(PEDIATRICS/WOMENS HEALTH)

Sifting the Myths and Realities of

Precocious Puberty
By Kathleen Jones, MS
Contributing Writer
In a recently overheard conversation, someone said: Did you know girls are going
through early puberty? It is from all of the hormones in the meat they eat.
Other people, reflecting on the same theme pointed the finger at soy. Still others
attribute the problem to endocrine-disrupting compounds in our food, cosmetics and
household products.
The point here is that early pubertyespecially in girlshas become a topic of
mainstream conversation, one that has raised significant concern for many parents, and
everyone concerned with the issue has a pet theory about whats to blame.
The downward shift in female pubertal age been well documented epidemiologically,
and in recent years it has received considerable media attention.
But is it really a new phenomenon?
With their recent book, The New Puberty: How to Navigate Early Development in
Todays Girls, coauthors Julianna Deardorff, PhD, and Louise Greenspan, MD, attempt
to shed greater light on this phenomenon, while dispelling some of the misinformation
as well as the anxiety that has gathered around it.
According to Deardorff and Greenspan, the age of puberty has been declining for as
long as documentation has existed. Its nothing new.
For example, in the late 1860s women did not experience their first menstrual periods
until around age 16. By the 1920s, that age had decreased to 14. Currently the age for
first menarche is roughly 12.5 years, which is down from 12.75 two decades ago.
The authors speculate that this decline in age of first menstruation is a net result of
increased access to more nutrient-dense foods over the last 150 years, including foods
high in fat such as dairy products.
Although this overall decline has slowed significantly over the past few decades, public
awareness of the phenomenon has increased. So has public anxiety.
Pubertys Lasting Longer
The onset of puberty, although typically defined by the first menstrual period, actually
begins years prior to that. The stages of puberty are recognized as breast budding,
pubic hair development, growth spurt, and finally menarche.

The initial public alarm bell about girls growing up too soon, was set off by a 1997
study by Marcia Herman-Giddens in the journal, Pediatrics. Her research showed that
breast budding was occurring with higher than anticipated frequency in young girls.
Normal puberty is defined by the National Institutes of Health as puberty that begins
naturally in girls 8-13 years old. Early puberty in girls refers to development prior to 8
years old. As a reference point, both Greenspan and Deardorff participated in a study,
published in Pediatrics in 2013, showing that less than 5% of girls began puberty before
the age of 8 only one generation ago.
Now, 18% of Asians and Caucasians, 43% of African Americans, and 31% of Spanish
girls begin puberty before turning 8.
But the age of menarche has decreased only very slightly in the past few decades.
Thus, the early puberty phenomenon reported in recent years is not so much a
reflection of decreasing menstrual age, but rather an increased incidence in early breast
development. This means that there is now a wider interval between the onset of breast
budding and pubertys culmination as menarche.
In short, puberty is lasting longer these days.
In The New Puberty, Deardorff and Greenspan detail two types of early puberty:

Central Precocious Puberty, recognized as true puberty initiated by

hypothalamic production of Gonadotropin Releasing Hormone (GnRH) which
then acts upon the pituitary to release Luteinizing Hormone (LH) and Follicle
Stimulating Hormone (FSH). This, in turn stimulates the gonads to release sex
hormones. The release of estrogen activates breast tissue development causing
breast buds, the first indication of puberty.

Peripheral or False Puberty, which begins with the gonads, thyroid, or

adrenals being activated without the involvement of the hypothalamus or the
pituitary. Though false puberty has different origins that true puberty, it still has
the same end result of physiological maturation.

When signs of development present themselves before age 8, it is important to try and
determine the cause.
If onset was triggered by the hypothalamus and pituitary, it is considered Central
Precocious Puberty. An x-ray of the wrist can confirm this by determining the childs
physiological age from measurements of the growth plates. If the hypothalamus and
pituitary are prematurely active, the x-ray determination of physiological age will suggest
that the girl is older than she is in actuality.
In these cases, a precautionary MRI makes good sense, to rule out abnormalities such
as brain tumors affecting the pituitary or hypothalamus. In the majority cases, there are
no such findings.

In very few cases, if the girl is extremely young or puberty rapidly progresses, it may
make sense to consider medicating with GnRH analogs, which block GnRH and halt the
progress, as very early development can prevent a full growth spurt from occurring and
leave the child with a short stature.
In addition, all of the emotional and psychological impacts of very early development
may weigh in favor of the drug route.
Early pubertal development is not without consequences. It has been linked to many
negative outcomes later on in life such as anxiety, depression, eating disorders, and
unwanted behaviors such as early sexual experiences, smoking, drinking, drug use, and
having older friends who can influence such behaviors.
In addition, there is an increased rate of breast cancer, ovarian cancer, cardiovascular
disease and all-cause mortality.
This does not mean that early pubertal onset causes any of these conditions, but there
is a propensity towards them. Taking action early on can help steer a child towards a
healthier life.
Dont Vilify Soy
In an interview with Holistic Primary Care, Deardorf-- a clinical psychologist at UC
Berkleychallenged what she and her colleague view as myths that have emerged
about premature puberty, including the notion that the declining age of puberty is the
result of hormones in meat, or phytoestrogens in soy.
She believes there are three dominant risk factors for early development:

