Health & Fitness

March 21, 2020, a stay-at-home order was enacted in Illinois due to the COVID-19 pandemic. It continued for 11 weeks, eventually being lifted May 30, 2020. During those 11 weeks, opioid-involved overdose deaths soared in Chicago and the surrounding suburbs of Cook County, worsening an already alarming epidemic of opioid deaths.

The report — the result of a collaboration between Northwestern University researchers and Dr. Ponni Arunkumar with the Cook County Medical Examiner’s Office — found that opioid overdose fatalities nearly doubled during the stay-at-home order compared to a 100-week period in 2018 to 2019, rising from 23 deaths per week to 44.¹

Lockdown Drove Up Opioid Overdose Deaths

The researchers analyzed weekly opioid overdose deaths for four different time periods:²

• 100 weeks from January 5, 2018, to December 3, 2019
• December 4, 2019, to March 20, 2020 — the 15 weeks prior to the stay-at-home order
• March 21, 2020, to June 5, 2020 — the 11 weeks during the stay-at-home order
• June 6, 2020, to December 23, 2020 — the 29 weeks after the order was lifted

In 2018 and 2019, Cook County had already recorded high levels of opioid-related overdose deaths, the researchers noted, “with a disturbing increase beginning in late 2019 and early 2020.” During this period, 4,283 opioid overdose deaths occurred, with a mean of 23 deaths per week during the initial 100-week period.

This increased to a mean of 35.1 per week in the 15-week period prior to the pandemic, which was followed by “an even more pronounced increase during the 11-week stay-at-home order: 44.1 mean weekly deaths.”³ When the lockdown was lifted, the number of weekly deaths quickly declined and then began to creep up again near the end of the 29-week period, settling at 32.7 deaths per week.

“Although deaths have declined below the peak weekly numbers seen during the stay-at-home period, opioid overdose deaths following the stay-at-home period remain elevated above pre-2020 levels,” the researchers noted,⁴ suggesting that the pandemic took a toll on those at risk of opioid overdose and death.

It’s not only Chicago, Illinois, that is being affected; lockdowns took similar tolls across the U.S. and, after weeks of extended isolation, many communities reported a rise in drug overdose deaths. Jacksonville, Florida, for instance, had a 20% increase in overdose emergency calls in March 2020. Four counties in New York also reported a rise in overdoses, while Columbus, Ohio, also had a surge in overdose deaths, including 12 over a 24-hour period the first week of April.⁵

Increased Anxiety, Depression Likely

The early days of the pandemic led to significant disruptions for people with substance use disorder (SUD) seeking in-person treatment and recovery services. According to the report:⁶

“For most people with SUD, the pandemic compounded an already tenuous situation with massive losses of service sector jobs and health insurance, and loss of in-person social support, resulting in increased anxiety, depression, and social isolation.”

Feelings of anxiety and depression were common not only in those with SUD but also the general population. The National Center for Health Statistics (NCHS), in partnership with the Census Bureau, set up an experimental data system known as the Household Pulse Survey.⁷ In all, from May 7 to May 12, 2020, 34.4% of adults reported symptoms of anxiety or depression, while 30% reported signs of anxiety and 24.1% reported symptoms of depression.

Rates varied by state, with more than 40% of adults in Illinois, Louisiana, Mississippi and Missouri, as well as Washington, D.C., reporting depression or anxiety symptoms. Black and Hispanic adults also reported anxiety or depression more often than whites or Asians, and women, younger adults and people with lower education levels were also more likely to be affected.⁸

Numbers held steady in the following months, with 30% of U.S. adults reporting symptoms of anxiety or depression the week of March 17 to 29, 2021.⁹ For comparison, prior to the pandemic in 2019, the survey revealed 8.1% of adults had symptoms of anxiety disorder, 6.5% had symptoms of depressive disorder and 10.8% had symptoms of anxiety disorder or depressive disorder.¹⁰

Research shows that severity of depression is associated with an increasing likelihood of misusing opioids for nonpain symptoms as well as self-increasing opioid dosage. Further, the increased use of opioids among people with major depressive disorder may be because they’re using it as a form of self-medication for social or emotional pain.¹¹

Disruptions to Treatment, Loss of Support Implicated

It’s well known that the psychological distress associated with economic recessions and unemployment is a significant factor in increasing drug use among adults. Even before the pandemic, opioid use disorder (OUD), which affects at least 2 million Americans, and those who misuse opioids — another 10 million¹² — were at epidemic levels.

Worldwide, 40.5 million people struggle with opioid dependence, a global prevalence of 510 cases per 100,000 people.¹³ “Before the first COVID-19 case in the United States, a different epidemic — the opioid crisis — was taking the lives of 130 Americans per day,” wrote two doctors from Yale School of Medicine in Annals of Internal Medicine.¹⁴ They were concerned, as early as April 2020, that the pandemic could increase opioid overdose rates.

Not only do social distancing and stay-at-home orders adversely affect mental health, but the closure of substance use treatment clinics during lockdown kept some people from accessing lifesaving care.¹⁵ Disruptions of care during stay-at-home mandates are a major concern for people with opioid use disorder, who depend on regular face-to-face health care.

Access to medications for addiction treatment was also restricted, while patients simultaneously faced challenges like loss of work, housing and food security, which could trigger a downward spiral leading to relapse and delayed recovery. When combined, the disruptions to care and social support accelerated what was already a catastrophic number of opioid overdose deaths.

It also may have driven some people to seek out even more dangerous drugs when their access to opioids disappeared. What’s more, while locked down at home, possibly alone, overdoses may have occurred in solitude, without bystanders able to call for help. The authors of the featured study explained:¹⁶

“The pandemic also led to interruptions and changes in the drug supply. Increasing use of illicit fentanyl had already been contributing to an increase in overdose deaths in Cook County. Fatal overdose risk is amplified when powerful, illicitly manufactured opioids are substituted for less potent drugs, which may have been unavailable during lockdown.

Loss of support groups and services may have led some in recovery to relapse, which can result in loss of drug tolerance. Social distancing may have led to solitary use of opioids in places with no bystanders available to administer naloxone, which can reverse opioid overdose effects when given in time.

These challenges for persons with SUD during the COVID-19 pandemic occurred in the context of rising overdose mortality rates beginning in late 2019 and were exacerbated during the early months of the pandemic.”

