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Joel Fuhrman, M.D.

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Girls' Early Puberty: What Causes It, And How To Avoid It

Posted: 05/06/11 09:40 AM ET

Today in the U.S., about 16 percent of girls enter puberty by the age of 7, and about 30 percent by the age of 8. A recent study determined that the number of girls entering puberty (defined by breast development) at these early ages has increased markedly between 1997 and 2010.[1]

Trends in Age at Menarche
The average age at menarche in Western countries began declining during the early part of the 20th century due to increased consumption of animal products and increasing calorie intake; the decline slowed in the 1960s, and now in the U.S. there has been a more recent surge in early puberty starting in the mid-1990s.[2]

In Europe, in 1830, the average age at menarche was 17. Similarly in the 1980s in rural China, the average age at menarche was 17.3 In the U.S. in 1900, the average was 14.2. By the 1920s, average age at menarche in the U.S. had fallen to 13.3 and by 2002, it had reached 12.34.[4] Similar trends are occurring in other Western nations.[5,6] For example, age at menarche in Ireland has declined from 13.52 in 1986 to 12.53 in 2006.[7] In Italy, a recent study showed that girls' age at menarche was on average 3 months earlier than their mothers'.[8]

Taking all this data together, we can estimate that the normal, healthy age at menarche under conditions of excellent nutrition without caloric excess would probably fall somewhere between 15 and 18. But today in the U.S., about half of girls begin developing breasts before age 10, and the average age at menarche is less than 12 ½ and still declining.

Why Is this happening?
The neurological and hormonal systems that regulate pubertal timing are complex, but research has identified a number of environmental factors that may be contributing to the decline in age at puberty:

Increasing rates of childhood overweight and obesity
Several studies have found associations between higher childhood BMI and earlier puberty in girls.[4,9-11] Excess body fat alters the levels of the hormones insulin, leptin, and estrogen, and these factors are believed to be responsible for the acceleration of pubertal timing by obesity. Also, physical inactivity may decrease melatonin levels, which can also affect signals in the brain that trigger pubertal development.[4, 12]

Increased animal protein intake
Higher total protein, animal protein, and meat intake in children age 3-7 have been associated with earlier menarche in multiple studies.[13-15] In contrast, higher vegetable protein intake at age 5-6 is associated with later menarche.[15] High protein intake elevates IGF-1 levels and promotes growth, which could accelerate the onset of puberty - IGF-1 contributes to pubertal development on its own and in part by its involvement in estradiol signaling.[4,16] Meat and dairy consumption in children may also reflect ingestion of environmental endocrine-disrupting chemicals (EDCs) that have accumulated in animal tissues (see EDCs below).

Other dietary factors:
High dairy consumption is associated with earlier than average menarche.[17] Soft drink consumption is associated with early menarche.[18]

Children with lower nutrient diets (based on analysis of macronutrients, vitamins, minerals, and certain whole foods) tend to enter puberty earlier.[19] Overall our modern diet rich in processed foods, dairy, processed meats and fast food is disruptive to normal development and aging. Early puberty is an early sign of premature aging.

Exposure to endocrine-disrupting chemicals (EDCs)
EDCs are hormonally active synthetic chemicals that either mimic, inhibit, or alter the action of natural hormones. These chemicals are ubiquitous in our environment, and are considered by scientists to be a significant public health concern. Although EDCs are thought to pose a threat to adults as well, children's bodies are more sensitive to exposure to exogenous hormones.[20]

Chemicals are not currently tested for their endocrine disruption potential before they are approved for use and enter our environment, and there are endocrine disruptors in a vast array of products we come into contact with every day, including organochlorine pesticides, plastics, fuels, and other industrial chemicals.[21]

The substances of most concern currently are BPA and phthalates. BPA is one of the highest volume chemicals produced in the world. It is used in the manufacture of polycarbonate plastics, such as rigid cups, water bottles and food storage containers; BPA is also found in the linings of food cans and dental sealants. BPA can leach from containers into food and beverages, especially during heating and washing.[4] BPA exposure is associated with early puberty in girls.[22]

