Question:
My 8 yr old daughter is showing signs of premature onset of pubery; she has adult-grade underarm odor, blemishes, headaches, and a few hairs under her arms. I have researched out the possible reasons, ie: environmental(plastics & pollutiants) & dietary(hormones in meats & dairy, etc) causes, and am being/have been as cautious as possible. Now I am seeking intervention to stop/slow this process and save her childhood. It is not genetics, in her case(my side of family-puberty started around 15, her fathers side-around 13). Is there a way to slow this overabundance of estrogen!! Homeopathic, or safe medicine??? I am doing everything else. Please help. Thank you
Sarah Doty   

Dr. Greene’s Answer:
I share your concerns, Sarah, about kids being exposed to too many estrogens from dietary and environmental sources – and in some cases (too many cases) from excess body fat.

You may be pleased, or not, to know that onset of puberty in an 8-year-old girl is now considered normal. Early puberty is usually defined as starting before the 8th birthday in girls.

The starting age for puberty has been falling in recent years, and in 1999 the Pediatric Endocrine Society lowered the age of concern even younger, suggesting intervening only when puberty starts before the 7th birthday in white girls or before the 6th birthday in black girls.

I do recommend that 8-year-olds in puberty have a careful evaluation by a doctor skilled in this area. There are medicines (and if there is abnormal hormone secreting tissue – surgery) that can slow or stop puberty until a better time.

Other than that, vigorous daily exercise is perhaps the safest and most effective way to slow puberty. In fact, young female athletes sometimes don’t start their periods until they decrease their training schedule, or increase their body fat to 16%.

Aiming for an ideal body weight can be helpful too, through getting a healthy amount of calories every day. I don’t recommend skipping meals, though, or restricting calories below what kids need to thrive.

Quercitin compounds, nutrients found in fruits, vegetables, leaves and whole grains (notably in green and black tea, citrus fruits, apples, red grapes, buckwheat, red onions, tomatoes, broccoli and leafy greens) are known to bind to estrogen receptors in the body and help correct effects from too much estrogen exposure.

The jury is out on whether quercitin supplements, in their isolated form, would help or hurt here.

But I am a big fan of making quercitin-rich foods a part of the diet every day. There’s enough variety in these foods that they could even be part of every meal and snack.

Some studies have found significantly higher quercitin levels in organic produce.

What you are already doing to avoid unecessary estrogens in meats, plastics, pesticides and personal care products is wise for any child, and especially with puberty starting at 8 years old. Your daughter is fortunate to have such an informed and pro-active mother. My best to you both.

Recent headlines have trumpeted an exciting study about how pomegranate juice may prove very useful at preventing and even treating breast cancer. In test tubes, it’s proven quite effective against breast cancer cells. It turns out that pomegranate juice functions as something we call an aromatase inhibitor. Aromatase is an enzyme that takes testosterone and turns it into estrogen; it’s been linked to causing breast cancer. (This is one of the reasons I hate Atrazine, one of the most widely used pesticide weed killers in American agriculture: Atrazine stimulates aromatase. And we spray the stuff on our food!?). Aromatase inhibitor medicines are among the most exciting developments in preventing and treating breast cancer. And pomegranate juice contains clinically significant amounts.

As a pediatrician, my mind races to possible quicker benefits of pomegranate juice for kids:

• Preventing early puberty in girls. Puberty is starting earlier in girls. In 1993, the average age for breast development was just before the 11th birthday, now the average is while they are still 9. It’s no longer unusual to see a girl with breasts in a 2nd grade class. (Early puberty increases risk for breast cancer later, by the way). Aromatase inhibitor medicines have been used successfully to treat precocious puberty. Might pomegranate juice be a gentle way to help prevent it? Someone please do the study!
• Preventing breast buds in teen boys. Today about 60 percent of boys develop breast buds during puberty. These breast buds come from an imbalance between estrogen and testosterone. Brief breast buds then can be normal, but today, for 25 percent they last for 2 years or more. Aromatase inhibitor medicines have been used with some success to reduce their size and decrease their tenderness. Might pomegranate juice be a gentle way to prevent this? Someone please do the study! (And maybe one on adult men, too).
• Preventing short stature in boys and girls. Aromatase inhibitor medications have also have also been used to add modestly to adult height in children with short stature. Might pomegranate juice be a gentle way to help here as well?