Addiction Often Starts With Prescriptions

Opioids have a very high rate of addiction, as they trigger your brain to release endorphins that not only relieve pain but also create feelings of pleasure and well-being. As the good feelings wear off, the craving to recreate them by taking more pills can be strong, but soon tolerance develops and an even higher dose is needed to get the same feel-good boost.

Using opioids for as few as five days increases the risk of long-term use,¹⁷ and many people who started out taking the drugs for back pain or other chronic pain end up addicted. An estimated 21% to 29% of people prescribed opioids for chronic pain misuses them and 8% to 12% develop an opioid use disorder. Many also transition to using heroin; an estimated 80% of heroin users misused prescription opioids first.¹⁸

Unfortunately, opioids continue to be prescribed in cases where less addictive medications could be used instead. Nonopioid pain relievers, such as acetaminophen (paracetamol) and nonsteroidal anti-inflammatory drugs (NSAIDs), work just as well as opioids for moderate to severe chronic back pain or hip or knee osteoarthritis pain, for instance.¹⁹

Yet, even children may be prescribed opioids after minor procedures. Insurance claims data from 2016 and 2017 reveal 60% of children between the ages of 1 and 18 with private insurance filled one or more opioid prescriptions after surgical tonsil removal.^20,21

Dentists even wrote a significant 18.1 million prescriptions for opioids in 2017, as the drugs are frequently prescribed for wisdom teeth extractions, even though it’s suggested that NSAIDs and acetaminophen be prescribed instead.²²

The True Cost of Lockdowns Is Unknown

It remains to be seen what the ultimate costs of stay-at-home orders will add up to, in terms of lives lost to untreated medical conditions, economic crisis, substance abuse and mental health conditions.

A report by the Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care estimated that up to 75,000 people may die during the COVID-19 pandemic from drug or alcohol misuse and suicide. These “deaths of despair” were exacerbated by:²³

• Unprecedented economic failure paired with massive unemployment
• Mandated social isolation for months and possible residual isolation for years
• Uncertainty caused by the sudden emergence of a novel, previously unknown microbe

The U.S. Centers for Disease Control and Prevention (CDC) also reported in December 2020 that the highest number of overdose deaths ever recorded in a 12-month period — over 81,000 — took place in the 12 months ending in May 2020,²⁴ which was during the height of lockdowns for many areas.

Help for Opioid Addiction

If you think you or a loved one may be struggling with opioid addiction, the Substance Abuse Mental Health Service Administration²⁵ can be contacted 24 hours a day at 1-800-622-HELP. I also urge you to listen to my interview with Dr. Sarah Zielsdorf, in which she explains how low-dose naltrexone (LDN), used in microdoses, can help you combat opioid addiction and aid in your recovery.

Using microdoses of 0.001 milligrams (1 microgram), long-term users of opioids who have developed a tolerance to the drug are able to, over time, lower their opioid dose and avoid withdrawal symptoms as the LDN makes the opioid more effective.

For opioid dependence, the typical starting dose is 1 microgram twice a day, which will allow them to lower their opioid dose by about 60%. When the opioid is taken for pain, the LDN must be taken four to six hours apart from the opioid in order to not displace the opioid’s effects.

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In the video above, James Corbett of The Corbett Report interviews¹ professor Mark Crispin Miller about mass persuasion and propaganda — topics he’s been teaching at the New York University Steinhardt School of Culture, Education and Human Development for the last two decades — and the current state of free speech.

Miller recently sued 19 of his department colleagues for libel after they signed a letter to the school dean demanding a review of Miller’s conduct. He points out that his course on propaganda is not focused on historical examples of mass persuasion but, rather, teaches his students to recognize and resist propaganda in real or recent times.

“This can be quite challenging,” he says. It’s rather easy to identify examples of propaganda that you do not agree with. It’s much more difficult when it’s something you care about, agree with or believe in; when it pushes your buttons. It requires you to detach, to take a bird’s-eye view and develop impartiality. You have to “make an attempt to think about it, critically,” Miller explains, and to look at both sides of the issue.

Unfortunately, as noted by Miller, getting the other side of the story is now becoming increasingly difficult, thanks to Big Tech censorship, which oftentimes filters out or blocks all but one viewpoint.

Identifying COVID Propaganda

At the beginning of this last semester, Miller suggested his students take a deep dive into the current propaganda narratives at work. He pointed out that the COVID-19 crisis, which justified distance learning, self-isolation and separation from family and friends, was driven by very powerful propaganda narratives.

He stresses that he’s not saying the COVID-19 pandemic is a fraud or that the narratives are false — propaganda can be factually accurate — only that propaganda tends to be one-sided. It offers just one, nearly always biased, side of the story. Miller offered up the example of mask mandates. Previous randomized studies show that masks are ineffective as barriers against respiratory viruses such as influenza.

He instructed his students to read those papers, as well as more recent studies that might suggest there’s some benefit. He also instructed them to analyze potential conflicts of interest that might have influenced the findings, such as funding by Big Pharma or the Bill & Melinda Gates Foundation. He also warned them that when using Google search, biased articles will typically show up first, “as Google owns two pharmaceutical companies,” he explains.

Cancel-Culture Strikes

As it turns out, one student asked to join his class late, which he accepted. Having missed these preliminary instructions and discussions about how to identify and study propaganda, the late-entry student took to Twitter to complain about the assignment to investigate mask narratives and demanded Miller be fired.

The department chair, without consulting with Miller, responded to the student’s tweet, saying the department would prioritize the matter and take steps to address it. The next day, the doctor who advises the NYU on its “insanely draconian COVID rules” and the dean emailed Miller’s students, without copying him on the correspondence, saying he had given them “dangerous misinformation” about masking.

Next, they demanded he cancel his propaganda course for the following semester. “I had no choice but to do that,” Miller says, “but I told them I’m doing it under protest.”

Petition for Academic Freedom

If this scenario strikes you as typical of the kind of intellectual and scientific censorship we’ve seen all around the world over the past year, you’re not alone. Miller recognized it too, and created an academic freedom petition,² which at the time of this writing has been signed by nearly 36,000 people.

“All it asks is that NYU respect my academic freedom and set a good example for other schools,” Miller says. “But I did it in the name of all professors, all journalists, all scientists, all doctors, activists and whistleblowers who have been gagged or punished for their dissidence, not just last year, but really, for decades.”

Review of Conduct

A month later, Miller received a letter from the dean, listing a number of accusations raised by 25 of his department colleagues, including “explicit hate speech,” “mounting attacks on students and others” in the community, “advocating for an unsafe learning environment,” “aggressions,” “microagressions” and discouraging his students from wearing masks.