Phthalates are chemicals used to make PVC plastics more flexible, and are found in a variety of products including toys, food packaging, hoses, raincoats, shower curtains, vinyl flooring, wall coverings, lubricants, adhesives, detergents, nail polish, hair spray, and shampoo. Phthalates are associated with early breast development in girls.[22, 23] They are considered chemicals of concern to the EPA and may be phased out -- some phthalates have already been removed from children's toys and cosmetics. [24]

Additional EDCs that have been associated with dysregulation of pubertal timing include industrial chemicals such as PCBs, pesticides such as DDT and endosulfan, the flame retardant PBB, and dioxins and furans, which are formed during incineration of waste, chlorine bleaching of paper, and chemical manufacturing. [22,23,25,26]

It is important to note that EDCs break down very slowly and accumulate in the fatty tissues of animals, so animal foods contain higher levels of these chemicals than plant foods.

Why is this troublesome?
The most significant and alarming consequence of early maturation is an increased risk for breast cancer in adulthood. Early menarche is an established risk factor for breast cancer, and this is believed to be due to the extended lifetime exposure to ovarian hormones.[10,27,28] Similarly, exposure to EDCs during childhood is associated with hormonal cancers, such as breast and testicular cancers.[29-31]

Girls of 7, 8 or 9 years old are not emotionally or psychologically equipped to handle puberty. As such, earlier puberty is also associated with a higher risk of psychological problems during adolescence such as anxiety, depression, and eating disorders. Girls who mature earlier are also more likely to take part in risky behaviors like smoking and alcohol use.[4,12]

What can parents do to protect their children?

  • Children's diets should focus on whole plant foods rather than animal foods -- this will keep protein intake in a safe range and reduce their consumption of EDCs.

  • Minimize dairy products in children's diets -- use almond and hemp milks instead of cows' milk

  • Encourage children to exercise and exercise with them.

  • Minimize processed foods -- these are calorie-dense and nutrient-poor, and they promote obesity and other diseases.

  • Children's diets should include a wide variety of natural plant foods as possible including, green vegetables, squashes, corn, carrots, tomatoes, onions, mushrooms, nuts, seeds, avocados, beans, fruits and whole grains. This means that healthy eating is a lifetime event.

  • Buy organic produce when possible to avoid synthetic pesticides.

  • Minimize children's exposure to BPA: Avoid using of rigid polycarbonate plastics (recycling label #7) whenever possible; Do not use plastic water bottles if they are old or scratched; Do not microwave in plastic containers; Minimize the use of canned foods and avoid canned infant formulas.32

  • Minimize children's exposure to phthalates:Avoid plastics marked with recycling label #3 (PVC) whenever possible; Check ingredient lists on personal care products for phthalates. Also be aware that "fragrance" listed as an ingredient often means that the products contains phthalates. For more information, visit the Environmental Working Group's guide to children's personal care products.

To conclude, the earlier occurrence of puberty is an ominous event that we can stop. We can even win the war on breast cancer in America and prevent millions of young females from developing it. The answer however, must begin in the way we feed ourselves and our children. The most effective type of health care is vigilant and excellent self care.


