The Functional Medicine Approach To Precocious Puberty - Transcript

Announcer: Coming up on this episode of the Doctor's Farmacy. Dr. Elizabeth Boham: We know that kids that are overweight or obese start puberty at a younger age and then we also know that kids who start puberty at a younger age have a higher risk of weight gain when they're older and they have a higher risk of PCOS, which is a problem with infertility and insulin resistance. So it becomes almost this vicious cycle. Dr. Mark Hyman: Welcome to the Doctor's Farmacy, I'm Dr. Mark Hyman, and that's Farmacy with an F, a place for conversations that matter. If you're worried about all the hormonal weirdness that's happening in our children and early puberty and how the environment may be affecting us, you should listen to this podcast because it's a special episode of the Doctor's Farmacy called House Call. We're talking to the doctors at the UltraWellness Center, our practice in Lenox, Massachusetts, and I'm so excited to have back again today, Dr. Elizabeth Boham, who you all know by now. She's one of the leading functional medicine doctors in the world, she teaches all over, she's trained in nutrition and exercise physiology, and she's just an all around amazing human. Welcome back. Dr. Elizabeth Boham: Thank you, Mark. It's great to be with you. Dr. Mark Hyman: Okay, let's get right into it. One of the things that I learned over the last few decades in practicing functional medicine was that we seem to seeing increasing prevalence of hormonally-related weirdness. And what I mean by weirdness, is all sorts of hormonal disorders, whether it's increasing endometriosis or infertility or precocious puberty, which we're going to talk about today. It's something that we really haven't even, as a society, grappled with. I mean, there's changes in the male to female birth ratio because of changes in the toxins in the environment that drive hormonal changes. So tell us, [Liz 00:03:53], what is going on with all these kids getting puberty when they're much younger than they should be getting puberty? Dr. Elizabeth Boham: You're absolutely right. We're seeing a lot of hormonal weirdness, or shifts in our health because of shifts in our hormones. Let's talk about it from the puberty perspective, because it's really fascinating. So typically, a girl starts to go through puberty between the ages of 8 and 13, so the average age is 10.5. And for girls, they start to develop some breast buds first and then some pubic hair and hair, and then they start to have their period a year or two later. For boys, they typically go through puberty between the ages of 9 and 14, with the average age being at 11.5. Dr. Mark Hyman: I was like 15. Dr. Elizabeth Boham: You were a late developer? Dr. Mark Hyman: A short, [shrimpy little 00:02:52] kid and then all of a sudden, boom, I grew six inches in a year. Dr. Elizabeth Boham: Yeah, so there's a lot of variation kids, and I think that's important for parents to understand because sometimes parents get concerned and really there's just a lot of normal variation within our children. But what we are starting to see, is some girls and boys going through puberty at a younger age. So what's considered an age where we want to be concerned or talk to our doctor about it or get more information about it? So what we're saying is precocious puberty, is when there is the onset of puberty, whether it's just breast bud development or hair growth for boys or girls, before the ages of eight in girls and before the age of nine in boys. There's definitely more of a concern when you see it before the age of six or seven, six in girls and seven in boys, but we start to wonder, is this earlier than it should be, for girls less than eight and for boys less than nine. There's a lot of variation in terms of what is the amount of kids going through puberty younger than we saw decades ago. Dr. Mark Hyman: Yeah, how big of a problem is it, right? Dr. Elizabeth Boham: Right. So they're saying somewhere between 7 and 23% of our kids are going through puberty younger than we used to see. And then the question is, is there a problem with that? And why is that? And what do we need to be concerned about? And I think you're absolutely right, our environment is definitely having an impact on our hormone levels. And we will delve into that today because we know that's something we need to be paying attention to because it's absolutely influencing everything from our fertility to endometriosis, to cancer, and to puberty. But then there's other things too that can be influencing what happens with puberty and when we develop puberty, such as our diet and our weight and our calories and our nutrition. So that's important for us to understand as well. Dr. Mark Hyman: I mean, it's staggering what you just said, Liz, that 7 to 23% of kids — that's almost one in four kids — has some weird hormonal