pool in I had, right and then guess who wanted to move in  -- my family, right? And I didn't have the boundaries to say no, you know, when I when I grew up in, in the way that I grew up, it was we shared everything like, you know, that's Yeah, you survived. We stayed connected. We shared we, you know, so when somebody says they want to move into my million dollar house, Okay, come on. I don't mean, forever, right. But why not? It was so good, right? And so before I knew it, I was paying so much money for the house for the pool upkeep for the grounds upkeep for the housekeeper -- because I'm not there, I got all these people but none of these people are doing this. And where did this go wrong, I don't even have enough money to travel and do the things I want to do. And here I am making all this money. And it didn't make a lot of sense. And my way of leaving it was to let the house go. It was right at the time, the whole housing bust was happening. So I ended up letting the house go so that everybody had to move out. There were seven people. And I only have one child. So everybody had to move out because I let the house go into foreclosure. I walked away from my job because my husband wanted to sue me for alimony and wanted to take half of my retirement. So I decided I would spend my retirement before we got through a divorce lawyer and I started just traveling with that money. And literally, it was awesome. I didn't know where I was going with all this. And at that point, I wasn't even sure I was gonna go back to medicine. I left my job. I didn't want to pay him alimony. I traveled.I smust have done like 17 cruises. All salsa dancing cruises and Soul Train cruises, you know, where I was just dancing and dating and doing whatever my heart desires for like five years. And I literally started driving Uber, when I ran out of money, I started driving, I wasn't sure that I was going to come back to medicine. And because I didn't know how to do it a different way. But I had gotten so much help from understanding functional medicine. And I kind of knew that maybe it's what I wanted to do before I left the hospital. But I really had no business experience. I didn't even know where to start or how to start. So it wasn't until probably 2018 that I actually opened an office, I paired up with a nurse practitioner who had a practice and I started doing hormone work and functional medicine. I'm still learning how to run a business. You know, I've been doing this now for three years. But the business part of this, and I'm still hiring people to teach me how to market and teach me how to keep a bank account. I need accountants and all these people that I've sort of learned not to trust. So I have again, mindset mindset mindset, right? I belong to the world. I belong to all humans. I don't just belong to New Yorkers, or Puerto Ricans or black folks or I don't just belong to I belong to everyone. We identify with these groups. And we think it's a way of belonging, but it's really a way of dis-belonging to other groups.

Bree Luck  34:07  
I just have to let that linger for a minute. I think it's really important to hear. I think it's really a difference between  being a member of a group and the dogma of a group or the limits of the conditioning of a group, right? 

Dr. Diaz  34:30  
yes. Right. Yep. So the more identities we take on the more variety of opinions I guess we get.

Bree Luck  34:40  
My background is in drama therapy. I have a master's degree in drama therapy. And one of the tenets of that is that we take on a number of different roles in our lives and when we experience distress or disease, not  necessarily medical disease, 

Dr. Diaz  35:03  
Dis Ease?

Bree Luck  35:04  
Dis ease, we are finding that we're not fully embodying or embracing the roles that we need or that certain roles are coming into conflict with each other. Or that we have an understanding of a role that is too limited, for example, the role of the daughter, right? There's the role of the daughter. And the daughter can be many things. The daughter can be young and naive and optimistic. The daughter can be dutiful .The daughter can be rebellious, The daughter can be a caretaker. The daughter can be so many things. And yet, sometimes we get stuck in one view of what the daughter is, so that we can be the daughter who says, Alright, everybody in my family can come live in my house.  Or we can be the daughter who says eff all y'all I'm getting out of here, I'm done, I'm done. Or we can be the daughter who finds a balance -- and any given point, we may need to access any one of those daughters in us. 

So what I love about this journey that you took, I mean, it's giving me chills talking about it, is that you were stuck in a role, you were stuck in a couple of roles. And you just said I'm gonna try other things. And experiment. And of course, not all of us can do it in the way that you did it. But I would also argue that probably people would have told you that you couldn't do it in the way that you did it. And yet you did it.

Dr. Diaz  36:54  
Right, right. You know,  there is a certain amount of risk, but there's but in the risk, for me, there's been a lot of excitement. So like, I got on a Greyhound bus when I was 19. And I ended up in California, I didn't know where I was going. I couldn't go any further west. So California, it was it was L.A. at that point, you know, and then I moved up to the North later. And  I was homesick for a while. So after I was out here 16 years, I went back to medical school on the East Coast, and I thought I was gonna stay there. But that's not the way it happened.