References:
1. Biro FM, Galvez MP, Greenspan LC, et al: Pubertal Assessment Method and Baseline Characteristics in a Mixed Longitudinal Study of Girls. Pediatrics 2010.
2. Biro FM, Khoury P, Morrison JA: Influence of obesity on timing of puberty. Int J Androl 2006;29:272-277; discussion 286-290.
3. Gates JR, Parpia B, Campbell TC, et al: Association of dietary factors and selected plasma variables with sex hormone-binding globulin in rural Chinese women. Am J Clin Nutr 1996;63:22-31.
4. Steingraber S: Tha Falling Age of Puberty in U.S. Girls: What We Know, What We Need To Know. In Breast Cancer Fund; 2007.
5. McDowell MA, Brody DJ, Hughes JP: Has age at menarche changed? Results from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. J Adolesc Health 2007;40:227-231.
6. Anderson SE, Must A: Interpreting the continued decline in the average age at menarche: results from two nationally representative surveys of U.S. girls studied 10 years apart. J Pediatr 2005;147:753-760.
7. O'Connell A, Gavin A, Kelly C, et al: The mean age at menarche of Irish girls in 2006. Ir Med J 2009;102:76-79.
8. Rigon F, Bianchin L, Bernasconi S, et al: Update on age at menarche in Italy: toward the leveling off of the secular trend. J Adolesc Health 2010;46:238-244.
9. Aksglaede L, Juul A, Olsen LW, et al: Age at puberty and the emerging obesity epidemic. PloS one 2009;4:e8450.
10. Vandeloo MJ, Bruckers LM, Janssens JP: Effects of lifestyle on the onset of puberty as determinant for breast cancer. Eur J Cancer Prev 2007;16:17-25.
11. Kaplowitz PB: Link between body fat and the timing of puberty. Pediatrics 2008;121 Suppl 3:S208-217.
12. Burt Solorzano CM, McCartney CR: Obesity and the pubertal transition in girls and boys. Reproduction 2010;140:399-410.
13. Berkey CS, Gardner JD, Frazier AL, et al: Relation of childhood diet and body size to menarche and adolescent growth in girls. Am J Epidemiol 2000;152:446-452.
14. Rogers IS, Northstone K, Dunger DB, et al: Diet throughout childhood and age at menarche in a contemporary cohort of British girls. Public Health Nutr 2010:1-12.
15. Gunther AL, Karaolis-Danckert N, Kroke A, et al: Dietary protein intake throughout childhood is associated with the timing of puberty. J Nutr 2010;140:565-571.
16. Veldhuis JD, Roemmich JN, Richmond EJ, et al: Endocrine control of body composition in infancy, childhood, and puberty. Endocr Rev 2005;26:114-146.
17. Wiley AS: Milk intake and total dairy consumption: associations with early menarche in NHANES 1999-2004. PloS one 2011;6:e14685.
18. Vandeloo MJ, Bruckers LM, Janssens JP: Effects of lifestyle on the onset of puberty as determinant for breast cancer. Eur J Cancer Prev 2007;16:17-25.
19. Cheng G, Gerlach S, Libuda L, et al: Diet quality in childhood is prospectively associated with the timing of puberty but not with body composition at puberty onset. J Nutr 2010;140:95-102.
20. Aksglaede L, Juul A, Leffers H, et al: The sensitivity of the child to sex steroids: possible impact of exogenous estrogens. Hum Reprod Update 2006;12:341-349.
21. Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, et al: Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev 2009;30:293-342.
22. Roy JR, Chakraborty S, Chakraborty TR: Estrogen-like endocrine disrupting chemicals affecting puberty in humans--a review. Med Sci Monit 2009;15:RA137-145.
23. Den Hond E, Schoeters G: Endocrine disrupters and human puberty. Int J Androl 2006;29:264-271; discussion 286-290.
24. Chemical Families: Phthalates. In Environmental Working Group.
25. Schell LM, Gallo MV: Relationships of putative endocrine disruptors to human sexual maturation and thyroid activity in youth. Physiol Behav 2010;99:246-253.
26. Massart F, Parrino R, Seppia P, et al: How do environmental estrogen disruptors induce precocious puberty? Minerva Pediatr 2006;58:247-254.
27. Leung AW, Mak J, Cheung PS, et al: Evidence for a programming effect of early menarche on the rise of breast cancer incidence in Hong Kong. Cancer Detect Prev 2008;32:156-161.
28. Pike MC, Pearce CL, Wu AH: Prevention of cancers of the breast, endometrium and ovary. Oncogene 2004;23:6379-6391.
29. Cohn BA, Cirillo PM, Christianson RE: Prenatal DDT exposure and testicular cancer: a nested case-control study. Arch Environ Occup Health 2010;65:127-134.
30. Cohn BA, Wolff MS, Cirillo PM, et al: DDT and breast cancer in young women: new data on the significance of age at exposure. Environ Health Perspect 2007;115:1406-1414.
31. Maffini MV, Rubin BS, Sonnenschein C, et al: Endocrine disruptors and reproductive health: the case of bisphenol-A. Mol Cell Endocrinol 2006;254-255:179-186.
32. Consumer tips to avoid BPA exposure. In Environmental Working Group.