“This is a very succinct description of the OPPOSITE of what I teach,” Miller says. “Every single one of these charges was false.” His colleagues had also demanded that a review of Miller’s conduct be performed to address these issues, which the dean approved, at the insistence of NYU lawyers. While the review was scheduled to wrap up in December 2020, Miller has yet to hear from the review board.

In response to that letter from the dean, Miller wrote a “cordial rebuttal,” in which he asked his colleagues to retract their accusations and issue an apology. He received no response. Getting no response after a follow-up letter, he then decided to file a libel suit against 19 of his 25 colleagues, excluding the junior members from the suit. He did it, he says, “because this kind of thing needs to end.”

At the time of this writing, Miller is waiting for the judge to rule on the defendants’ motion to dismiss the case. All of the documents relating to this case can be found on Miller’s website, MarkCrispinMiller.com.³ If you want to make a donation to help fund Miller’s legal case, you can do so on his GoFundMe page.⁴ Donations are held in an escrow account managed by his attorney and are reserved for legal expenses only.

The Censorship Trifecta — Common Repression Tactics

As noted by Corbett, some of Miller’s students have clearly failed to live up to the adage that “It is the mark of an intelligent mind to entertain a thought without accepting it.” Indeed, this failure appears rampant these days, and is certainly not limited to the most naïve of students.

Interestingly, Miller cites a Japanese student, who some years ago told him that “Higher education in the United States is teaching students how to take offense,” which he thought was quite astute. “That’s absolutely true,” Miller says, “and students such as this young woman are used to being rewarded for saying these kinds of things.” He goes on to list “the censorship trifecta” — repressive tactics — that he was hit with:

Part and parcel of all three of these tactics is the labeling of any science that deflates or disproves the propaganda narrative as “alternative science” or “fringe science.” It doesn’t matter if it’s published in prestigious peer-reviewed journals. It’s still dismissed as unreliable at best and misinformation at worst, incapable of standing up to the wisdom of the Dr. Fauci’s of the world.

The Deeper Significance of This Case

The problem with normalizing these weapons of censorship is that it makes education impossible, it makes science impossible, it makes democracy impossible. Everything is reduced to compliance versus noncompliance.

As noted by Corbett, Miller’s case goes beyond mere freedom of speech, which everyone ought to have, it goes into the issue of freedom of inquiry itself — the freedom to ask questions and ponder an issue or problem from multiple angles. Without the ability to think freely and express those thoughts, life itself becomes more or less meaningless.

Who’s Running the Show?

An obvious question is, what is the source of this cancel-culture, censorship-embracing phenomenon? With regard to his own case, Miller believes it has been “steered,” although it is unclear by whom.

With just 79 followers on Twitter, the dissatisfied student’s tweet somehow spread like wildfire, resulting in three separate smear pieces in mainstream media. So, “it got some help,” Miller says.

Miller also questions the advice by NYU lawyers, who insisted the dean must set up a conduct review in response to the student’s complaint, even though the Foundation for Individual Rights in Education (FIRE) sent the president of NYU a detailed letter explaining why there were no legal, Constitutional grounds for Miller’s review. 

Miller admits there may be several reasons — including financial and political — for the attacks on him, and reviews some of those details in the interview, but none of them has anything to do with what or how he teaches.

More broadly, it’s clear that the entire global COVID-19 narrative has been created and is steered from or by a core, unelected nongovernmental body. I often refer to this group as the technocratic elite, members of which are found in global NGOs, think-tanks, big business, academia, media, scientific centers, regulatory agencies and political strata around the world.

It is this thorough infiltration that allows for the global coordination we now see and experience — this lockstep activity around the world — which includes censorship of counternarratives and divergent points of view, without regard for an individual’s background or expertise. Officially recognized, credible sources have been identified, and all others are dismissed as misinformation.

You Can’t Resist Propaganda if You Can’t Recognize It

“I can’t imagine a more important moment for the study of propaganda than the present,” Miller says, because we are bombarded with it every moment of every day now. Once you learn to recognize it, you’ll find there’s hardly anything else.

“I used to think it was vulgar to compare the contemporary American media with Dr. [Joseph] Goebble’s practices [editor’s note: a German Nazi politician and Reich Minister of Propaganda from 1933 to 1945],” Miller says.

“I no longer think so. I don’t think that’s a stretch at all. The daily dissemination of absolute 100% falsehoods by The New York Times on every single page, and by CNN and the rest of them — it’s breathtaking to me.”

To learn more about the journalistic failures and staggering fabrications published by The New York Times, read “The Gray Lady Winked” by Ashley Rindsberg.⁵ Miller wrote the foreword to this book.

“We have to talk back,” Miller says. “We have to take the bull by the horns and say, ‘Yes, we’re conspiracy theorists if the alternative is swallowing this preposterous narrative you’re trying to push.’ That’s a badge of honor as far as I’m concerned.

It’s people like us, who insist on telling the truth, who are really essential to the survival of not just democracy but humanity itself. I know that sounds a bit grandiose, but I sincerely believe that now, because we are at a very dire crossroads in the history of Western civilization and have got to fight back for our children’s sake and the sake of everything we hold dear.”

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By Dr. Mercola

Reaching puberty is a rite of passage that we've all been through, but children are now reaching it earlier than ever before, and while precocious puberty in girls has received most of the attention, we now know the trend applies to boys as well.

In the 19th century, the onset of menstruation in girls occurred around the age of 15. Now the average age of the first period is around 12. Some girls develop breasts as early as age seven¹ .

According to a recent study in the journal Pediatrics², boys are now beginning sexual development anywhere from six months to two years earlier than the medically accepted standard based on previous studies.

African-American boys were found to hit the onset of puberty the soonest, starting around the age of nine. Caucasian and Hispanic boys begin developing around the age of 10.

"The causes and public health implications of this apparent shift in US boys to a lower age of onset for the development of secondary sexual characteristics in US boys needs further exploration," the authors write.

Indeed, while some may shrug off the trend of earlier maturation, it's actually pretty significant, as it can affect both physical and psychological health in a number of ways, including raising the future risk for hormone-related cancers. Girls who enter puberty earlier are at an increased risk of breast cancer, for example, due to the early rise in estrogen.

