The Functional Medicine Approach To Precocious Puberty with Dr. Elizabeth Boham

Coming up on this episode of the Doctor's Pharmacy.

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.

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Welcome to the Doctor's Pharmacy.

I'm Dr. Mark Hyman, and that's Pharmacy with an F, a place for conversations that matter. And if you're worried about all the hormonal weirdness that's happening in our children in early puberty, and how the environment may be affecting us. You should listen up to this podcast, 'cause it's a special episode of the Doctor's Pharmacy called House Call. We're talking to the doctors at the Ultra Wellness 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.

Thank you, Mark. It's great to be with you.

Okay, so 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 be seeing an 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. And, 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, what is going on with all these kids getting puberty when they're much younger than they should be getting puberty?

Yeah, you're absolutely right, right? We're seeing a lot of hormonal weirdness or shifts in our health because of shifts in our hormones. And so let's talk about it from the puberty perspective. And it's because it's really fascinating. So typically a girl starts to go through puberty between the ages of eight 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 nine and 14, with the average age being at 11.5.

I was like 15.

You were a late developer?

I was like a short, trim little kid, and then all of a sudden, boom, I grew six inches in a year.

Yeah, so there's a lot of variation with 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 start to, where we wanna 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. And 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? And there's a lot of variation in terms of what is the amount of kids going through puberty younger than we saw decades ago, right?

How big a problem is it, right? Right.

So they're saying somewhere between seven and 23% of our kids are going through puberty younger than we used to see. And then the question is, well, 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.

I mean, it's staggering what you just said, Liz, that 7 to 23% of, I mean, kids, that's almost one in four kids has some weird hormonal dysregulation leading to early puberty. And, you know, it seems to me that there's two main drivers of this phenomena. This is 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.

Right?

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.

So we know that when we gain weight, when we gain weight, we actually we have shifts in hormones in our body. And 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 other 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. And so one of the things we know is when kids are obese, 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. And what's the major driver of that? Like you said, our food. Right? 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, you know, when we're giving our children stuff from the children's menus, which drives me crazy, then, you know, 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 risk or increased rate of precocious puberty.

So, Liz, it seems that diet plays such a huge role in controlling hormones and you mentioned the processed food, the starchy carbohydrates, the sugar. What's the mechanism that it uses to drive the changes? How does that work?

Well, there's a few things but our diet impacts our hormonal balance and one of the things that our diet drives is insulin. 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 this vicious, 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. So, you know, I think that a lot of times, you know, with kids, parents are like, oh, they're kids. Let them just eat, you know, some crap here and there. Excuse me. So, and we think, oh, 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?

No, it's so true. And I think, you know, we don't, we know that, you know, the obesity issue is there from the processed food, but the amount of, of estrogen that gets produced as a result of high levels of insulin and obesity in the fat cells, basically producing extra estrogen through aromatase, which is this enzyme that converts, you know, like for men, for example, it converts testosterone into into estrogen, which is time. Yeah, no fun.

And so I, I think, 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 infertility that talk about the role of the, the environmental toxins, because I think, you know, there's some genetic conditions that have to do with it, with precocious puberty. We're not going to go into that too much, but talk about how our exposure to these endocrine disrupting chemicals drives some of these hormonal aberrations.

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. 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, the DCP, DCPB, 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, you know, 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, what? That's right, exactly. I mean, I think of parabens all the time when I'm picking out sunblock. Moisturizers, exactly. My sunblock, my makeup, my, you know, we know things that have methylparaben, butylparaben, propylparaben, All of those parabens, shampoos, conditioners, our body care products are estrogen disruptors, right? 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 food so much. So I was talking to our nutrition director, Maggie, I'm like, How? I mean, is this in a lot of foods? So I did a little more research and I guess it's there's parabens in processed foods, muffins, and then these corn tortillas, I was like, I guess it makes it soft and pliable. Why are we're eating parabens?