 
 
 

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Today in the U.S., about 16 percent of girls enter puberty by the age of 7, and about 30 percent by the age of 8. A recent study determined that the number of girls entering puberty (defined by breas...
Today in the U.S., about 16 percent of girls enter puberty by the age of 7, and about 30 percent by the age of 8. A recent study determined that the number of girls entering puberty (defined by breas...
 
 
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06:44 PM on 05/10/2011
Other things I read on this subject years ago place the blame for early menarche on stress. A female raised in a high-stress environment became much more likely to menstruate earlier; the theory was that the biological body received the constant -fight or flight- stress hormones, triggering it to believe the organism was in imminent and danger and breeding needed to be accelerated to satisfy the imperative for reproduction. As more and more people live lives in urbanized 'danger' zones, or in broken-home, stressed out 'family' situations, or in an economic depression constantly stressing over money, food, security, etc- this affects the children. Asking the perpetual ' why is this happening ' would seem to lead to an understanding of the cause and how to fix it; but because there are so many 'experts' chasing different leads, the simplest answer is often overlooked.
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iamjones
01:56 PM on 05/10/2011
once again, i am so happy to be a vegetarian..... whenever i read these types of articles it merely confirms what i already live and know to be true.
01:43 PM on 05/12/2011
I get the same feeling about being a carnivore when I read about e. coli outbreaks.
10:43 AM on 05/10/2011
Another downside with girls hitting puberty earlier is when they start menstruating their growth plates 'close' and they will only grow maybe an inch or two after that. It can be more difficult to maintain a healthy weight later in life since women's metabolism slows as we age, gaining 10 pounds for someone tall can be unnoticeable, but for someone shorter its more apparent. I hit puberty at 14 and my friends at 12, within that time span I grew an extra 7 inches. Not everyone is going to be super tall, but hitting puberty early isn't going to let you grow to your maximum potential height.
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WarriorLemming
An avalanche On Republican's B*llsh*t Mountain
07:50 AM on 05/10/2011
QUOTE:
"Excess body fat alters the levels of the hormones insulin, leptin, and estrogen, and these factors are believed to be responsible for the acceleration of pubertal timing by obesity."

