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

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. We know that kids that are overweight or obese go into 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.

Starting point is 00:00:23 So it becomes almost this vicious cycle. Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me, helping patients heal using real food and functional medicine as your framework for getting to the root cause. What's critical to understanding what each individual person and body needs is testing, which is why I'm excited to tell you about Rupa Health. Looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables can help us find the most effective path to optimize health and reverse disease. But up till now, that meant you were usually ordering tests

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Starting point is 00:03:05 awake and focused and balanced after enjoying my matcha every morning. Right now, you can take advantage of their limited time special offer on your first order of Sun Goddess Matcha and the other delicious teas from Peak. Just head over to peaktea.com, four-size hymen, use the code hymen, and that's P-I-Q-U-E, peak, T-E-A-A,.com slash Hyman with the code Hyman for 5% off and free shipping when you purchase two or more cartons. You may also get a free bamboo whisk while supplies last. Now let's get back to this week's episode of The Doctor's Pharmacy. 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

Starting point is 00:03:49 that's happening in our children in early puberty and how the environment may be affecting us, you should listen up to this podcast because 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. You know, one of the things that I learned over the last few decades in practicing functional

Starting point is 00:04:33 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, so tell us, what is going on with all these kids getting puberty when they're much younger than they should be getting puberty? Yeah, it's, you're absolutely right, right? We're seeing a lot of hormonal weirdness or shifts in

Starting point is 00:05:19 our, our health because of shifts in our hormones. And so let's, 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?

Starting point is 00:06:02 I was like a short, trimmy 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 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

Starting point is 00:06:55 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.

Starting point is 00:07:23 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, you know, 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 seven to 23% of, I mean,

Starting point is 00:08:28 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 a 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 underappreciation of the way in which both toxins and food drive changes in our hormones.

Starting point is 00:09:12 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, you know, we're seeing 20% of our kids in the U.S. 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

Starting point is 00:10:15 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 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 starch, the carbohydrates, the sugar. What's the mechanism that it uses to drive the changes?

Starting point is 00:11:03 Well, there's a few things, but our diet impacts our hormonal balance. And one of the things that our diet drives is insulin. And 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

Starting point is 00:11:52 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 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, 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 estrogen that gets produced as a result of

Starting point is 00:12:51 high levels of insulin and obesity and the fat cells basically producing extra estrogen through aromatase, which is this enzyme that converts, you know, like for men, for example, converts testosterone into, into estrogen, which is not good. Yeah, no fun. And 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 infertility. Talk about the role of the environmental toxins, because I think there's 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

Starting point is 00:13:29 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. 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

Starting point is 00:14:18 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 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. 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, you know, but I was just looking at the package and there was parabens in it. And I was like, that's right. Exactly. I mean, I think of parabens all the time when I'm picking out

Starting point is 00:15:11 my moisturizers, exactly. My sunblock, my makeup, my, you know, we know things that have methyl paraben, butyl paraben, propyl paraben, all of those parabens, shampoos, conditioners, our body care products are estrogen disruptors, right? They are, they are xenoestrogens. They combine 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, you know, there's parabens in processed foods, muffins, you know, and then these, these corn tortillas, I was like, I guess it makes it soft and pliable. Why are we eating parabens? I have no idea. These are petrochemical products.

Starting point is 00:16:03 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 the amount of devastation to our environment from these compounds and then their effect on our human biology is just staggering. I remember reading a book years ago, you probably remember this one, called Our Stolen Future by Theo Colburn, where she talked about these

Starting point is 00:16:35 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? 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,

Starting point is 00:17:19 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 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 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

Starting point is 00:18:18 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, no, 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 deal with it from a dietary perspective and from addressing the environmental exposures to reduce them? And

Starting point is 00:18:59 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? I think that 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 start avoid, stop, you know, you know, putting chemicals on your lawn. Buy organic whenever possible, you know, really start to avoid chemical exposure as much as you can. And then we talk about what can we do

Starting point is 00:19:43 to support the body's detoxification capacity. And one of the biggest things to work on here 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, 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 no plant foods, right? There's no colorful plant foods. It's all processed package junk, you know? And, um, junk. And so it's really, that's not supporting our detoxification systems in our body. And so 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

Starting point is 00:20:46 on a regular daily basis to support 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.

Starting point is 00:21:15 And then in the food part, that's what really we do at the Cultural 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'd be really, really useful to have an understanding about that. You know, 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

Starting point is 00:21:49 diagnostic criteria for precocious puberty, which as we said, for girls is less than eight. So, but, but mom was concerned about her development. You know, she noticed that she was having an easier time gaining weight. She was developing faster than her other sisters. And, um, and mom was really concerned. Like, is this, is this something we should be worried about? What can we do about it? And, you know, so her in general, her physical exam was very non-concerning. Um, but what, what we did notice is that she was overweight. Officially she was obese. So when, when with children, when they're greater than 95% of the, uh, of their BMI for their age, they're considered obese. So they, they measure based on the growth chart and, and we, or we measure based on the growth

Starting point is 00:22:39 chart and look at what is your percentage above the, uh, 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 a really detailed history that there was, 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. We did do some testing with her in terms of the xenoestrogens and how she detoxified. And her levels looked pretty good.

Starting point is 00:23:36 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 work to make sure that all the skincare products they were using were clean. We work 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, and, you know, she did really well her, 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.

Starting point is 00:24:29 And then she actually started her period at the age of 13, which was 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. That's 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. You work on their diet and their environmental exposures. You can really make a difference. That's what you're saying. Absolutely, right?

Starting point is 00:24:46 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, 1,000 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 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 on them. It's pretty scary when you start

Starting point is 00:25:31 thinking about it, but it's worth really focusing on because, you know, 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? Just get them eating right from the start makes a huge impact on their overall health. And we're seeing, you know seeing this problem was 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, you know,

Starting point is 00:26:12 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 this could be a depressing conversation. I think it's hopeful because it's like,

Starting point is 00:26:30 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 a whole foods, plant-rich diet, really high quality food. It 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

Starting point is 00:26:53 great resource for that, awg.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's kind of 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 the things that are causing harm and improve the things that are needing your body to thrive. Absolutely. Absolutely. Well, Liz, this has been a great conversation about a very

Starting point is 00:27:39 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 and we see the stories that are happening in the literature around this it's it to me it's it's like we're just we're just like the guinea pigs now and 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

Starting point is 00:28:15 all synergistic. It's not just one plus one equals two. They're actually worked together to actually create 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,

Starting point is 00:28:32 please share 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 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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The Dr. Hyman Show - The Functional Medicine Approach To Precocious Puberty with Dr. Elizabeth Boham

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