Bree Luck  37:24  
So now you have a functional medicine practice, and you are taking on and farming out some of the roles because you're an entrepreneur and a business person now and that's asking you to take on different responsibilities. And so I love that you are finding a way  to figure out what you could use support on and to ask for that support. I think that's brilliant. What is different medically about functional medicine? How does it differ from 

Dr. Diaz  38:00  
conventional medicine, 

Bree Luck  38:01  
conventional medicine.

Dr. Diaz  38:04  
So you know, if I got into a car accident and broke some bones, I'd want conventional medicine. And if I were having a heart attack, or some thing very acute, pneumonia, I want conventional medicine. But for chronic issues of lifestyle of eating poorly, not exercising, not sleeping, and too much stress -- For those type of things, the symptoms that come from those, conventional medicine is not good for. And part of it, I believe, has a lot to do with the pharmaceuticals having a big hand in everything medical. They sort of direct what we can and cannot say. I don't know how they do it, but they do -- they direct what's okay to say what's not okay to say. And then eventually the insurance companies have  limited how much time we can spend. And essentially, in conventional medicine, we're treating symptoms, we're going to treat a urinary symptom or I'm going to treat your hot flashes or I'm going to treat your depression or I'm going to treat your obesity,  all of those are going to be done with some pill that a pharmaceutical company sells.  I knew that  and I learned or figured out on somewhere along the way that if we change our lifestyle, we wouldn't need over 80% of it. So in functional medicine I get to spend a lot of time with patients.  Like my initial intake with a patient is two hours long.

Bree Luck  39:32  
I love that! What a gift! What a gift.

Dr. Diaz  39:37  
Yep. It's two hours long and I initially do blood labs -- a pretty comprehensive set of labs -- and we go over line by line. Not only that, I go over your history from the time you were born, and even what was going on with your parents when you were born. All of that affects our health, like if it was full of trauma and violence and stuff that's health affecting.  You know, people always talking about how people of color have all these effects and they're more prone to this or people who live poor have more -- It's stressful! It's like I learned to live chronically with stress, right? And trauma. It's not one incident. It's not a four year period. My entire childhood was traumatic. So they don't really say a lot about that. Well, what happens to people like that? And I think about even slavery, like people say you got Post Traumatic Stress Syndrome, because you had someone in your family die. I'm not saying that that's small, but imagine the trauma that's impacted on somebody there for years and years. 

Bree Luck  40:41  
Absolutely. 

Dr. Diaz  40:42  
So to undo that is not a simple process, you know, there's a lot that goes into it, you know. Sometimes you have to separate from your family, sometimes you have to do a lot of crying. Then it's like my favorite thing to do, sometimes. I just have to cry. I woke up was it not last night, but the night before I was anxious, I didn't know why I read some really sad post on Facebook and all sudden, I just started bawling in the middle of the night. And I didn't even have it attached to anything, it's just a release of some grief that was in there. And just to allow that to be in approval of that when people are talking about I'm anxious, I'm anxious because you're not able to, you're not open to accessing the energy that's trying to come up.

Bree Luck  41:29  
I don't know that this is Americanor Western in general, or a modern evolution of thought. We feel like to be healthy means that we never feel any distress or pain or sorrow, or, or anything. To live a joyful life means that you never wake up in the middle of the night crying, but it's just not true.

Dr. Diaz  41:54  
Yeah, absolutely. It is not real life.

Bree Luck  41:57  
It is not real life. And those moments of I really feel you that waking up in the middle of the night and just needing the release of tears.

Dr. Diaz  42:06  
Oh my god, it was it was it was interesting because I was up --and I'm usually a very good sleeper. I'm just working on some stuff that you know, require some studying and understanding and you know. It's that piece when you have to struggle through the materials. I felt a little bit anxious because I had been really working on that and so you know, because I couldn't go back to sleep I started to get up and and maybe do some more work or try to understand some more about it. Right, I started to do some more work on it. My partner, he said, like, Oh, it's you got a stuffy nose. I said, No, I was crying. He said, Come here. He had me just cuddle up next to him. And that's when I started just bawling. And my thought was good if I could have had this at three years old, right? If I could have had this as a child, somebody I could turn to the amount of separating myself from those feelings just to survive, you know, just created such a need to uncover all of it again, you know, it's like to go back to it to grieve it later. Like I am clear that I had to store an enormous amount of grief in my body, which is why I was 300 pounds. And food became the way I did it. Right. And you know, everybody has a different vice. That happened to be mine. And, you know, I have to uncover and release all that grief. And there's still more always I can actually measure -- sort of measure, you know, the amount of grief I still have by how difficult it is to stay clean in my eating. Like what am i avoiding? What do I have to feel not to eat this next scoop of ice cream, I work all day. And sometimes I stay unconnected, right? All of a sudden, it's time to stop working. And that's when I want to eat. And it's interesting. It's Oh, this is when I need to reconnect with my body. Because why did I let go of it all day long. Why? Why is it that I can't just bring that part of me that is I call it the feminine part of me along with me. What happens during the day that that cannot be integrated. And it's part of how you know I learned to survive, right? So it's Yeah, that integration is like, it's the answer to all addictions is integrating those two things --  that feminine part inside that feels with the thinking, rational part.