(N.B. Most of today’s kids get too many sweet calories in their drinks, and I agree with the Academy of Pediatrics in recommending no more than 4 to 6 ounces a day of fruit juice before age 6, and no more than 8 to 12 ounces for older children.)

Pomegranates are one of 21 types of foods that I recommend in Feeding Baby Green to teach your child to love. Each of these diverse foods have been eaten by humans for thousands of years, and are packed with goodness we have yet to discover – and inhibiting aromatase is just the latest example.

I recently visited the King Tut exhibition at the de Young Museum in San Francisco and alerted my friends on Twitter when I learned that pomegranate seeds had been hidden in his tomb. Among the wealth of treasures there, this fruit is right at home.

Adams, L.S., Zhang, Y., Seeram, N.P., Heber, D., and Chen, S. “Pomegranate Ellagitannin-Derived Compounds Exhibit Antiproliferative and Antiaromatase Activity in Breast Cancer Cells In vitro.” Cancer Prevention, Jan 2010, 3(1):108-113.

Aksglaede, L., Skakkebaek, N.E., and Juul, A. “Recent Decline in Age at Breast Development: The Copenhagen Puberty Study.” Pediatrics, May 2009, 123(5):e932-939.

American Academy of Pediatrics, Committee on Nutrition. “The Use and Misuse of Fruit Juice in Pediatrics.” Pediatrics, May 2001, 107(5):1210-1213.

Cernich, J., Jacobsen, J.D., Moore, W.V., and Popovic, J. “Use of Aromatase Inhibitors in Children with Short Stature.” Pediatric Endorcinologic Review, Sep 2004, 2(1):2-7.

Feuillan, P., Merke, D., Leschek, E.W., and Cutler, G.B. “Use of Aromatase Inhibitors in Precocious Puberty.” Endocrine-Related Cancer, 1999, 6:303-306.

Riepe, F.G., Baus, I., Wiest, S., Sippell, W.G., and Partsch, C.J. “Treatment of Pubertal Gynecomastia with the Specific Aromatase Inhibitor Anastrozole.” Hormone Research in Paediatrics, 2004, 62:(3):113-118.

Shulman D.I., Francis, G.L., Palmert, M.R., and Eugster, E.A. , for the Lawson Wilkins Pediatric Endocrine Society Drug and Therapeutics Committee. “Use of Aromatase Inhibitors in Children and Adolescent with Disorders of Growth and Adolescent Development.” Pediatrics, Apr 2008, 121(4):e975-983.

From 1973 to 1999, childhood cancers increased by 26 percent, making cancer the greatest health threat to children. Currently, one in a 100 8-year-old children in the U.S. have been diagnosed with autism spectrum disorder, according to U.S. Centers for Disease Control and Prevention researchers, and the number might be as high as 1 in 58 for boys, according to a phone survey in the journal, Pediatrics. According to Robyn O’Brien, author of The Unhealthy Truth, one out of every three U.S. kids currently suffers from allergies, asthma, ADHD, or autism—our children’s bodies are clearly under assault. But why?

In yesterday’s article I mentioned how, as one concerned father, I set out to try to find out the dangers that are children are facing and how I learned about something called endocrine disruption, or the disruption of the hormones that control everything from mood to gene expression.

As I was researching my fact-based novel, one of the things I discovered was that since World War Two, approximately 80,000 chemicals have been invented, and thousands of these have been produced in excess of millions of pounds per year. Only a small percentage of these chemicals have ever been tested to discover their effects on animals and humans. (If you want to discover how the chemical industry undermined government regulation, watch Bill Moyers brave and brilliant documentary, Trade Secrets.)

