Puberty Before Age 10: A New ‘Normal’?


Early Puberty

Story at-a-glance

  • Precocious puberty, which is the appearance of secondary sex characteristics like pubic hair or breast growth before age 8, or the onset of menarche before age 9, impacts at least 1 in 5,000 U.S. children, and the rate is on the rise
  • Early puberty is linked to emotional and behavioral problems, along with an increased risk of diabetes, heart disease and other cardiovascular diseases, as well as cancer, later in life
  • Environmental chemicals, and particularly estrogen-mimicking, “gender-bending” chemicals that easily leach out of the products that contain them, are a likely culprit; this includes phthalates, parabens, PFOA, bisphenol-A (BPA) and more (these environmental chemicals are also linked to other health risks like cancer and heart disease)
  • Among the best ways to avoid early puberty are to limit your child’s exposure (and your own during pregnancy) to hormone-disrupting chemicals and stress, as well as to optimize your child’s vitamin D levels and to encourage a regular exercise program.

Reaching puberty is a rite of passage that we’ve all been through, but children nowadays are reaching it earlier than ever before — a trend that has both health experts and parents alarmed.

Precocious puberty, which is the appearance of secondary sex characteristics like pubic hair or breast growth before age 8, or the onset of menarche before age 9, impacts at least 1 in 5,000 U.S. children, and the rate is on the rise.1

Even in the last three decades, children (particularly girls) are maturing at younger and younger ages (precocious puberty is 10 times more common in girls than in boys).

Puberty, Once the Norm at Age 15, Now Occurring in 7-, 8- and 9-Year-Olds

In the 19th century the onset of menstruation occurred around the age of 15. Now the average age of the first period, or menarche, is around 12. The time during and before puberty is one of rapid development and change, which is why even months matter when it comes to first menstruation. Before menstruation, girls will show beginning signs of development, such as breast “budding” and growth of pubic hair.

These signs are now becoming unsettlingly common among 7-, 8- and 9-year-old girls, to the extent that many health care providers, rather than labeling these children with a diagnosis that something is wrong, have simply changed the definition of what’s normal… but is it really “normal” for girls to mature at such a young age?

There are more questions than answers in the case of precocious puberty, but what is certain is that girls are developing earlier than they have even 10, 20 or 30 years ago.

One study in the journal Pediatrics revealed that by age 7, 10 percent of white girls, 23 percent of black girls, 15 percent of Hispanic girls and 2 percent of Asian girls had started developing breasts, with researchers noting:2

“The proportion of girls who had breast development at ages 7 and 8 years, particularly among white girls, is greater than that reported from studies of girls who were born 10 to 30 years earlier.”

Early puberty can set the stage for emotional and behavioral problems, and is linked to lower self-esteem, depression, eating disorders, alcohol use, earlier loss of virginity, more sexual partners and increased risk of sexually transmitted diseases. There is also evidence that suggests these girls are at increased risk of diabetes, heart disease and other cardiovascular diseases, as well as cancer, later in life.

Environmental Chemicals a Likely Factor

Scientists have brought forth a number of potential explanations for the rising rates of early puberty, but one that deserves special attention is environmental chemicals, and particularly estrogen-mimicking, “gender-bending” chemicals that easily leach out of the products that contain them, contaminating everything they touch, including food and beverages.

As the featured New York Times article reported:

” …animal studies show that the exposure to some environmental chemicals can cause bodies to mature early. Of particular concern are endocrine-disrupters, like “xeno-estrogens” or estrogen mimics. These compounds behave like steroid hormones and can alter puberty timing.

For obvious ethical reasons, scientists cannot perform controlled studies proving the direct impact of these chemicals on children, so researchers instead look for so-called “natural experiments,” one of which occurred in 1973 in Michigan, when cattle were accidentally fed grain contaminated with an estrogen-mimicking chemical, the flame retardant PBB.

The daughters born to the pregnant women who ate the PBB-laced meat and drank the PBB-laced milk started menstruating significantly earlier than their peers.”