dysregulation leading to early puberty. It seems to me that there's two main drivers of this phenomena, this relatively new phenomena, and I don't think it's talked about much, but the two drivers are: one, environmental toxins; and two is our food. Our food is driving hormonal changes. So can you talk about those two things and how those influence hormonal development and also just our overall hormonal milieu in general? Because I think there's a real under appreciation of the way in which both toxins and food drive changes in our hormones. Dr. Elizabeth Boham: So we know that when we gain weight, we have shifts in hormones in our body. So when we put on body fat, our estrogen levels in our body are higher. And we've talked about this before with breast cancer risk and PMS and that sort of thing, but we know that when we're heavier in weight, when we have more percentage of body fat, our estrogen levels are higher. So one of the things we know is when kids are overweight or obese, they tend to go through puberty at a younger age. And we're seeing 20% of our kids in the US are obese, and so it's no wonder we're seeing shifts in hormones because of that. Because, again, you put on more weight, your estrogen levels increase, and that then is influencing your hormone balance in your body. Dr. Elizabeth Boham: And what's the major driver of that? Like you said, our food. So when we're eating a lot of refined and processed foods, a lot of refined carbohydrates, a lot of sugary foods, a lot of sodas and juices, when we're giving our children stuff from the children's menus — which drives me crazy — then a lot of that food is refined and processed and quick and fast food, and that just drives weight gain for our kids. And that drives hormonal levels to increase and that is one of the reasons we're seeing this increased rate of precocious puberty. Dr. Mark Hyman: So Liz, it seems that diet plays such a huge role in controlling hormones, and you mentioned the processed food, the starchy carbohydrates, or sugar, what's the mechanism that it uses to drive the changes? How does that work? Dr. Elizabeth Boham: Well, there's a few things, but our diet impacts our hormonal balance and one of the things that our diet drives is insulin. So when we're eating foods that are really high in processed carbohydrates and simple sugars, we have much higher levels of insulin floating around. And then that high level of insulin drives other growth hormones in the body, it drives us to gain weight around the belly, and then that weight gain drives more estrogen production in the body and then it becomes almost a vicious cycle. We know that kids that are overweight or obese start puberty at a younger age, and then we also know that kids who start puberty at a younger age have a higher risk of weight gain when they're older and they have a higher risk of PCOS, which is a problem with infertility and insulin resistance. So it becomes almost this vicious cycle of weight gain; hormonal increases, like insulin, estrogens; and then further weight gain and shifts in our hormone balance. Dr. Elizabeth Boham: I think that a lot of times with kids, parents are like, "Oh, they're kids, let them just eat some crap here and there." Excuse me. And we think it's not a big deal, but it can really start this vicious cycle, this snowball effect, in terms of weight gain, hormonal shifts, weight gain, hormonal shifts, which make it very hard for kids when they're adults to maintain a healthy weight. Dr. Mark Hyman: No, it's so true. We know that the obesity issue is there from the processed food, but the amount of estrogen that gets produced as a result of high levels of insulin and obesity, and the fat cells basically producing extra estrogen through aromatase, which is this enzyme that converts, like for men, for example, it converts testosterone into estrogen, which is not good. Dr. Elizabeth Boham: No fun. Dr. Mark Hyman: So I think we're sort of in this really scary time where both our diet and our environment are driving these hormonal changes that are affecting all of us, but particularly, it's showing up in these kids and it's showing up in fertility. Talk about the role of the environmental toxins, because there're some genetic conditions that have to do with precocious puberty, we're not going to go into that too much, but talk about how our exposure to these endocrine-disrupting chemicals drive some of these hormonal aberrations. Dr. Elizabeth Boham: Yeah, like you just mentioned, there are some rare conditions that are genetic in nature or tumor-related or shifts in adrenal function that can shift our puberty, but what we're going to really focus on today are these subtle shifts in our health that are affecting lots of people, that may be impacting how quickly our children are going into puberty. So one of the other areas, we talked about weight and body fat and our diet and how that