The trend also raises serious questions about environmental factors spurring this development. Lead researcher Marcia Herman-Giddens told CNN Health³:

"The changes are too fast. Genetics take maybe hundreds, thousands of years. You have to look at something in the environment. That would include everything from (a lack of) exercise to junk food to TV to chemicals."

Environmental Chemicals a Likely Factor

Scientists have brought forth a number of potential explanations for the rising rates of early puberty, but one that deserves special attention is environmental chemicals, and particularly xeno-estrogens, i.e. estrogen-mimicking chemicals. These compounds behave like steroid hormones and can alter the timing of puberty, and affect disease risk throughout life.

In adults, xeno-estrogens have been linked to decreased sperm quality, stimulation of mammary gland development in men, disrupted reproductive cycles and ovarian dysfunction, obesity, cancer and heart disease, among numerous other health problems.

We're surrounded by hormone-disrupting chemicals these days, many of which are plasticizers. Bisphenol A (BPA) for example, is an industrial petrochemical that acts as a synthetic estrogen, and can be found plastics and tin can linings, in dental sealants, and on cash-register receipts. Three years ago, laboratory tests commissioned by the Environmental Working Group (EWG) detected BPA in the umbilical cord blood of 90 percent of newborn infants tested -- along with more than 230 other chemicals!

In September 2010, Canada declared BPA a toxic substance, but to date no other country has followed suit, although BPA has been banned in baby bottles in Canada, Europe and the United States. Frustratingly, the US FDA has denied the request to ban BPA, however many American companies have voluntarily removed the chemical from their products, in response to consumer demand. So, if you check around, you can find a lot of BPA-free products.

However, buyer beware, as it recently came to light that some companies are simply replacing the offending BPA with another less known but equally toxic chemical called bisphenol-S (BPS)! Not only does BPS appear to have similar hormone-mimicking characteristics to BPA, but research suggests it is actually significantly less biodegradable, and more heat-stable and photo-resistant, than BPA.

10 Top Offenders that Can Disrupt Your Hormones

Beside BPA and BPS, other top offenders you should be aware of, and watch out for, include:

Phthalates, a group of industrial chemicals used to make plastics like polyvinyl chloride (PVC) more flexible and resilient. They're also one of the most pervasive of the endocrine disrupters, found in everything from processed food packaging and shower curtains to detergents, toys and beauty products like nail polish, hair spray, shampoo, deodorants, and fragrances. Exposure to phthalates can lead to incomplete testicular descent in fetuses, reduced sperm counts, testicular atrophy or structural abnormality and inflammation in newborns.	Fluoride, which is added to the majority of public water supplies in the United States. Research has shown that animals treated with fluoride had lower levels of circulating melatonin, as reflected by reduced levels of melatonin metabolites in the animals' urine. This reduced level of circulating melatonin was accompanied -- as might be expected -- by an earlier onset of puberty in the fluoride-treated female animals.
Perfluorooctanoic acid (PFOA), a likely carcinogen found in grease- and water-resistant coatings and non-stick cookware.	Methoxychlor and Vinclozin, an insecticide and a fungicide respectively, have been found to cause changes to male mice born for as many as four subsequent generations after the initial exposure.
Nonylphenol ethoxylates (NPEs). Known to be potent endocrine disrupters, these chemicals affect gene expression by turning on or off certain genes, and interfere with the way your glandular system works.	Bovine growth hormones (rBGH) commonly added to commercial dairy have been implicated as a contributor to premature adolescence.
MSG, a food additive that's been linked to reduced fertility.	Non-fermented soy products, which are loaded with hormone-like substances.
DDE (a breakdown product of the pesticide DDT)	PCBs

New Concern: Metalloestrogens

Recent research has also confirmed the existence of a previously unknown class of cancer-causing estrogen-mimicking compounds: "metalloestrogens." The following metals, which are added to thousands of consumer products, including vaccines, have been identified as being capable of binding to cellular estrogen receptors and then mimicking the actions of physiological estrogens:⁴

Aluminum	Antimony	Arsenite	Barium	Cadmium	Chromium	Cobalt
Copper	Lead	Mercury	Nickel	Selenite	Tin	Vanadate

Tips to Reduce Exposure to Hormone-Disrupting Substances

While young girls and boys may show obvious signs of exposure to hormone-disrupting substances via early puberty, other signals are more insidious and may not show up until a disease is already present. You can cut back on your family's exposure to these dangerous chemicals by following these 12 guidelines. Pregnant women and women who may become pregnant should pay particular attention to reducing their exposure as much as possible to protect the health of their unborn baby:

1. Eat whole, preferably organic, produce and free-range, organic meats to reduce your exposure to added hormones, pesticides and fertilizers. Also avoid milk and other dairy products that contain the genetically engineered recombinant bovine growth hormone (rBGH or rBST)
2. Eat mostly raw, fresh foods. Processed, prepackaged foods (of all kinds) are a major source of soy and chemicals such as BPA and phthalates.
3. Store your food and beverages in glass rather than plastic, and avoid using plastic wrap and canned foods (which are often lined with BPA-containing liners).
4. Use glass baby bottles and BPA-free sippy cups for your little ones.
5. Make sure your baby's toys are BPA-free, such as pacifiers, teething rings and anything your child may be prone to suck on.
6. Only use natural cleaning products in your home to avoid phthalates.
7. Switch over to natural brands of toiletries such as shampoo, toothpaste, antiperspirants and cosmetics. The Environmental Working Group's Skin Deep Database⁵ is a great resource for finding personal care products that are free of phthalates, parabens and other potentially dangerous chemicals.
8. Avoid using artificial air fresheners, dryer sheets, fabric softeners or other synthetic fragrances.
9. Replace your non-stick pots and pans with ceramic or glass cookware.
10. When redoing your home, look for "green," toxin-free alternatives in lieu of regular paint and vinyl floor coverings.
11. Replace your vinyl shower curtain with one made of fabric.
12. Avoid non-fermented soy, especially if you're pregnant. Also, never use soy-based infant formula.

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By Dr. Mercola

Reaching puberty is a rite of passage that we've all been through, but children nowadays are reaching it earlier than ever before -- a trend that has both health experts and parents alarmed.

Precocious puberty, which is the appearance of secondary sex characteristics like pubic hair or breast growth before age 8, or the onset of menarche before age 9, impacts at least 1 in 5,000 U.S. children, and the rate is on the rise.¹

Even in the last three decades, children (particularly girls) are maturing at younger and younger ages (precocious puberty is 10 times more common in girls than in boys).