Keep eating those cookies for Sarah Palin, meh!
11:06 PM on 05/09/2011
I agree with Dr. Joel Fuhrman’s assessment that girls entering menarche at an earlier age is an area of concern. However, his blanket indictment of phthalates is misleading. Phthalates are a class of chemicals with significantly different properties. For example, phthalates in consumer products have been used for decades without any evidence of adverse effects in humans. It is important to distinguish these different properties to not only minimize consumer anxiety but also to avoid unwarranted regulations that ban chemicals deemed safe with less-effective alternatives that have not been thoroughly tested for safety.
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TeamSanity
strong emotions don't equate strong arguments
12:26 PM on 05/09/2011
I'm just glad we're conversing about this. I was born in '65, and NO girls in my elementary school were maturing early .... but I've now taught in public school, and many of my family and friends have, and very young girls are hitting puberty. This is a topic that needs addressing. I'm glad to see the conversation is out there.
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Jokergirl
No joke actually, humor helps heal
04:47 AM on 05/09/2011
It's always go ORGANIC, okay, then make it so people can AFFORD to go ORGANIC. Instead families go to McDonalds for dinner because the dollar meals can feed a family of four. Food prices certainly DO NOT HELP with the choices that kids can eat or families can afford.
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Saxton
11:11 AM on 05/10/2011
Have you noticed that the junk food in the grocery store is a lot cheaper than buying fruits and vegetables. I often think that the food industry wants to limit the choices for the consumer and manipulate how their dollars are spent so that many people feel compelled to purchase the processed foods over the fruits and vegetables. When have you ever seen a coupon in the Sunday papers for fruits, vegetables and whole grains?
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Jokergirl
No joke actually, humor helps heal
02:04 AM on 05/11/2011
No I have not, you're right the food that is actually GOOD for us is EXPENSIVE and the BAD food is CHEAP!!! Maybe it's the pharmaceutical industry behind this guise because they make those pills that cause people to get rid of gas, lower cholesterol, acid reflux, etc. etc. that all has to do with the food we eat. Just a thought.
01:46 PM on 05/12/2011
There is no scientific evidence that exonerates ORGANIC anything from the dangers of their non-organic counterparts.
04:22 AM on 05/09/2011
How about the well evidenced loss (95% plus) of highly protective plant hormones once super abundant in our ancestral diet due to our unique co-evolutionary relationship with hormonally rich plant developmental environments (fruit).
This has left us increasingly exposed to our own more ‘primitive’ hormone regime resulting in earlier sexual maturity directly reducing the necessary period for advanced brain development leaving us with an ever more primitive brain and hormone regime. Unfortunately we are now just too stupid to recognise how stupid we are.
http://www.brainwaving.com/2009/11/17/377/
12:18 PM on 05/10/2011
Speak for yourself, Tony.
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stonemann
To argue with an idiot, can mistake you for one.
02:32 AM on 05/09/2011
There was a time when it took 5 to 7 years to get a cow to slaughter weight. Now, it can be done in as little as 16 months. Subsequently, we don't eat adult cows anymore; we're eating adolescent cows that look like adult cows. Since we are what we eat and kids consume allot of bovine products, it's not surprising to see much earlier puberty manifest in our kids.
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KDMac
It's called sarcasm, Genius.
01:34 PM on 05/09/2011
Chicken is full of hormones as well.
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Susan Shaffer
watching you...
02:49 AM on 05/10/2011
how do they do it in 16 months and not 5-7 years?
is the animal mature or is it just bigger?
has it reached cow puberty?
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stonemann
To argue with an idiot, can mistake you for one.
03:18 AM on 05/10/2011
Before, cows were grass fed from cradle to grave, or what we call free range today. Now, they go to massive feed lots and are fed what they normally don't eat, a fortified, calorie dense corn based feed. Cows don't eat corn, they eat grass, but corn is cheaper. They are given allot of drugs, some for growth like growth hormone and others to prevent infection, since many cows develop ulcers from their diet and spend allot of time standing in their own excrement. So, with the calorie dense feed, much more calorie dense than grass, along with the hormones, we can put several hundred pounds on a calf in a shorter period of time. It's a good thing, since a cow, in that miserable environment, couldn't survive no more than a couple of years.
04:01 PM on 05/08/2011
Dr. Fuhrman, I read "Disease-proof Your Child," and am raising my son vegan. I'm vegan, too. Keep speaking out; more people will change when they are ready. Thank you!
01:47 PM on 05/12/2011
"Disease-proof" by making them susceptible to dying of a flu? Good luck
10:10 PM on 05/13/2011
I am not seeing my reply, so adding another response.

We receive our flu vaccines, which are egg-based. We aren't stupid. We are responsible citizens and parents. We receive all vaccines and boosters. I happen to be allergic to eggs, but I still get the shot. It's worth it. Is it vegan? No. Duh. Am I perfect? No. However, I approach the world with kindness and do appreciate that we can receive a flu vaccine, and appreciate the hens who unwillingly provide the eggs for the vaccine.

If you want to educate others, you'd be better received if you had a kinder approach. Given your moniker, you'd rather hide behind a wizard's curtain and throw insults instead of just being kind. But perhaps crudeness is easier for you than kindness. Unfortunate.

Dr. Fuhrman does not need me to cheerlead for him and tell you the extent of his expertise and research. You would be well advised to read his books and then make an educated argument for your position.

Do not reply to this thread. Your comments are unwelcome and unnecessary for me to see. Save your comments for other threads on this article or anywhere else.
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FeralForever
I'm watching you...so play nice
02:51 AM on 05/08/2011
Interesting posts. Soy replicates estrogen in many ways and is found in almost everything we eat. Try looking at some lables of your latest canned or frozen food purchases. There is a reason why it is one of the biggest commodities on the global stock markets.

Also, there is no mention in the article of what modern lighting is doing to humans. It is only in the last century that saw the advent of modern electricity and unnatural lighting everywhere. Before that it was subdued lamp lighting and candles.