Bree Luck  44:13  
So much of what you just said were questions and it just makes me think of the importance of curiosity. When we're looking for change, that it's not about finding the answers. It's about finding the questions. And speaking of questions, and intimacy and release, I know that you practice orgasmic meditation. Let's talk about some orgasms.

Dr. Diaz  44:40  
Yes. So here's an interesting thing. I was at a conference before I left the hospital not too long before I left the hospital because I found orgasmic meditation almost within the same month that I was leaving the hospital -- which is kind of interesting. There was a female gynecologist standing up in the conference of these almost majority male suited doctors, just so you get in a visual. And she's up there she's talking about orgasm and female sexual connection. And I'm sitting there like, oh my god, is she talking about this in the middle of this group. I was just kind of blown away that this woman was up there doing it. And I felt like she was really brave. But what I remember is she mentioned the book called Slow Sex. And that's what that's the main thing I remembered from it because I knew I was going to go away and find that book. And that book was the first place I learned about orgasmic meditation. I'm thinking, is this crazy? First of all, let me say what it is: Orgasmic meditation is a 15 minute practice, where a woman takes off everything from her waist down, she lays on a blanket, she butterflies her legs, her partner sits to her right, and then he or she takes their left index finger and they stroke her clitoris, for a time. They literally set a timer for 15 minutes. And there's no goal in the practice, except for both of them to feel what happens in their body as a result of that practice. Oh boy, I mean, I'm like what! Like, all the times that I couldn't even have an orgasm in a sexual encounter with another person. All the times that even when I was younger, when I used to fake an orgasm, right. All the times, you know, my partner would turn over and I would, I would like, turn to my vibrator. Like, that's what came up when I heard about this book. And when I read about orgasmic meditation, and like its literally going to give my genitals the attention she wants, like, what?

Bree Luck  46:53  
Fascinating.

Dr. Diaz  46:56  
And one of the things I learned is she loves attention as much as I have been taught to deny it, deny her that attention. So I read this book, June of 2012. And there was a man that I was -- we were flirting we hadn't been sexual or anything, or hadn't really done more than flirt. But I told him about this practice and asked him if he would do it with me. And he was like, Yeah, of course. Right? It's this is where I started breaking so many conditioning patterns in my system, which was the shame. And the idea that men don't really want to please me that they sit in a higher position than I do. Like, there's a lot of things in there that I didn't even realize I had that got broken in my practice of orgasmic meditation. So he said, Yes, I'll do that. And when I laid down and I butterflied my legs, and, you know, he begins to stroke, you know, about, I don't know, five minutes into it,  I said -- okay, that's enough. He said -- Why? And I said, cuz I'm embarrassed. And then he's like, we still have 10 more minutes lay down. I remember that response, like, very impactful. And that's exactly what I did, you know, I was like, well, we can, you know. There's that feeling like, do I smell? What does this look like? And we do it in the light. That's the other thing if you have to turn on the light, he has to be able to see your genitals.

Bree Luck  48:24  
It sounds so intense,

Dr. Diaz  48:27  
Especially at first, so much will want to come through when you do this, you know, when and if you do this practice, you know, be ready with support if you can. Don't do it alone. You know, I was doing it alone. I actually found you  a community shortly after, but it's a lot and I had already done a lot. But I have watched people who haven't done a lot of work in it. It's a lot that comes out and it starts to really show you how much trauma we hold as women, especially around our sex, and our sex is our power center. So we lose a lot of power by not having our sex.

Bree Luck  49:04  
And I think it's important to address that a lot of women who are going through perimenopause and menopause have fear that I hear a lot iof losing sexual desire and desirability, both. And it sounds like a practice like this might be helpful.