Puberty, Once the Norm at Age 15, Now Occurring in 7-, 8- and 9-Year-Olds

In the 19th century the onset of menstruation occurred around the age of 15. Now the average age of the first period, or menarche, is around 12. The time during and before puberty is one of rapid development and change, which is why even months matter when it comes to first menstruation. Before menstruation, girls will show beginning signs of development, such as breast "budding" and growth of pubic hair.

These signs are now becoming unsettlingly common among 7-, 8- and 9-year-old girls, to the extent that many health care providers, rather than labeling these children with a diagnosis that something is wrong, have simply changed the definition of what's normal... but is it really "normal" for girls to mature at such a young age?

There are more questions than answers in the case of precocious puberty, but what is certain is that girls are developing earlier than they have even 10, 20 or 30 years ago.

One study in the journal Pediatrics revealed that by age 7, 10 percent of white girls, 23 percent of black girls, 15 percent of Hispanic girls and 2 percent of Asian girls had started developing breasts, with researchers noting:²

"The proportion of girls who had breast development at ages 7 and 8 years, particularly among white girls, is greater than that reported from studies of girls who were born 10 to 30 years earlier."

Early puberty can set the stage for emotional and behavioral problems, and is linked to lower self-esteem, depression, eating disorders, alcohol use, earlier loss of virginity, more sexual partners and increased risk of sexually transmitted diseases. There is also evidence that suggests these girls are at increased risk of diabetes, heart disease and other cardiovascular diseases, as well as cancer, later in life.

Environmental Chemicals a Likely Factor

Scientists have brought forth a number of potential explanations for the rising rates of early puberty, but one that deserves special attention is environmental chemicals, and particularly estrogen-mimicking, "gender-bending" chemicals that easily leach out of the products that contain them, contaminating everything they touch, including food and beverages.

As the featured New York Times article reported:

" ...animal studies show that the exposure to some environmental chemicals can cause bodies to mature early. Of particular concern are endocrine-disrupters, like "xeno-estrogens" or estrogen mimics. These compounds behave like steroid hormones and can alter puberty timing.

For obvious ethical reasons, scientists cannot perform controlled studies proving the direct impact of these chemicals on children, so researchers instead look for so-called "natural experiments," one of which occurred in 1973 in Michigan, when cattle were accidentally fed grain contaminated with an estrogen-mimicking chemical, the flame retardant PBB.

The daughters born to the pregnant women who ate the PBB-laced meat and drank the PBB-laced milk started menstruating significantly earlier than their peers."

This is an extreme case, but the truth is we are all part of a "secret experiment" of sorts, because hormone-disrupting chemicals are all around us. Bisphenol A (BPA), an industrial petrochemical that acts as a synthetic estrogen, is found in our plastics and our tin can linings, in dental sealants and on cash-register receipts. Laboratory tests commissioned by the Environmental Working Group (EWG) detected BPA in the umbilical cord blood of 90 percent of newborn infants tested -- along with more than 230 other chemicals. As written in the New York Times:

"One concern, among parents and researchers, is the effect of simultaneous exposures to many estrogen-mimics, including the compound BPA, which is ubiquitous."

No one knows what happens when a developing fetus or young child is exposed to hundreds of chemicals, many of which mimic your body's natural hormones and can trigger major changes in your body even as an adult, let along during the most rapid and vulnerable periods of development (in utero and as a young child).

BPA is, unfortunately, but one example. Others include phthalates, a group of industrial chemicals used to make plastics like polyvinyl chloride (PVC) more flexible and resilient. They're also one of the most pervasive of the endocrine disrupters, found in everything from processed food packaging and shower curtains to detergents, toys and beauty products like nail polish, hair spray, shampoo, deodorants, and fragrances.

Other environmental chemicals like PCBs and DDE (a breakdown product of the pesticide DDT) may also be associated with early sexual development in girls. Both DDE and PCBs are known to mimic, or interfere with, sex hormones.

Perfluorooctanoic acid (PFOA), found in non-stick cookware, also falls into this dangerous category, as does fluoride, which is added to the majority of public water supplies in the United States. Research showed that animals treated with fluoride had lower levels of circulating melatonin, as reflected by reduced levels of melatonin metabolites in the animals' urine. This reduced level of circulating melatonin was accompanied -- as might be expected -- by an earlier onset of puberty in the fluoride-treated female animals.

These Chemicals Also Increase Your Risk of Cancer and Heart Disease

If a chemical is capable of influencing the rate of your reproductive development, it stands to reason that it would be capable of influencing other hormone-sensitive growth processes as well, and this is indeed the case.

For instance, new research has detected the presence of paraben esters in 99 percent of breast cancer tissues sampled.³ Parabens are chemicals with estrogen-like properties, and estrogen is one of the hormones involved in not only puberty but also the development of breast cancer. They are widely used in household products such as:

✓ Deodorants and antiperspirants	✓ Shampoos and conditioners	✓ Shaving gel	✓ Toothpaste
✓ Lotions and sunscreens	✓ Make-up / cosmetics	✓ Pharmaceutical drugs	✓ Food additives

Recent research has also confirmed the existence of a previously unknown class of cancer-causing estrogen-mimicking compounds: metals. Yes, a broad range of metals have been shown to act as "metalloestrogens" with the potential to add to the estrogenic burden of the human body, thereby increasing the risk of breast cancer and also possibly early puberty. The following metals, which are added to thousands of consumer products, including vaccines, have been identified as being capable of binding to cellular estrogen receptors and then mimicking the actions of physiological estrogens:⁴

✓ Aluminum	✓ Antimony	✓ Arsenite	✓ Barium	✓ Cadmium	✓ Chromium	✓ Cobalt
✓ Copper	✓ Lead	✓ Mercury	✓ Nickel	✓ Selenite	✓ Tin	✓ Vanadate

Data from a long-running British health survey, meanwhile, has shown that if you have high levels of the chemical BPA in your urine, you may be at an increased risk of heart disease. Some of the greatest concern surrounds early-life, in utero exposure to BPA, which can lead to chromosomal errors in your developing fetus, causing spontaneous miscarriages and genetic damage. But evidence is also very strong showing these chemicals are influencing adults and children, too, and leading to decreased sperm quality, early puberty, stimulation of mammary gland development, disrupted reproductive cycles and ovarian dysfunction, obesity, cancer and heart disease, among numerous other health problems.