This is an extreme case, but the truth is we are all part of a “secret experiment” of sorts, because hormone-disrupting chemicals are all around us. Bisphenol A (BPA), an industrial petrochemical that acts as a synthetic estrogen, is found in our plastics and our tin can linings, in dental sealants and on cash-register receipts. Laboratory tests commissioned by the Environmental Working Group (EWG) detected BPA in the umbilical cord blood of 90 percent of newborn infants tested — along with more than 230 other chemicals. As written in theNew York Times:

“One concern, among parents and researchers, is the effect of simultaneous exposures to many estrogen-mimics, including the compound BPA, which is ubiquitous.”

No one knows what happens when a developing fetus or young child is exposed to hundreds of chemicals, many of which mimic your body’s natural hormones and can trigger major changes in your body even as an adult, let along during the most rapid and vulnerable periods of development (in utero and as a young child).

BPA is, unfortunately, but one example. Others include phthalates, a group of industrial chemicals used to make plastics like polyvinyl chloride (PVC) more flexible and resilient. They’re also one of the most pervasive of the endocrine disrupters, found in everything from processed food packaging and shower curtains to detergents, toys and beauty products like nail polish, hair spray, shampoo, deodorants, and fragrances.

Other environmental chemicals like PCBs and DDE (a breakdown product of the pesticide DDT) may also be associated with early sexual development in girls. Both DDE and PCBs are known to mimic, or interfere with, sex hormones.

Perfluorooctanoic acid (PFOA), found in non-stick cookware, also falls into this dangerous category, as does fluoride, which is added to the majority of public water supplies in the United States. Research showed that animals treated with fluoride had lower levels of circulating melatonin, as reflected by reduced levels of melatonin metabolites in the animals’ urine. This reduced level of circulating melatonin was accompanied — as might be expected — by an earlier onset of puberty in the fluoride-treated female animals.

These Chemicals Also Increase Your Risk of Cancer and Heart Disease

If a chemical is capable of influencing the rate of your reproductive development, it stands to reason that it would be capable of influencing other hormone-sensitive growth processes as well, and this is indeed the case.

For instance, new research has detected the presence of paraben esters in 99 percent of breast cancer tissues sampled.3 Parabens are chemicals with estrogen-like properties, and estrogen is one of the hormones involved in not only puberty but also the development of breast cancer. They are widely used in household products such as:

Deodorants and antiperspirants Shampoos and conditioners Shaving gel Toothpaste
Lotions and sunscreens Make-up / cosmetics Pharmaceutical drugs Food additives

 

Recent research has also confirmed the existence of a previously unknown class of cancer-causing estrogen-mimicking compounds: metals. Yes, a broad range of metals have been shown to act as “metalloestrogens” with the potential to add to the estrogenic burden of the human body, thereby increasing the risk of breast cancer and also possibly early puberty. The following metals, which are added to thousands of consumer products, including vaccines, have been identified as being capable of binding to cellular estrogen receptors and then mimicking the actions of physiological estrogens:4

Aluminum Antimony Arsenite Barium Cadmium Chromium Cobalt
Copper Lead Mercury Nickel Selenite Tin Vanadate

 

Data from a long-running British health survey, meanwhile, has shown that if you have high levels of the chemical BPA in your urine, you may be at an increased risk of heart disease. Some of the greatest concern surrounds early-life, in utero exposure to BPA, which can lead to chromosomal errors in your developing fetus, causing spontaneous miscarriages and genetic damage. But evidence is also very strong showing these chemicals are influencing adults and children, too, and leading to decreased sperm quality, early puberty, stimulation of mammary gland development, disrupted reproductive cycles and ovarian dysfunction, obesity, cancer and heart disease, among numerous other health problems.