Dr. Diaz  49:28  
It's life changing. It changed my life. I mean, it was at the very beginning when I decided to leave work, and then I started traveling, it completely changed my life. It was like, how -- and somebody asked me this -- How would your life be different if you lived by desire rather than obligation?

Bree Luck  49:44  
How would your life be different if you lived by desire rather than obligation? Oh,

Dr. Diaz  49:53  
yeah. Like I started thinking -- how my life would be different.  Like, Oh my god, what are you talking about? My life would be so much different and I tried it on. That's how I ended up spending five years traveling and I did so many things during that time. I did so many things. I went to Costa Rica, I went to Spain, I went, you know, I, like I said, 17 cruises, I took classes and coaching. I went to concerts in DC and then Florida. I went to like Disney World with my daughter, I you know, I just did so much stuff that I never got to do growing up and I had retirement I had to use up because I was trying to get that divorce, right? He wasn't gonna get half of it so i just --

Bree Luck  50:40  
you savored it, it sounds like you really, really enjoyed it. And it also makes me think of how hard it is for us to receive, in general, as women, that we feel like we are always providing caretaking, holding space, creating the container. And I hear a lot of adventure in your story. But I also hear particularly with the orgasmic meditation profound reception, profound ability to receive,

Dr. Diaz  51:13  
you know, it actually caused me to open that right, I really think, you know, reception has not been my strong point. Right. And I think that it had a huge impact on my ability to receive, because in a way, my ability to receive requires that I'd be willing to create room by removing some of the trauma by like, allowing. You know, you were speaking earlier about, we think we should all be joyful, but we can not be joyful, if we cannot feel our sorrows. It's like, it's a whole gamut. It's like a bandwidth. So how big is our bandwidth, and I had to increase the bandwidth for having all of my emotion and to be in approval of them -- to be able to go all the way down if I have to, and you know, tolerate as much as I can tolerate, and then come in. And it's not overnight, this can be a slow process, I started working on all this kind of stuff in my 20s when my sister was like, she's always crying, right? Or I can't do that, or, you know, I of course, you know, share what I do. And people like they have this response. It's like resistant. But the benefits of doing this work is I can't even --  like I wouldn't be a doctor if I didn't do that work, right. I know, everything that I know, if I didn't do that work, I couldn't share in a real way with people. If I didn't do this work. It's just like everything that I teach, I do it because it helps me. It helps me to do this work.

Bree Luck  52:41  
We are better teachers, when we are healing ourselves. We can't just sit there on top of that. I mean, the days is sitting in an ivory tower and looking down and professing This is what you need to do are Done. Done.

Dr. Diaz  53:00  
And it's easy to undo. I mean, it's not like a you know, it's not like I don't have some of that sometimes, and I have to be aware of it. Like I you know, it's funny, because we was in a doctor's group and somebody who was leading I said this --  you said I can cuss right.

Bree Luck  53:15  
You can totally cuss.

Dr. Diaz  53:20  
You know, in a doctor's group, I was you know, I don't know, 20 doctors in this group. And he said, I want you to turn to another doctor here. And I want you to tell them how you have been an asshole. And I was like, Wow, what a question. To explore that, because you know, you could resist that question, you know, yeah. Yeah. You know, you know, for me, it was like, Oh, how many times have I thought it was okay to be late to an appointment? Where is it that I'm not respecting the time of a patient? Or, I don't know, just different things like where am I? Where do I not respond as urgently as say somebody is asking for -- or just taking a look at that. It was just like, really a big deal to me. And it was an awesome question. 

Bree Luck  54:07  
It is an awesome question. 

Dr. Diaz  54:09  
You know, where do I sit and think I'm going to teach you but not really teach myself even that I still you know, I'm still noticing that like, I'm learning something new. I'm like, oh, how can I share this with somebody? How can I teach somebody this instead of like taking it into your system? Take it into my own system? Why am I trying to learn this right now? Why? What do I want to know from me in this? How can I have it be a part of me?

Bree Luck  54:32  
I think we can all use that. I think we can all use curiosity around ways that we are not seeing whole people, right? Because that's what being an asshole is. In many ways. It's just missing the full humanity of the person that we're dealing with. And we're only human, we're going to have to make short cuts, we don't have time to consider the full humanity of every human. So we go through the motions sometimes, and sometimes that leads us to being an asshole. But I love the courage to take a look at where we show up as assholes. I'm going to ask you a little bit of a professorial question. And it's not fair because you had just given us so many gems to think about as women going through transitions as humans, I mean, I hope --  I'm gonna make my husband listen to that I won't have to make him -- he will listen to it. But I think everyone should listen to this episode because of all that you are offering here. But one question I'd like to ask you is right now in this moment, what is one thing that you think people who are going through perimenopause should know? Or do?