Avoiding Hormone-Disrupting Substances is Crucial for Children and Adults Alike

While young girls may show obvious signs of exposure to hormone-disrupting substances via early puberty, other signals are more insidious and may not show up until a disease is already present. Here are 11 measures you can implement right away to help protect yourself and your children from common toxic substances that could cause precocious puberty and other long-term health problems:

1. As much as possible, buy and eat organic produce and free-range, organic meats to reduce your exposure to added hormones, pesticides and fertilizers. Also avoid milk and other dairy products that contain the genetically engineered recombinant bovine growth hormone (rBGH or rBST)
2. Eat mostly raw, fresh foods. Processed, prepackaged foods (of all kinds) are a major source of soy and chemicals such as BPA and phthalates.
3. Store your food and beverages in glass rather than plastic, and avoid using plastic wrap and canned foods (which are often lined with BPA-containing liners).
4. Use glass baby bottles and BPA-free sippy cups for your little ones.
5. Make sure your baby's toys are BPA-free, such as pacifiers, teething rings and anything your child may be prone to suck on.
6. Only use natural cleaning products in your home to avoid phthalates.
7. Switch over to natural brands of toiletries such as shampoo, toothpaste, antiperspirants and cosmetics. The Environmental Working Group has a great safety guide to help you find personal care products that are free of phthalates, parabens and other potentially dangerous chemicals.
8. Avoid using artificial air fresheners, dryer sheets, fabric softeners or other synthetic fragrances, many of which can also disrupt your hormone balance.
9. Replace your non-stick pots and pans with ceramic or glass cookware.
10. When redoing your home, look for "green," toxin-free alternatives in lieu of regular paint and vinyl floor coverings.
11. Replace your vinyl shower curtain with one made of fabric.
12. Avoid non-fermented soy, especially if you're pregnant and in infant formula.

Theo Colburn's book Our Stolen Future is a great source for further investigation as it identifies the numerous ways in which environmental pollutants are disrupting human reproductive patterns. I believe it is one of the best resources on this topic and highly recommend it.

Vitamin D Also Linked to Early Puberty

It has been suggested that girls who live closer to the equator start puberty at a later age than girls who live in Northern regions. Since this indicates a potential connection with sun exposure, researchers decided to investigate whether vitamin D was, in fact, related. Upon measuring vitamin D levels in 242 girls aged 5-12, researchers from the University of Michigan School of Public Health found that those who were deficient were twice as likely to start menstruation during the study period as those with higher levels.⁵

Specifically, among the vitamin-D-deficient girls, 57 percent started their period during the study, compared to 23 percent with adequate vitamin D. However, researchers defined adequate vitamin D as ≥ 30 ng/mL, which is actually still a deficiency state! For optimal health, vitamin D levels should be a minimum of 50 ng/mL, which means the number of vitamin-D-deficient girls with early puberty was probably much higher than the study reported.

The earlier you enter puberty, the longer you're exposed to elevated levels of the female hormone estrogen, which is a risk factor for certain cancers such as breast cancer. This has been the primary "link" between early puberty and cancer that has been explored, but it's important to understand that vitamin D deficiency is also a major risk factor for cancer, heart disease and many other diseases. So it could be that some of the increased risks that come from early puberty are linked to low vitamin D levels.

What You Should Know About Obesity, Stress and Exercise

Obesity (which exposes girls to more estrogen because estrogen is both stored and produced in fat tissue) is another likely factor in early puberty. The New York Times reported:

"As Robert Lustig, a professor of clinical pediatrics at the University of California, San Francisco's Benioff Children's Hospital, explains, fatter girls have higher levels of the hormone leptin, which can lead to early puberty, which leads to higher estrogen levels, which leads to greater insulin resistance, causing girls to have yet more fat tissue, more leptin and more estrogen, the cycle feeding on itself, until their bodies physically mature."

As for stress, this, too, has been linked to early puberty, with girls whose parents divorced when they were between 3- and 8-years-old significantly more likely to experience precocious puberty. "Evolutionary psychology offers a theory," the New York Times reports. "A stressful childhood inclines a body toward early reproduction; if life is hard, best to mature young. But such theories are tough to prove." Interestingly, in addition to avoiding environmental chemicals, obesity and stress, and optimizing your vitamin D, regular exercise appears to be one of the best known ways to help prevent early puberty.

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As plastic ages or is exposed to heat or stress, it can release trace amounts of some of its ingredients. Of particular concern are bisphenol-a (BPA), used to strengthen some plastics, and phthalates, used to soften others.

These chemicals are used in hundreds of household items; BPA is in everything from baby bottles to can linings, while phthalates are found in children‘s toys as well as vinyl shower curtains. They enter your body through the food, water and bits of dust you consume, or are simply absorbed through your skin.

BPA and phthalates are endocrine disrupters, which mimic hormones. Estrogen and other hormones in relatively tiny amounts can cause vast changes, so researchers worry that BPA and phthalates could do the same, especially in young children.

To cut down on your exposure, avoid plastic bottles and toys labeled with the numbers 3 or 7, which often contain BPA or phthalates, and canned foods, especially those with acidic contents like tomatoes. You should also avoid heating plastic in microwaves.

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More than three decades of scientific research suggests that repeatedly telling children that they are especially smart or talented leaves them vulnerable to failure, and fearful of challenges.

Children raised this way develop an implicit belief that intelligence is innate and fixed, making striving to learn seem less important than seeming smart; challenges, mistakes, and effort become threats to their ego rather than opportunities to improve.

However, teaching children to have a “growth mind-set,” which encourages effort rather than on intelligence or talent, helps make them into high achievers in school and in life. This results in “mastery-oriented” children who tend to think that intelligence is malleable and can be developed through education and hard work.

This can be done by telling stories about achievements that result from hard work. Talking about math geniuses who were born that way puts students in a fixed mind-set, but descriptions of great mathematicians who developed amazing skills over time creates a growth mind-set.

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More than 80 percent of schools in America use toxic pesticides as a preventative measure, whether it‘s needed or not.

Mark Lame, an entomologist and professor at Indiana University‘s School of Public and Environmental Affairs, believes this is an entirely unnecessary practice that carries more risks than benefits to students and faculty.

The most widely used pesticides are, in fact, nerve poisons. They cause uncontrolled nerve firing, and disrupt the delicate hormone systems.

The link between pesticide exposure and health problems in children is already well established. Research has connected these endocrine-disrupting pesticides to health problems such as ADHD, autism, and infertility -- all of which are on the rise.

