Delayed Puberty In Girls 

What Is Delayed Puberty In Girls?

[dropcap]D[/dropcap]elayed puberty in girls is a concerning condition characterized by decreased functional activity of the ovaries resulting in late onset of ovulation and secondary sex characteristics.

Q: When should puberty in girls begin?

A: Puberty in girls is a stage of reproductive development that occurs at the average age of 12.1 years (between the ages of 9 and 15 years) and ends in sexual maturity.

Secondary sex characteristics are breast development and appearance of pubic hair that is followed by underarm hair and white vaginal secretion. The first menstrual period (menarche) follows this sequence.

What Is Delayed Puberty in Girls In Celiac Disease and/or Gluten Sensitivity?

• Delayed puberty in girls is a symptom of untreated celiac disease and may be a presenting feature that brings the child to the clinician for treatment.
• Celiac disease may impair the reproductive life of affected females, eliciting delayed menarche.¹

How Prevalent Delayed Puberty In Girls In Celiac Disease and/or Gluten Sensitivity?

• Puberty is significantly retarded in girls with untreated celiac disease compared with girls following a gluten free diet.²
• Delayed menarche is frequently associated with celiac disease. Average age of menarche in girls with celiac disease is 13.5 years vs. 12.1 years in controls.³
• 31% of patients  who were diagnosed with celiac disease at a hospital endocrinology department, had delayed puberty.⁴

What Are The Symptoms Of Delayed Puberty In Girls?

Delayed puberty in girls is marked by the following symptoms:

• Abnormal delay of breast development.
• Abnormal delay of secondary hair development.
• Abnormal delay of initial onset of menstrual period.

How Does Delayed Puberty In Girls Develop In Celiac Disease and/or Gluten Sensitivity?

• Delayed puberty in girls results from endocrine dysfunction involving gluten exposure and nutritional deficiencies in celiac disease.⁵
• The pathogenesis still awaits clarification.⁶
• In celiac disease there is a high level of autoantibodies directed against self-antigens, so there could be antibodies against hormones or organs critical for pubertal development. Moreover, in celiac disease there could be a selective malabsorption of micronutrients essential for the metabolism of carrier or receptor proteins for sex hormones.²
• Nutritional deficiences include zinc, vitamin A, vitamin D, folic acid, iron, B vitamins, and omega-6 fatty acids.

Does Delayed Puberty In Girls Respond To Gluten-Free Diet?

Yes. Celiac disease-related delayed puberty responds to gluten free diet and is preventive of delay.⁷,⁵,²

6 Steps To Improve Delayed Puberty In Girls In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both reproductive health and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁸
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

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Certain prescription drugs cause deficiencies of these nutrients: zinc, vitamin A, vitamin D, folic acid, iron, B vitamins, and omega-6 fatty acids that can cause delayed puberty in girls. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Calcium, Chromium, Folic Acid, Iron, Vitamin A, Vitamin B12, Vitamin D.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Folic Acid, Iron, Vitamin A, Vitamin B12, Vitamin D.
• Prevacid®, Prilosec® deplete Vitamin B12.
• Alka Seltzer®, Baking Soda deplete Folic Acid.

ANTI-DEPRESSANTS

• Adapin®, Aventyl®, Elavil®, Pamelor®, and others deplete Riboflavin, Vitamin B12.

ANTIBIOTICS disrupt intestinal permeability.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins.
•  Tetracyclines deplete Iron, Zinc, Riboflavin.

ANTI-INFLAMMATORIES disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Folic Acid.
• NSAIDS (Motrin®, Aleve®, Advil®, Anaprox®, Dolobid®, Feldene®, Naprosyn® and others) deplete Folic acid.
• Aspirin and Salicylates deplete Folic acid, Iron.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Folic Acid, Vitamin B12, Vitamin B1, Vitamin D.

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Vitamin B12.

DIURETICS

• Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Vitamin B1, Vitamin B6.
• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Folic Acid.[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications. Contain folic acid, vitamin B12, and riboflavin.
• Ferrous fumarate or gluconate  as prescribed following blood test for iron status.
• Vitamin A as prescribed following blood test for status.
• Vitamin B12 as prescribed following blood test for status.
• Vitamin D as prescribed following blood test for status.
• Chelated zinc  as prescribed but do not take at same time as calcium or other minerals because they compete for absorption.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• At least 4 glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Delayed Puberty In Girls In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Endocrine manifestations of celiac disease.” This study investigating the prevalence of endocrinopathies in 36 patients who were diagnosed with celiac disease at a hospital endocrinology department found delayed puberty in 31% of patients.

Other manifestations found (after complete evaluation) were short stature (58%), elevated alkaline phospahatase (67%), low calcium (22%), X-rays suggestive of osteomalacia or rickets (8%), carpopedal spasm (6%), and night blindness (6%). Anti-TPO antibody positivity was found in 53%, hypothyroidism in 28%, subclinical hypothyroidism in 17%, and type-1 DM in 25% of the patients. A total of 14% patients had no GI symptoms.¹⁰

“Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease.” This study analyzing gynecological disturbances in patients with Celiac Disease in relation to their nutritional status and adherence to a Gluten Free Diet demonstrated adolescents who were not adherent to a Gluten Free Diet presented delayed menarche and secondary amenorrhea. Gluten could explain the disturbances and malnutrition would worsen the disease in a consequent vicious cycle. Celiac Disease should be included in screening of reproductive disorders.⁵

“Obstetric and gynecological problems in women with untreated celiac sprue.” This study investigating the gynecological history of newly diagnosed patients with Celiac Disease demonstrated that delayed menarche is frequently associated with celiac disease. Mean age of menarche at 13.5 years vs.12.1 years in controls.¹¹

Sources:

1. Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. Gynecologica endocrinology: the Official Journal of the International Society of Gynecological Endocrinology. Dec 2000;14(6):454-63. [↩]
2. Bona G, Marinello D, Orderda G. Mechanisms of abnormal puberty in coeliac disease. Hormone Research. 2002;57(Suppl 2):63,3p. [↩] [↩] [↩]
3. Molteni N, Bardella MT, Bianchi PA. Obstetric and gynecological problems in women with untreated celiac sprue. Journal of Clinical Gastroenterology. Feb 1999;12(1)37-9. [↩]
4. Philip R, Patidar P, Saran S, Agarwal P, Gupta K. Endocrine manifestations of celiac disease. Indian J Endocrinol Metab. 2012 December; 16(Suppl 2): S506–S508. [↩]
5. Kotze LM. Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease. Journal of Clinical Gastroenterology. Aug 2004;38(7):567-74. [↩] [↩] [↩]
6. Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. Gynecologica endocrinology: the Official Journal of the International Society of Gynecological Endocrinology. Dec 2000;14(6):454-63. [↩]
7. Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. Gynecologica endocrinology: the Official Journal of the International Society of Gynecological Endocrinology. Dec 2000;14(6):454-63. [↩]
8. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
9. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
10. Philip R, Patidar P, Saran S, Agarwal P, Gupta K. Endocrine manifestations of celiac disease. Indian J Endocrinol Metab. 2012 December; 16(Suppl 2): S506–S508. [↩]
11. Molteni N, Bardella MT, Bianchi PA. Obstetric and gynecological problems in women with untreated celiac sprue. Journal of Clinical Gastroenterology. Feb 1999;12(1)37-9. [↩]