Florescent lighting actually has a great effect on the human brain. Many studies have brought this point to bear. It is only natural, and had been for millions of years, that our brains adjusted to the coming and going of sunlight. There is a school of thought which connects our exposure to unnatural light as being one (just one, mind you) possible link to early menarche. I do hope more is explored on this subject.
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Jokergirl
No joke actually, humor helps heal
02:07 AM on 05/11/2011
Soy can actually BLOAT some people, it did me I lost 10 POUNDS just be eliminating soy completely, go figure.
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Parkite
Still haven't found what I'm looking for
08:44 PM on 06/05/2011
They feed corn and soy to animals to fatten them up. Look what it does to us.
06:56 PM on 05/07/2011
"Taking all this data together, we can estimate that the normal, healthy age at menarche under
conditions of excellent nutrition without caloric excess would probably fall somewhere between 15 and 18."

I would love to see the evidence for that. Although the article raises interesting questions that sentence is absurd. The more reasonable interpretation of this phenomenon is that improving nutritional value of the diet (not necessarily great nutrient content, but abundant caloric resources) is inducing females to menstruate earlier because of they can. Reaching reproductive state earlier in resource rich environments is seen all the time in animals. When you think about this in humans you want to look at what other animals do with increasing access to resources.

There is simply no basis for this claim. On the contrary, there is every reason to believe that an animal will attempt to become reproductive as early as possible. Whether or not this is ideal for long term health is irrelevant; getting breast cancer right after menopause is not a selected trait. Maximizing reproductive lifespan has major fitness consequences.
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dsws
No owning ideas. Limit only commercial use.
06:38 PM on 05/07/2011
Injected hormones don't stay in the animal's body very long. Growth hormone has a half-life in circulation of under an hour. Testosterone has a half-life of something like twenty minutes. Hormones have to be inactivated or they wouldn't be able to do their job of indicating transient physiological states. They carry messages: if the slate weren't wiped clean, they couldn't carry a new message later.

It would be a waste of money to give an animal hormones on the day it's going to be slaughtered. So it seems unlikely to me that meat would have hormones given to the animal to make it grow faster. Of course, this reasoning doesn't say anything about eggs and milk.
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mtwa
01:59 PM on 05/09/2011
Hormones are stored in the fat of animals. They are not inactive.
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dsws
No owning ideas. Limit only commercial use.
07:02 PM on 05/09/2011
Hormones do get inactivated. My understanding is that steroid hormones can go back and forth between fat and blood quickly enough that they're basically always in equilibrium. Thus storage in fat happens somewhat, but isn't particularly important because the hormones diffuse back into circulation and get cleared. This article on steroid metabolism http://www.glowm.com/?p=glowm.cml/section_view&articleid=277 doesn't even mention storage in fat.

Peptide hormones aren't fat-soluble. Growth hormone is a peptide. It's broken down quickly, and not stored in fat.

Synthetic hormone-analogues are not broken down quickly, and are used in beef cattle. http://www.fda.gov/AnimalVeterinary/NewsEvents/FDAVeterinarianNewsletter/ucm110712.htm
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NotEve
Facts are of no use against the irrational
06:04 PM on 05/07/2011
I'm surprised that the author makes no mention of dietary soy as a source of phyto-estrogens.

Soy is a major source of exogenous estrogen and has even been recommended as an alternative to hormone replacement therapy in menopausal women. Although more research is needed, some studies have indicated that high amounts of dietary soy can lead to hormonal imbalances in both men and women.

As for the protein:
The first article cited had a cohort of only 67 girls and none of the studies seemed to make any distinction regarding the source of the animal protein. This is very relevant because the use of growth hormones in meat production is common.

These studies can't make the claim that high-protein diets are causing early menarche without comparing diets of hormone and non-hormone raised meat products.

For the concerned consumer I would not cite these studies as evidence that protein is causing early menarche, BUT the hormones commonly used in meat production could be. You're better off with a plant-heavy diet that incorporates organically/naturally raised meat products.

Meat and dairy are important and efficient sources of many essential and important nutrients, particularly for growing children. I would be reluctant to completely remove them from a child's diet.

The real lesson here is to consider the source of these products. Buy local.
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Susan Shaffer
watching you...
02:51 AM on 05/10/2011
does anyone know if the early menarche is only in the west or is it a worldwide phenomenon?
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Erinaleks
Architectural Artisan, Free Thinker
03:13 PM on 05/07/2011
Dr.Fuhrman, I read your books "Eat To Live" and "Fasting For Health". The best books I ever read on healthy eating.