Professor Lame says pest problems are better managed through an integrated approach -- by preventing the conditions that attract pests into school facilities in the first place.

Lame serves as a consultant for schools around the country, helping them reduce the toxic load by implementing his Integrated Pest Management (IPM) process.

Science Daily July 21, 2007

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Alexis Fernandez may be most known for her podcast Do You F***king Mind, but her new book Be Bold: Manifest Your Dream Life is making huge waves.

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Some commercially prepared baby foods can contain as much sugar and unhealthy fats as junk food. A recent Congressional report has also found some of the largest commercially prepared baby food brands also contain significant levels of toxic heavy metals.^1,2

Commercially prepared baby food may also contain other questionable ingredients, including genetically modified soy, synthetic vitamins, inorganic minerals and excessive levels of protein. These are packed into convenient containers of baby food, which also lack the immune-boosting nutrients found in breast milk.

Although many pediatricians continue to advise parents to feed rice cereal mixed with breastmilk or formula as a baby's first meal, I believe this is irresponsible advice. Feeding carbohydrate-packed white rice³ can set babies up for a lifetime of bad eating habits and place them at risk for diabetes.⁴

During processing, the vitamins, fiber and other nutrients in white rice are stripped away, leaving carbohydrates that turn to sugar and raise insulin levels. The result of this congressional review also supports a 2019 study that found toxic metal in 95% of the baby food tested and also found the neurotoxic contaminant perchlorate.⁵

Congressional Report Finds Heavy Metals in Baby Food

The report, published in February 2021, revealed there were significant levels of arsenic, cadmium, lead and mercury found in some of the most popular commercial baby foods on grocery store shelves. The tests were requested by the Subcommittee on Economic and Consumer Policy after receiving reports there were high levels of heavy metals in baby food.⁶

Products from seven manufacturers of baby foods in the U.S. were tested. Four of the companies also provided their internal test policies and results. Some companies tested the ingredients and finished products and others tested only one or the other. However, there were three companies, including Walmart, Campbell Soup company and Sprout Organic Foods, that did not cooperate.⁷

“The Subcommittee is greatly concerned that their lack of cooperation might be obscuring the presence of even higher levels of toxic heavy metals in their baby food products than their competitors’ products.”

Campbell Soup company sells baby food under the Plum Organics baby food brand and Walmart baby food brand is Parent's Choice. Chair of the subcommittee Raja Krishnamoorthi, D-Ill., spoke with a journalist from The Washington Post after the report was released, saying:⁸

“Over the last decade advocates and scientists have brought this to the attention of the Food and Drug Administration. The FDA must set standards and regulate this industry much more closely, starting now. It’s shocking that parents are basically being completely left in the lurch by their government.”

While it may have been shocking to Krishnamoorthi, it fits with past actions from the U.S. Food and Drug Administration. The report discovered that one of the dangers of testing only ingredients was in some cases the finished product tested up to 93% higher in heavy metals than when just the ingredients were tested.⁹

For instance, when the levels of heavy metals in Hain Celestial Group baby foods were tested, the difference in results between testing the ingredients and the finished product may have been the result of added ingredients, such as vitamin and mineral premix.¹⁰

Testing Revealed Significant Heavy Metal Levels

Arsenic is found in soil and water, poses a significant risk to human health and is the leading substance on the priority list from the Agency for Toxic Substances and Disease Registry (ATSDR).¹¹

The Washington Post reports that only rice cereal has a maximum set for inorganic arsenic, 100 parts per billion (ppb). Yet the FDA has set “maximum allowable levels in bottled water,” which are far below the level set for baby food, at 10 ppb.¹²

Documents from Hain Celestial Group, makers of Earth's Best Organic baby food, showed many of the ingredients had arsenic levels as high as 309 ppb and at least 24 ingredients in the company’s baby food products measured higher than 100 ppb of arsenic.¹³

The second substance on the ATSDR list is lead. The Washington Post reports that to date, there is no set federal standard for lead allowed in baby food. Although some experts may believe 1 ppb is an acceptable exposure level in baby food, the American Academy of Pediatrics writes, “Lead exposure has been associated with health, learning and behavior problems, and no amount is considered safe.”¹⁴

The congressional report shows that ingredients used in Beech-Nut baby food measure as high as 886.9 ppb of lead and 483 ingredients had levels measuring over 5 ppb. Jason Jacobs, vice president of food safety, quality and innovation at Beech-Nut, commented on the results of the report, saying:¹⁵

“Beech-Nut established heavy metal testing standards 35 years ago, and we continuously review and strengthen them wherever possible. We look forward to working with the FDA, in partnership with the Baby Food Council, on science-based standards that food suppliers can implement across our industry.”

Environmental Defense Fund¹⁶ analyzed raw data from the FDA’s Total Diet study from 2014 to 2016. The analysis showed lead levels in food designed for babies and children, including teething biscuits, arrowroot cookies, carrots and sweet potatoes, were high.

They analyzed data from August 2019 and found when results for baby food were compared against samples of fruit and vegetables, baby carrots and peeled, boiled carrots had significantly lower lead levels than baby food carrot puree. In fact, 83% to 100% of samples of baby food root vegetables, crackers and cookies had detectable levels of lead.

The report¹⁷ also found high levels of cadmium and mercury in baby foods from all the companies tested and the levels tested in baby food for each of the heavy metals is “multiples higher than allowed under existing regulations for other products.” The congressional report found:¹⁸

“The test results of baby foods and their ingredients eclipse those levels: including results up to 91 times the arsenic level, up to 177 times the lead level, up to 69 times the cadmium level, and up to 5 times the mercury level.”

Does the Dose Make the Poison?

FoodNavigator-USA¹⁹ interviewed executive director of the Clean Label Project (CLP) Jackie Bowen, whose organization has been advocating for manufacturing companies to think carefully about how raw materials are sourced and what ends up on the label.

Bowen pointed out that food safety regulations in the U.S. are often focused on microbial contaminants rather than toxins. In the absence of regulatory guidance, manufacturers are left to determine what they believe is safe for release to the grocery stores.

However, as reported by The Washington Post,²⁰ even when baby foods have tested higher than the companies’ limit set for heavy metals, the products continue to be sold to the public. In answer to the question of whether the dose makes the poison, Bowen points to the responsibility and power that consumers have.²¹

“Consumers are new arbiters of truth and safety with Mom's serving as the Chief Operating Officer of their households. Over the past five years, there have been at least four consumer advocacy calls to action about heavy metals in baby food. Low level of repeat exposure to heavy metals has been linked to cancer and infertility. It is past time for brands to recognize that parents expect better.