Avoiding Hormone-Disrupting Substances is Crucial for Children and Adults Alike

While young girls may show obvious signs of exposure to hormone-disrupting substances via early puberty, other signals are more insidious and may not show up until a disease is already present. Here are 11 measures you can implement right away to help protect yourself and your children from common toxic substances that could cause precocious puberty and other long-term health problems:

  1. As much as possible, buy and eat organic produce and free-range, organic meats to reduce your exposure to added hormones, pesticides and fertilizers. Also avoid milk and other dairy products that contain the genetically engineered recombinant bovine growth hormone (rBGH or rBST)
  2. Eat mostly raw, fresh foods. Processed, prepackaged foods (of all kinds) are a major source of soy and chemicals such as BPA and phthalates.
  3. Store your food and beverages in glass rather than plastic, and avoid using plastic wrap and canned foods (which are often lined with BPA-containing liners).
  4. Use glass baby bottles and BPA-free sippy cups for your little ones.
  5. Make sure your baby’s toys are BPA-free, such as pacifiers, teething rings and anything your child may be prone to suck on.
  6. Only use natural cleaning products in your home to avoid phthalates.
  7. Switch over to natural brands of toiletries such as shampoo, toothpaste, antiperspirants and cosmetics. The Environmental Working Group has a great safety guide to help you find personal care products that are free of phthalates, parabens and other potentially dangerous chemicals.
  8. Avoid using artificial air fresheners, dryer sheets, fabric softeners or other synthetic fragrances, many of which can also disrupt your hormone balance.
  9. Replace your non-stick pots and pans with ceramic or glass cookware.
  10. When redoing your home, look for “green,” toxin-free alternatives in lieu of regular paint and vinyl floor coverings.
  11. Replace your vinyl shower curtain with one made of fabric.
  12. Avoid non-fermented soy, especially if you’re pregnant and in infant formula.

Theo Colburn’s book Our Stolen Future is a great source for further investigation as it identifies the numerous ways in which environmental pollutants are disrupting human reproductive patterns. I believe it is one of the best resources on this topic and highly recommend it.

Vitamin D Also Linked to Early Puberty

It has been suggested that girls who live closer to the equator start puberty at a later age than girls who live in Northern regions. Since this indicates a potential connection with sun exposure, researchers decided to investigate whether vitamin D was, in fact, related. Upon measuring vitamin D levels in 242 girls aged 5-12, researchers from the University of Michigan School of Public Health found that those who were deficient were twice as likely to start menstruation during the study period as those with higher levels.5

Specifically, among the vitamin-D-deficient girls, 57 percent started their period during the study, compared to 23 percent with adequate vitamin D. However, researchers defined adequate vitamin D as ≥ 30 ng/mL, which is actually still a deficiency state! For optimal health, vitamin D levels should be a minimum of 50 ng/mL, which means the number of vitamin-D-deficient girls with early puberty was probably much higher than the study reported.

The earlier you enter puberty, the longer you’re exposed to elevated levels of the female hormone estrogen, which is a risk factor for certain cancers such as breast cancer. This has been the primary “link” between early puberty and cancer that has been explored, but it’s important to understand that vitamin D deficiency is also a major risk factor for cancer, heart disease and many other diseases. So it could be that some of the increased risks that come from early puberty are linked to low vitamin D levels.

 

What You Should Know About Obesity, Stress and Exercise

Obesity (which exposes girls to more estrogen because estrogen is both stored and produced in fat tissue) is another likely factor in early puberty. The New York Times reported:

“As Robert Lustig, a professor of clinical pediatrics at the University of California, San Francisco’s Benioff Children’s Hospital, explains, fatter girls have higher levels of the hormone leptin, which can lead to early puberty, which leads to higher estrogen levels, which leads to greater insulin resistance, causing girls to have yet more fat tissue, more leptin and more estrogen, the cycle feeding on itself, until their bodies physically mature.”

As for stress, this, too, has been linked to early puberty, with girls whose parents divorced when they were between 3- and 8-years-old significantly more likely to experience precocious puberty. “Evolutionary psychology offers a theory,” the New York Timesreports. “A stressful childhood inclines a body toward early reproduction; if life is hard, best to mature young. But such theories are tough to prove.” Interestingly, in addition to avoiding environmental chemicals, obesity and stress, and optimizing your vitamin D, regular exercise appears to be one of the best known ways to help prevent early puberty.