impacts when our children are going into puberty, but these endocrine-disrupting chemicals are huge in terms of our understanding of how they're impacting our fertility. So there's multiple different endocrine-disrupting chemicals that we know impact hormone levels in the body and impact fertility and many have been associated with early puberty in our kids. So things like dioxins; pesticides; herbicides; DCB, which is this chemical that controls moths or molds, have been definitely shown to cause or result in early puberty in our girls; parabens, we've spoken about a lot. Dr. Elizabeth Boham: Crazy, I was just looking at a package of tortillas the other day, like the soft corn tortillas, and this was not a brand that I typically get, but I was just looking at the package and there was parabens in it. And I was like- Dr. Mark Hyman: What? Dr. Elizabeth Boham: That's right, exactly. I mean, I think of parabens all the time when I'm picking out- Dr. Mark Hyman: Sunblock. Dr. Elizabeth Boham: ... my moisturizers. Exactly, my sunblock, my makeup. We know things that have methylparaben, butylparaben, and propylparaben, all of those parabens; shampoos, conditioners, our body care products, are estrogen-disruptors. They are xenoestrogens, they can bind to the estrogen receptor in the body and almost act like estrogen in the body. But I wasn't thinking about it in foods so much, so I was talking to our Nutrition Director, Maggie, I'm like, "Is this in a lot of foods?" So I did a little more research and I guess there's parabens in processed foods, muffins, and then these corn tortillas. I guess it makes it soft and pliable. Why are we're eating parabens? I have no idea. Dr. Mark Hyman: Oh yeah, [crosstalk 00:12:49] plastic. These are petrochemical products. The whole idea is that the petrochemical products are turned into all sorts of plastic components that we use every day and they're in all of our, as you said, all of our personal care products our household products, they're in our food, they're in our water. I mean, it's pretty frightening. And the amount of devastation to our environment from these compounds and then their effect on our human biology is just staggering. Dr. Mark Hyman: I remember reading a book years ago, you probably remember this one, called Our Stolen Future by Theo Colborn, where she talked about these endocrine-disrupting chemicals and xenobiotics and xenoestrogens. How do we deal with these? I mean from a traditional medicine point of view, these are not something that most doctors will really look at, think about, test, measure, they certainly don't know how to treat for it. And the diet part is something that traditional doctors should be able to, but they don't know much about nutrition. So what are the ways that a traditional approach would take to precocious puberty and what would be the differences in a functional medicine approach from a diagnostic and a treatment point of view? Dr. Elizabeth Boham: Absolutely. So one of the things in functional medicine that we always do is take a really detailed history. You really want to figure out that patient's timeline, what was their early life exposures like, get a really good diet history so you get a sense of, is this more diet related or is this more toxin related? And then many times we'll do some more in-depth testing. We can do some antibody testing against toxins that give us a sense of exposure to these xenoestrogens, like parabens; to the pesticides and herbicides; to the dioxins and the BPA; and unfortunately, now with BPA they're shifting it a little bit, so they can call it BPA-free, but it's still these weird chemicals that can impact our hormones in our body. Dr. Elizabeth Boham: So we can measure some of those. Looking at antibodies against these toxins, sometimes can measure them directly, we can look to see how the body does detoxify. What are our levels of glutathione? What are our levels of oxidative stress? What are our genetics like? That can give us a sense of, do we need to support this person's detoxification system or do we really need to just focus more on the diet or a little bit of both? So there's a lot of things we can look at, testing wise, which can really help direct us to know how best to treat the patient. Dr. Mark Hyman: Yeah, no, it's true. I mean, we can measure those things now in the urine. I remember this woman who used sunblock all the time because she didn't want to get skin issues, and she had really high levels of parabens in her urine. I was like, "Where is this coming from?" Or phthalates, from people drinking out of plastic bottles, and it's just so ubiquitous, pretty much we're all toxic waste dumps. Then the real question is how do we deal with it from a dietary perspective and from addressing the environmental exposures to reduce them? And also, how do we enhance our body's own ability to get rid of these and how does