Excess Fat: Adipose tissue is very biologically active and is capable of

producing hormones that can stimulate early development like estrogen. Adipose
cells also secrete leptin, which is tied to the onset of puberty. This hormone,
which is supposed to increase satiety is, necessary but not sufficient, in other
words it opens the door for puberty to commence.
Environmental Factors: Many household products contain endocrine disruptors
that may dysregulate the natural hormonal balance. These compounds include
antibiotics, phenols (like Bisphenol-A), phthalates, flame retardants, pesticides,
PCBs, and even natural compounds found in lavender and tea tree oil. Some of
these may mimic the effects of estrogen in the body and increase the chance of
hormone dysregulation and perhaps even weight gain. These substances are
found in everything from non-organic food, to beauty and cleaning products,
cookware, and even mattresses, sofas, and carpeting.
Stress: Recent research suggests that stress plays a part in pubertal timing.
Girls exposed to high levels of stress early in life tend to experience pubertal
development earlier than girls with lower stress levels. Studies have also shown
a higher prevalence of early puberty among girls who grew up without their
biological fathers, or who were adopted as infants. Early childhood stressors and

other psychosocial variables may get overlooked in our collective haste to put the
sole blame on environmental toxins or dietary factors.
Soy has gained a bad reputation as a promoter of premature puberty due to its high
phytoestrogen content. Yet recent research suggests it may not be such a culprit after
all. In fact, soy consumption may actually be beneficial. If girls are exposed to
phytoestrogens in soy at an early age, it may desensitize their estrogen receptors and
make them less reactive to the effects of real estrogen. Soy may have a protective
effect against early development, argues Dr. Deardorff.
Promote Positive Family Lifestyle
To promote optimal health in pre-pubertal girls, Deardorff recommends a whole foods
diet, with emphasis on eating organic as much as possible, especially for animal
products like meat, eggs and dairy. When organic fruits or vegetables are not an option
for whatever reason, people should know to thoroughly washing their conventionallygrown produce to decrease their pesticide exposure.
In order to improve young girls diets, Deardorff suggests tackling the low hanging fruits
first. For example, adding additional servings of whole fruits and vegetables, and
eliminating all sugary beverages can make a big difference. Although they may seem
like simple steps, these changes can actually be a great overhaul for many families. It is
important for clinicians to keep that in mind.
Given how many potentially endocrine-disrupting compounds are now present in our
food, cosmetics, and household products, it does make sense for parents concerned
about precocious puberty to eliminate products containing these substances as much
as possible.
Again, this sounds simple, but it can be overwhelming to many families and even
infeasible if they attempt to get rid of everything all at once. Similar to the dietary
recommendations, Deardorff suggests, taking baby steps, replace disposable products
with a non-toxic alternative when you run out, and hold off on replacing the big ticket
items until your budget allows.
Regular exercise and healthy sleep habits are very important for young girls, and can go
a long way in helping to regulate hormone balance and decrease excess body fata
major driver of the early puberty phenomenon. Deardorff also emphasized limiting
childrens screen time. Hours spent passively in front of computers or TVs are not
generally very healthy for young kids.
The Cuddle Factor
Deardorff believes it is very important to pay attention to the stress factors and
emotional milieu surrounding prepubertal girls. The latest research has demonstrated
that having close, warm, stable relationships and parental monitoring have strong
protective effects.

Quoting the book, Parenting Without Power Struggles by Sue Stiffelman, Deardorff
suggests the best role for parents to take is to act as captains of their ship, even when
the waters are rough, and navigating their childs development. Another way of looking
at it is for parents to act as scaffolding for their childrens growth, supporting and
structuring their development.
Parents should strive to maintain open and active lines of communication with their
daughters. Discussions that normalize body development can prove invaluable.
Deardorff recommends to start the discussions about pubertal changes with a nonthreatening subject such as hygiene and body odor, which usually precede actual
puberty.
Although boys are largely left out of public and even scientific discussion of precocious
puberty, we should not turn a blind eye. The absence of coversation is mostly because
that research is still in its infancy.
Its not clear whether boys are experiencing a similar shift in when they start puberty.
Some of the same factors that initiate puberty early in girls may delay it in boys.
From a practical viewpoint, boys can benefit from all of the same recommendations that
would be applied to girls. Even if boys are not experiencing early puberty early as
frequently as girls, they will need additional support to understand and respond
appropriately to the discrepancy in development between themselves and their siblings
or classmates.
The message that Deardorff echoed throughout the interview is that even though
precocious puberty serious concern, it warrants reasoned attention and not alarm.
There are a lot of protective factors for girls going through early puberty she stated.
Parents and physicians can take steps to protect against early puberty or mitigate the
associated negative effects. Together, they can play a vital role in shaping the future
landscape of health for todays young girls.
END
Kathleen Jones MS, is a recent graduate of New York Chiropractic College where she
received a degree in Applied Clinical Nutrition, and is currently a nutrition intern at
Maryland University of Integrative Health. She resides in Washington DC and is
pursuing certification as a Certified Nutrition Specialist practitioner through the Board for
Certification of Nutrition Specialists.

The New Puberty book: http://www.thenewpuberty.com/