The clock ticks faster.


The signs of physical and functional decline may take a few years to show
APThe signs of physical and functional decline may take a few years to show
Early puberty, hypertension and diabetes in children, early menopause… The alarming issue of premature ageing points inescapably to our way of living, finds out Sudha Umashanker

Girls as young as seven or eight coming of age, young children being diagnosed with hypertension and diabetes, women with plummeting ovarian reserves in their late 20s or early 30s — the ageing clock seems to be ticking differently these days.

Kousalya Nathan, lifestyle and age management consultant, Nova Specialty Surgery, Chennai, points out, “More than ageing and its associated degenerative disorders, the alarming problem is premature ageing, which implies significant functional decline in various organs due to unmanaged lifestyle disorders.”

As the International Journal of Diabetes Care (1999) states, “Although Type 2 Diabetes Mellitus has historically been characterized as an adult onset of diabetes, it has been shown to be on the rise in young people in recent years, comprising some alarming 30 per cent of new cases of diabetes in the second decade of life. The mean age at diagnosis of Type 2 Diabetes in young people is 12-14 years.” (Incidentally, Indian ethnicity is at higher risk.)

Listing out the factors suggestive of the prevalence of premature ageing, Dr. Nathan notes, “Early puberty is a pointer. We also live in an environment that favours unhealthy weight gain in children and adolescents. This has reached epidemic proportions in India, with consequences ranging from inability to play or climb stairs, to hypertension, dyslipidemia, back pain and psychosocial problems. Even greying and loss of skin tone, which are signs of middle age, are seen in 10- to 12-year-olds. In the worst-case scenario, deaths due to non-communicable diseases in those in their 30s and 40s are also happening.”

Nandita Palshetkar, infertility specialist, Lilavati Hospitals Mumbai and Fortis Bloom IVF Centres, says, “Nowadays, more and more girls are attaining early puberty. Earlier, puberty which was seen at age 12 is now seen at the age of seven to eight years, in approximately 15 per cent of the girls. There are several reasons for this — such as unhealthy weight gain, stress, estrogens-like hormones such as bisphenol A found in hard plastics, certain metals that act as metalloestrogens, (eg. tin, cadmium, mercury, lead and aluminium, copper), situations in which the father is absent or the child is living with the step-father, Vitamin D deficiency, early exposure to sex-related messages in the media etc. Higher body mass index is associated most often with lifestyle changes that have occurred in the last couple of decades in our society. Early puberty, in turn, is associated with repercussions such as increased risk of heart problem, osteoporosis and early menopause.”

Rapid depletion of ovarian reserves, and therefore early ovarian ageing in young women, is yet another cause of concern. While it could be due to polycystic ovaries, in several cases, the cause is unknown. “Measures must be taken to reduce contamination by Endocrine Disrupting Compounds (EDCs) if we want to take steps to decrease reproductive disorders in women of the next generation,” stresses Dr. Palshetkar. EDCs that affect the functioning of the thyroid and ovary are found in pesticides, dioxins (produced when plastic is burnt, certain industrial processes and from improper incineration of waste), bisphenols (found in hard plastics, some baby bottles, water bottles and the insides of some food and beverage cans.) Corroborating the incidence of diabetes in overweight young children, Vijay Viswanathan, head and chief diabetologist, M.V. Hospital for Diabetes, Chennai, says that a recent survey in Chennai done by his institution showed that “many children who were overweight had raised blood pressure levels. These children showed aspects of insulin resistance, which makes them prone to hypertension and also diabetes.”

Asked if this can be considered a form of ageing, Dr. Viswanathan affirms, “Yes, this is a type of ageing, since the blood vessels develop stiffness and lose their elasticity even by the age of 10 or 15 in children who are insulin-resistant. These early blood vessel changes make these children prone to developing hypertension at an early stage, and may also lead to heart blocks by the time they get into their 20s or 30s.”