I have no idea. 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 or household products. They're in our food, they're in our water. I mean, it's pretty frightening. And, and the amount of, of Devastation to our environment from these compounds and then their effect on our human biology is, is staggering. I remember reading a book years ago. You probably remember this one called the our stolen future by Theo Colburn, where she, she talked about these endogenous 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, you know, 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? What would be the differences in a functional medicine approach from a diagnostic and a treatment of view.

Absolutely. So, you know, one of the things in functional medicine that we always do is take a really detailed history. You know, you really want to figure out that patient's timeline, what was their early life exposures like, you know, 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, and then many times we'll do some more in-depth testing. We can look at, 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 they're 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. So, you know, We can measure some of those looking at antibodies against these toxins. Sometimes we 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? And 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? and 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. Yeah, I know it's true. I mean, we can measure those things now in the urine.

I mean, 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'm like, where is this coming from? Or phthalates, people drinking out of plastic bottles. And it's just so ubiquitous. And pretty much we're all toxic waste dump. So the real question is, how do we, 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?

You know, I think that our body has this tremendous ability to rebalance and heal. And so, you know, 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 the BPAs and the plastics and the parabens and the phthalates. Let's start to stop putting chemicals on your lawn. Buy organic whenever possible. Really start to avoid chemical exposure as much as you can. And 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 is our phytonutrients, right? Our colorful plant foods that have this tremendous ability to support our body's detoxification system. You know, 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. And the thing that I get so concerned about, you know, 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, right? There's no colorful all plant foods. It's all processed packaged junk, you know? And so it's really, that's not supporting our detoxification systems in our body. And so, you know, 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 their detoxification system.

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. And then in the food part, that's what really we do at the Ultra Wellness 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 would be really, really useful to have an understanding about that. And so, as I mentioned at the beginning, I do get Parents who bring in children and they have a concern, like, is this a normal, 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. So, 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 and mom was really concerned, like, is this something we should be worried about? What can we do about it? And, you know, 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 they measure based on the growth chart or 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. And so that was where we really had to just pull out more of these non-nutritive foods, right? The things that sneak into our kids diet, the crackers, the fishy crackers, right? Popcorn, muffins, juices, you know, just 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, you know. She actually, we did do some testing with her in terms of the xenoestrogens and how she detoxifies, 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, you know, she did really well. She didn't really lose weight, but 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 went in, became a normal BMI as she grew taller. which was great. And then she actually started her period at the age of 13, which was a really within the normal window. So she was completely fine.

So often if you get these kids and you work on their diet and their environmental exposures, you can really make a difference, is what you're saying.

Absolutely, right? 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.

That's so important what you're saying. The early life influences, even the 100 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 or 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. Absolutely, right? Get them eating right from the start.

Makes a huge impact on their overall health. And we're seeing this problem. Well, it's 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. And I think 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. And so this is, you know, could be a depressing conversation. 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? And I think it's really about Following the principles of Whole Foods, plant-rich diet, you know, really high quality food, gets rid of all the cock 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, ewg.org, 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, you know, 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 helpful? And so I think it's an empowering message even though it sounds a little scary. But 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 things that are causing harm and improve the things that are that are needing your, your body's need to thrive.

Absolutely. Absolutely.

Well, this has been a great conversation about a very, on tough conversation about a very tough topic because, you know, just the idea of, of our kids being damaged in this way and the, their fertility being threatened. I mean, it's just, it's, it's a, it's an existential threat. And I, you know, we see the stories that are happening in the literature around this. It's, it's to me, it's like we're just like the guinea pigs now in the society where everything is being.

You.

Know, kind of used on us without a lot of testing, a lot of experience. And often these chemicals are not just, you know, 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're actually worked together to actually create more, more disruption than just a regular simple dose. 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 like this podcast, please share with your friends and family on social media. Leave a comment. We'd love to hear from you. How have you found your hormones are screwed up by any diet or toxins? And we'd love to hear from you.

And we'll see you next time on the doctor's Pharmacy.

Hey, everybody, it's Dr. Hyman.

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