We feed these chemicals to our children through the chemicals on the food they eat, in the water they drink, in the lotions we put on their skin, in the products that they touch, and even in the air they breath. A recent study of fetal cord blood—the blood a child is born with before they take their first breath—found 413 chemicals and on average more than 200 different chemicals per child.

Many endocrine disrupting chemicals are plastics. You may have heard of the chemical Bisphenol A, or BPA, which is a plasticizer that has been used to make plastic bottles (including baby bottles), to coat children’s teeth so they don’t get cavities, and to line canned food. In lab animals (we can not do controlled studies on people for obvious reasons), BPA has been shown to impair brain development, cause down syndrome, cause breast cancer, prostate cancer, low sperm count, and even obesity.

Obesity? Have a look at this picture. The mouse on the left is a normal mouse; the one on the right was exposed to tiny amounts of BPA during its gestation. Could exposure to this chemical, seven billion pounds of which is produced and put into our environment every year, play a role in the epidemic in adult and childhood obesity that is spreading around the world?

Why don’t you know about this? Well, let’s just say there are lots of people who don’t want you to know about this and have worked hard to obscure the facts. On Sunday, May 31, 2009, the Washington Post broke the story that manufacturers of packaging for beverages and foods, including some of their customers, like Coca-Cola, were trying to defend the use of BPA and use “scare tactics” to make sure that the chemical was not banned. I couldn’t believe it. It was as if some of the villains from my novel had come to life. But if I had my characters try to recruit a pregnant woman to discuss the benefits of BPA—as they industry execs apparently did—no one would have believed it.

Out of shortsighted economic interests, also known as greed, we are conducting an unprecedented experiment on the health of our children.

Tomorrow, we will look at how what’s happening to our children is happening to the whole planet, and the next day why some children get sick and other’s don’t. Then we’ll discover the silver lining and what can turn this around. Finally, on Friday, we look at what you can do to try to keep your family safe.

For more information about endocrine disruption, the research mentioned in this blog post, and about Doug’s fact-based eco-thriller, Eye of the Whale, please visit www.DouglasCarltonAbrams.com.

Precocious puberty is defined as the onset of true puberty before 8 years of age in girls or 9 years of age in boys. (Boepple, et al. Endocrinology, Surgery, and Technology, Vol 1, 1996)

Isolated breast development that doesn’t progress to the rest of puberty is called premature thelarche, and is a different, benign condition.

Precocious puberty is 10 times more common in girls than in boys. Sexual development may begin at any age. Pregnancy has been reported as early as 5 1/2 years old.

The Lawson Wilkins Pediatric Endocrine Society recommends evaluating for an underlying medical condition in Caucasian-American girls who have development of breast and/or pubic hair before age seven and in African-American girls before age six (Kaplowitz and Oberfield, Pediatrics 1999 Oct;104(4 Pt 1):936-41). These medical conditions include tumors, cysts, thyroid problems, McCune-Albright syndrome, or external sources of estrogen. Doing studies to look into these possible causes is especially important in girls younger than 6, and in all boys.

The earlier before age 12 a girl starts her period, the higher her lifetime risk for breast cancer (probably from the prolonged estrogen exposure). The highest average risk for breast cancer is in non-Hispanic white women, where it is 1 in 8, or 12.5%. In all girls who start their periods before the age of 12, taken together, the risk is 16.25%.

As a girl reaches maturity, she needs to be made aware of controllable risk factors for breast cancer, such as use of estrogen-containing birth control pills (10 years of use would raise her risk to about 22%), first pregnancy after age 30 (if she did this also, it would raise the risk to about 35%), high-fat diet, alcohol use, fertility drugs, pesticides, and radiation exposure. Each of these factors multiplies her accumulated risk.