What are the signs that should alert us before visible changes of ageing happen?

Weight gain, skin discoloration in underarms, inner thighs, nape of the neck, frequent infections, tiredness, irregular periods in girls, rough skin, overeating and eating disorders, stress and sleeping difficulties in children,” should put us on the alert, says Dr. Nathan.

While there are molecular-level changes of ageing in children, to see the physical and functional decline, it might take a few years. “It is a complex and multi-factorial process. Lifestyle accelerates loss of genetic materials, causing premature ageing,” Dr. Nathan concludes.

Preventive steps

Lifestyle modification is top priority.

– Opt for an anti-ageing diet — 60 per cent complex carbohydrates (legumes, cereals and vegetables), 20 per cent protein (white meat, dal, paneer, tofu, soy protein), 20 per cent fats (nuts, olives, sesame seeds, pumpkin seeds)

– Undertake regular physical activity

– Avoid exposure to estrogens-like compounds and environmental toxins

– Consume organically-grown vegetables

– Teach children to bust emotional stress by taking up creative pursuits

 

The clock ticks faster.


The signs of physical and functional decline may take a few years to show
AP The signs of physical and functional decline may take a few years to show
TOPICS

Early puberty, hypertension and diabetes in children, early menopause… The alarming issue of premature ageing points inescapably to our way of living, finds out Sudha Umashanker

Girls as young as seven or eight coming of age, young children being diagnosed with hypertension and diabetes, women with plummeting ovarian reserves in their late 20s or early 30s — the ageing clock seems to be ticking differently these days.

Kousalya Nathan, lifestyle and age management consultant, Nova Specialty Surgery, Chennai, points out, “More than ageing and its associated degenerative disorders, the alarming problem is premature ageing, which implies significant functional decline in various organs due to unmanaged lifestyle disorders.”

As the International Journal of Diabetes Care (1999) states, “Although Type 2 Diabetes Mellitus has historically been characterized as an adult onset of diabetes, it has been shown to be on the rise in young people in recent years, comprising some alarming 30 per cent of new cases of diabetes in the second decade of life. The mean age at diagnosis of Type 2 Diabetes in young people is 12-14 years.” (Incidentally, Indian ethnicity is at higher risk.)

Listing out the factors suggestive of the prevalence of premature ageing, Dr. Nathan notes, “Early puberty is a pointer. We also live in an environment that favours unhealthy weight gain in children and adolescents. This has reached epidemic proportions in India, with consequences ranging from inability to play or climb stairs, to hypertension, dyslipidemia, back pain and psychosocial problems. Even greying and loss of skin tone, which are signs of middle age, are seen in 10- to 12-year-olds. In the worst-case scenario, deaths due to non-communicable diseases in those in their 30s and 40s are also happening.”

Nandita Palshetkar, infertility specialist, Lilavati Hospitals Mumbai and Fortis Bloom IVF Centres, says, “Nowadays, more and more girls are attaining early puberty. Earlier, puberty which was seen at age 12 is now seen at the age of seven to eight years, in approximately 15 per cent of the girls. There are several reasons for this — such as unhealthy weight gain, stress, estrogens-like hormones such as bisphenol A found in hard plastics, certain metals that act as metalloestrogens, (eg. tin, cadmium, mercury, lead and aluminium, copper), situations in which the father is absent or the child is living with the step-father, Vitamin D deficiency, early exposure to sex-related messages in the media etc. Higher body mass index is associated most often with lifestyle changes that have occurred in the last couple of decades in our society. Early puberty, in turn, is associated with repercussions such as increased risk of heart problem, osteoporosis and early menopause.”