this impact the course of hormonal dysfunction, particularly in these kids? Dr. Elizabeth Boham: Our body has this tremendous ability to rebalance and heal. And so I think we always work with diet first with our patients and say, "Okay, let's start cleaning up the diet. Let's start avoiding these chemicals, first and foremost. Let's start avoiding these: the BPAs, and the plastics, and the parabens, and the phthalates. Let's stop putting chemicals on your lawn, buy organic whenever possible, really start to avoid chemical exposure as much as you can." Then we talk about what can we do to support the body's detoxification capacity. And one of the biggest things to work on here is our phytonutrients. Our colorful plant foods that have this tremendous ability to support our body's detoxification system. Eating from the rainbow, getting some green and yellow and red and orange and purple and blue and tan foods in our diet every day. Dr. Elizabeth Boham: And the thing that I get so concerned about ... Actually, my son's working at a camp this summer and he came home so concerned too, he's like, "You just can't imagine what the kids are eating," because there's just no plant foods. There's no colorful plant foods, it's all processed, packaged junk. That's not supporting our detoxification systems in our body. So many foods that kids are eating are not helping, and so we really need to help them get used to eating lots of plant foods and vegetables on a regular daily basis to support their detoxification system. Dr. Mark Hyman: So increasing plant foods and obviously, getting rid of the starch and sugar, all the weird ingredients in our food, household products, facial care products, skin products. The Environmental Working Group is a great resource for that because they have a tremendous list of products that are safe to use, that don't have all this stuff in them, whether it's food or household products or cleaning products or facial products, it's really a great resource.Then in the food part, that's what really we do at UltraWellness Center, is help guide people to nutrition that's going to regulate their hormones, whether you're going through precocious puberty or you just have hormonal dysregulation related to our crappy diet. So tell us about this case of this 10-year-old girl, because I think it was kind of instructive, and I think it'd be really useful to have an understanding about that. Dr. Elizabeth Boham: So as I mentioned at the beginning, I do get parents who bring in children and they have a concern like, "Is this normal development?" And so this girl was 10, so she didn't meet the official diagnostic criteria for precocious puberty, as we said, for girls is less than eight. But mom was concerned about her development. She noticed that she was having an easier time gaining weight, she was developing faster than her other sisters, and mom was really concerned like, "Is this something we should be worried about? What can we do about it?" Dr. Elizabeth Boham: So in general, her physical exam was very non-concerning, but what we did notice is that she was overweight — officially, she was obese. So with children, when they're greater than 95% of their BMI for their age, they're considered obese. So we measure based on the growth chart and look at what is your percentage above the BMI, your body mass index. And so she met that criteria for obesity and so mom was concerned. So that was where we really had to just pull out more of these non-nutritive foods, the things that sneak into our kid's diet: the crackers, the fishy crackers, popcorn, muffins, juices, and lack of vegetables. And that's what we saw when we took her really detailed history, that there wasn't enough of the good, healthy vegetables in her diet and that it was really just a little too many of these refined and processed foods. And that's where we really focused with her. Dr. Elizabeth Boham: We did do some testing with her in terms of the xenoestrogens and how she detoxified and her levels looked pretty good, there wasn't a ton of concerns there, but we really worked on getting the eight servings at least of phytonutrients in a day. So focusing on broccoli and onions and adding more vegetables into soups, and we worked to make sure that all the skincare products they were using were clean. We worked to increase her activity. We know with exercise, we sweat, and that's a really great way to get toxins out of the body. And of course, exercise also improves your insulin sensitivity, and that helps with weight loss and maintaining a healthy weight. And she did really well her, she didn't really lose weight, which is what we typically do with kids — if possible — we just have them maintain their weight as they grow. And so she then just became a normal BMI as she grew taller, which was great. Then she actually started her period at the age of 13, which was within the normal