Dr. Diaz  55:47  
The first thing that came up is stop turning to conventional medicine for the answer. That's the first thing that came in to my mind because they're not going to lead you in the way that you need them to lead you. pay attention to hormones, but pay attention to lifestyle. Now this is a chance to shift direction. You know, I've watched many, many older people head right to one nursing home because they don't exercise because they don't eat well, they haven't taken a look at their lifestyle. But you can also shift it to where, you know, I intend to be on a dance floor or skiing, or traveling to the next concert I want to watch! I have patients in their 90s who are on hormones still. And so the fears that they put out -- Really, really do your research -- turn to somebody that's knowledgeable. You know, don't assume that it's dangerous. ask, Is it dangerous? Don't assume. Don't believe everything you hear, ask the question. Is this true? Does this make sense? Is it in all cases? If you're worried about getting cancer, it's almost like if every time I got in a car, I was worried about being in an accident? Well, no, I mean, to learn safe driving -- well you need to learn how to use hormones safely. Get tested, don't over those yourself, don't underdose yourself, right? Those are things that are really important. I keep track of patients, when I have them on hormones, I don't let them go, I make sure they get their mammograms, their colon screens, their dexa scans, those are important ways of taking care of yourself. You stopped doing cigarettes, you stopped doing alcohol, these are all things that are super important, and especially menopause, because you're gonna feel it because as soon as those hormones go away, all of this comes through. All of those mistreatments that we've done, the last one years are going to show themselves. 

Bree Luck  57:39  
And how can we find you 

Dr. Diaz  57:41  
I have a Facebook group is called women's support group for menopause. So I'm there, I have a webpage that is called orgasmic medicine dot com.

I did want to go back to functional medicine, you know, how is that different than conventional because I didn't complete that thought. And one of the things I wanted to say was in functional medicine, we are looking for the cause of maybe many symptoms, it may be one or two causes for 10 different symptoms that we're having that if we go to conventional medicine, we'll have 10 different docs. But if we correct the thing that's causing those 10 different symptoms, a lot of times I just changed somebody's diet, and all of a sudden five of the 10 symptoms are gone. If we are constipated, you know, and when I say constipated, we're not going to the bathroom, every day. You should be moving your bowels every day, if not more than once a day. If you're not, then that needs to be corrected, because that's going to cause all kinds of detox issues and dysbiosis which means the microbes in the in the gut are not going to be balanced in causes inflammation, etc. So sometimes I can just introduce vegetables, right? And suddenly they're going and like five different symptoms will go away. It could be a joint pain, it could be an autoimmune disease that's beginning, it could be fatigue, like all of these things can actually go away just by changing what you're eating. So it's an important part of what functional medicine does. It says, let's take a look at what is causing your symptoms, not just -- You know, for instance, if I was if I were standing on a nail, and I said my foot hurts, let's just say the nails in my foot, my foot hurts. And you just give me ibuprofen? Well, yeah, it may help my pain. Right? But if you go to the nail and we remove it, then you've removed the cause, and then you do something to help me repair it. It's not just treating the pain, it's also removing the cause of it and it's also helping you repair the damage. So that's what functional medicine does.

Bree Luck  59:46  
I really appreciate that overview of the systemic approach to looking at disease. And so thank you for sharing that. 

Thank you so much for coming on today and for sharing your incredible story and your wealth of knowledge. It has been a joy to meet you.

Dr. Diaz  1:00:11  
Oh, I've enjoyed this too. I'm tickled.

Bree Luck  1:00:16  
I hope you enjoyed this conversation with Dr. Diaz as much as I did. Here are my key takeaways from the conversation. Number one, Dr. Diaz says there are a lot of myths out there about hormones, and yet there's also a lot of potential in bioidentical hormone therapy. So make sure you're asking good questions as you deal with perimenopause side effects, because you don't have to suffer.  Number two: include more vegetables in your diet. In fact, try to include 20 different vegetables on a regular basis. Number three, when looking at a health issue, look at the whole system, not just the symptom. Number four, cultivating a life replete with pleasure and allowing ourselves to integrate a whole spectrum of feelings may not lead us to a life without hardships, but it can release us from a lifetime of suffering.