Rapid depletion of ovarian reserves, and therefore early ovarian ageing in young women, is yet another cause of concern. While it could be due to polycystic ovaries, in several cases, the cause is unknown. “Measures must be taken to reduce contamination by Endocrine Disrupting Compounds (EDCs) if we want to take steps to decrease reproductive disorders in women of the next generation,” stresses Dr. Palshetkar. EDCs that affect the functioning of the thyroid and ovary are found in pesticides, dioxins (produced when plastic is burnt, certain industrial processes and from improper incineration of waste), bisphenols (found in hard plastics, some baby bottles, water bottles and the insides of some food and beverage cans.) Corroborating the incidence of diabetes in overweight young children, Vijay Viswanathan, head and chief diabetologist, M.V. Hospital for Diabetes, Chennai, says that a recent survey in Chennai done by his institution showed that “many children who were overweight had raised blood pressure levels. These children showed aspects of insulin resistance, which makes them prone to hypertension and also diabetes.”

Asked if this can be considered a form of ageing, Dr. Viswanathan affirms, “Yes, this is a type of ageing, since the blood vessels develop stiffness and lose their elasticity even by the age of 10 or 15 in children who are insulin-resistant. These early blood vessel changes make these children prone to developing hypertension at an early stage, and may also lead to heart blocks by the time they get into their 20s or 30s.”

What are the signs that should alert us before visible changes of ageing happen?

Weight gain, skin discoloration in underarms, inner thighs, nape of the neck, frequent infections, tiredness, irregular periods in girls, rough skin, overeating and eating disorders, stress and sleeping difficulties in children,” should put us on the alert, says Dr. Nathan.

While there are molecular-level changes of ageing in children, to see the physical and functional decline, it might take a few years. “It is a complex and multi-factorial process. Lifestyle accelerates loss of genetic materials, causing premature ageing,” Dr. Nathan concludes.

Preventive steps

Lifestyle modification is top priority.

– Opt for an anti-ageing diet — 60 per cent complex carbohydrates (legumes, cereals and vegetables), 20 per cent protein (white meat, dal, paneer, tofu, soy protein), 20 per cent fats (nuts, olives, sesame seeds, pumpkin seeds)

– Undertake regular physical activity

– Avoid exposure to estrogens-like compounds and environmental toxins

– Consume organically-grown vegetables

– Teach children to bust emotional stress by taking up creative pursuits

Precocious puberty in girls may carry risk for psychological problems.


Girls who begin puberty before 8 years of age are at risk for psychological problems, sexual abuse and early pregnancy, according to information published in a review in the United Kingdom.

“Starting puberty early can have a significant impact both psychologically and socially on both the child and her family. Puberty marks the start of a child’s sexual development, and early onset could result in a higher risk of sexual abuse,” Sakunthala Sahithi Tirumuru, MRCOG, specialist registrar in the department of obstetrics and gynecology at Alexandra Hospital in the United Kingdom, said in a press release.

Tirumuru and colleagues said early puberty may cause short adult height, besides psychological problems brought on by high levels of sex steroids and demand for maturity based upon outward appearance.

The cause is often unclear in most girls with central precocious puberty, but evidence of underlying conditions should be examined, they said.

According to the review, treating precocious puberty should halt or regress secondary sexual characteristics, prevent early menarche, slow skeletal maturation and improve adult height and prevent psychological problems. Gonadotropin-releasing hormone treatment, “the mainstay of therapy,” they wrote, is usually ceased during the time at which normal puberty should begin. The decision to end therapy should be shared by the endocrinologist, patient and the parents or caregivers. Adverse effects of treatment include headaches, hot flashes, mood swings and injection site reactions.

However, further review of the effects of hormone therapy is needed, Tirumuru said.

“This all needs to be considered by the health care team, and further studies are needed to evaluate the effects of hormone treatment on quality of life and long-term impact,” she said.

Additionally, to effectively manage girls with suspected premature sexual development, it is paramount that the physiology and timing of normal pubertal events is made clear.

“The appropriate age thresholds for the definition of precocious puberty remain controversial: Well-performed longitudinal assessments of normally developing children are needed to inform these criteria. The best approach for differentiating progressive from non-progressive forms of precocious puberty remains unclear,” the researchers wrote.

Source: Endocrine Today