window. So she was completely fine. Dr. Mark Hyman: So [inaudible 00:21:27] get these kids and you work on their diet and their environmental exposures, you can really make a difference, is what you're saying. Dr. Elizabeth Boham: Absolutely, and that's exactly what we want to do, we want to start early to prevent problems later in life. And again, I think it's important that we pay attention to the fact that what we're feeding our kids early is having a huge impact on so many aspects of their health, including how early they go through puberty, their risk of obesity later on in life, the risk of different issues with hormone imbalance as well. Dr. Mark Hyman: And that's so important, what you're saying, is that the early life influences, even a hundred days, a thousand days, makes such a difference. Even the uterine environment plays such a role in determining what happens with these kids. So whether you're a mother and looking at what your exposures are when you're pregnant or whether you're trying to figure out what to feed your kids. I mean, a lot of the baby formulas have all kinds of stuff in them. It's pretty scary when you start thinking about it, but it's worth really focusing on because if you get your kids started in the right way, they often can avoid a lot of long-term issues down the road. Dr. Elizabeth Boham: Absolutely. Just get them eating right from the start, it makes a huge impact on their overall health. Dr. Mark Hyman: And we're seeing this problem is not just around precocious puberty or kids, but we're seeing a whole range of hormonal dysfunction. I mean, a lot of the cancers we're seeing are hormonally related: prostate, breast, uterine cancers, ovarian cancers. We're seeing increasing infertility rates, we're seeing changes in the birth rate in terms of male/female ratios, so we're seeing a lot of dysfunction in our hormonal regulation as it relates to just this normal pattern that we're supposed to have. But when we see the effect of diet and we see the effect of these environmental toxins, they're quite staggering. The good news is that there's ways to diagnose them, there's ways to treat it, there's ways to get to the root of it, there's ways to avoid them. So this could be a depressing conversation, but I think it's hopeful because it's like, "Okay, well, if this is really true, and these things are really screwing up our hormones" — and it's not just women, men too — "then what do we do about it?" Dr. Mark Hyman: And I think it's really about following the principles of a whole foods, plant rich diet, really high quality food, get rid of all the [inaudible 00:23:35] and crap and chemicals and the sugar and processed foods, and then really reducing your toxic load, which is ... I think the Environmental Working Group is such a great resource for that,, and it's really a wonderful place to go to look and say, "Okay, well, if I'm buying a skincare product or if I'm buying makeup or if I'm buying shampoo or I'm buying a toilet bowl cleaner or I'm eating this food or that food or this fish or that meat or this vegetable, which one can I pick, that's going to have the least impact on me or that's going to be the most healthful?" So I think it's an empowering message, even though I said it was scary. I think that's really the whole purpose of functional medicine is to help people understand what's really going on and then provide a roadmap for how to optimize their health and reduce the things that are causing harm and improve the things that your body need to thrive. Dr. Elizabeth Boham: Absolutely, absolutely. Dr. Mark Hyman: This has been a great conversation about a very ... A tough conversation about a very tough topic, because just the idea of our kids being damaged in this way and their fertility being threatened. I mean, it's an existential threat, and I always see the stories that are happening in the literature around this. To me, we're just like the Guinea pigs now, in the society where everything is being used on us without a lot of testing, a lot of experience, and often, these chemicals are not just one, you're getting exposed to dozens of these or hundreds of these chemicals and they're all synergistic. It's not just one plus one equals two, they actually work together to actually create more disruption than just a regular simple dose. Dr. Mark Hyman: So, yeah, I think there's a lot of opportunity for change, a lot of opportunity for thinking about what you eat and your exposures, and everybody should check it out. If you guys liked this podcast, please share it with your friends and family on social media, leave a comment, we'd love to hear from you. Have you found your hormones are screwed up by diet or toxins? We'd love to hear from you and we'll see you next time on the Doctor's Farmacy. Announcer: Hi everyone, I hope you enjoyed this week's episode. 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