As to the old adage that the dose is the poison, contaminants like lead are the exception that proves the rule: the Environmental Protection Agency, Food and Drug Administration, the World Health Organization, the Centers for Disease Control and Prevention, the American Medical Association and the American Academy of Pediatrics have all independently stated there is no safe level of lead for children. In this case, the poison is the poison.”

Heavy Metals Have Long-Term Effect on Babies

Dan Fabricant, CEO and president of the Natural Products Association, once called the CLP’s statements on contaminants in protein powder "defamatory." He attempted to justify the toxic exposure, saying:²²

"Just look at the language and how they use the term 'detectable levels.' It's all made to look very scandalous and salacious. Everything suggests implicitly that there is a critical public health issue. We believe this is bad for the brands themselves and bad for the industry."

It's important to remember that any detectable level of heavy metals is concerning since they are not easily removed by the body. A paper in the British Medical Bulletin called exposure to cadmium, lead, arsenic and mercury — the heavy metals found in many baby foods — a “main threat to human health.”²³

By far the most studied of the heavy metals is lead, which has demonstrated a particular danger as a neurotoxin in children.²⁴ Scientists have been aware of this for the last 100 years and research has focused on the effects of the poison on the developing nervous system for the past 60 years. Despite this growing body of evidence and public awareness, legislation has not been effective.

One review of the literature²⁵ in emerging market countries reported on blood and urine concentrations of heavy metals. These were generally found to be higher than U.S. reference values. The analysis identified the health effects that were associated with this exposure.

They found associations between gestational age, birth weight and cognitive scores with levels of arsenic in the blood or urine. Children drinking arsenic contaminated water demonstrated skin lesions and different degrees of peripheral neuropathy.

With cadmium exposure, researchers found low birth weight, slightly decreased IQ and smaller head circumference. In the 55 articles focused on lead exposure, there were negative associations between measured blood levels and mental development, and neurological and behavioral test scores.

Other health conditions included low birth weight, stunted growth and aplastic anemia. Twelve studies were focused on mercury exposure and found lower mental and psychomotor developmental test scores as well as children ages 9 to 17 years with ataxia, dysdiadokinesis and pathological reflexes.

Consider Homemade Baby Foods When Possible

There is no denying that prepackaged baby foods are convenient when you are traveling. However, you do have options to lower the risk of exposure to heavy metals and other toxins by making baby food at home using organically grown and locally sourced fruits and vegetables. As I mentioned earlier, steer clear of rice paste cereals as they are high in arsenic and carbohydrates and low in nutrients.

When you make your own food at home, you also have greater control over what goes into the foods as you can select higher quality fruits and vegetables and steer clear of preservatives, additives and added sugar. It reduces food waste and it saves you money in the long run.

For instance, Happy Family Organics²⁶ compares the price of two to three containers of baby food against that of six pears, which can be pureed for 10 or more meals. With a vegetable peeler, steamer basket and blender or food processor you have all you need to get started making and freezing baby food.

Most pediatricians recommend exclusively breastfeeding to at least 6 months of age and introducing your baby's first spoons of solid food at around 6 months.²⁷ Making baby food at home also improves the nutrient value, since many baby food purees have a long shelf life, which may even be older than your baby.

You also can control the thickness of the puree you make at home, which helps you transition your baby from purees to solid food as they grow older. Once you finish making the food you can add it to an ice cube tray, cover it and let it freeze for at least five hours before transferring to a freezer-safe container.

Remove the food the day before and place into the refrigerator to thaw. It can also be warmed on the stovetop over medium to low heat. Just be sure to stir the food completely so there are no hot spots and test the food yourself, so you don't burn your baby's tongue.

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The question of where and how to give birth is a relatively new one for women. Up until the early 20th century, fewer than 5% of women gave birth in a hospital. In the 1950s the birth of a baby, an event that had once been a family affair and attended by a midwife, became more medicalized.¹

Pregnancy and birth were seen more as a sickness than a natural part of life. One mom described the birth of her first child in the 1960s as occurring without pain medication, with minimal interaction from medical staff and a forced two-week hospital stay.²

Dads began attending births in the 1970s and by the 1990s childbirth was swinging back toward being a natural part of life. More women are now offered choices that are respectful of their wishes, without repeating the horror stories of past generations. This is an important factor in the future health of mother, child and family as recognized by the World Health Organization.³

The outcome not only affects the mother but may also be important in the development of the mother’s and child's relationship and mom’s future childbearing experiences. Researchers have found that a woman's positive and negative perceptions of birth are related more to her ability to control the situation and have a choice in her options, than specific details.

Low-Risk Home Birth as Safe as Hospital Birth

Evidence doesn’t back the long-held belief that low-risk deliveries are better served in the hospital where medical intervention may be used to speed delivery.

The safety debate surrounding home births is not a new one. Nearly 11 years ago data showed when a home birth was planned by a woman with a low-risk pregnancy and attended by a midwife, there were:⁴

" … very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician."

In 2008 the American College of Obstetricians and Gynecologists (ACOG) published a statement in opposition to home births, writing that “Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.”⁵

Despite evidence to the contrary, their statement published nearly 10 years later did not change: In 2017 they recommended women be informed of the risks, specifically that there are a lower number of risks to the woman but a higher rate of perinatal deaths.⁶

In another study of 530,000 births in the Netherlands,⁷ researchers found no differences in the rate of death in mother or baby between those born at home or in a hospital. The study was sparked by the suggestion that the high rate of infant mortality may be due to the high number of home births. The review of medical records did not bear out the hypothesis. Professor Simone Buitendijk commented to the BBC:⁸

"We found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife. These results should strengthen policies that encourage low-risk women at the onset of labour to choose their own place of birth."

Safety Data Positive With Well-Educated Midwives

It should be noted data were published long before the 2017 policy statement from ACOG mentioned above. In 2014, a review of 16,924 home births recorded between 2004 and 2009 were examined. Researchers noted the rise of home births by 41% from 2004 to 2010, writing there is a⁹ “need for accurate assessment of the safety of planned home birth.”

The scientists found that of the participants who planned a home birth, 89.1% did in fact do so. Most of the transfers to the hospital during labor were for failure to progress. However, 93.6% went on to have a spontaneous vaginal delivery, and 86% of infants were breastfeeding exclusively by 6 weeks of age. The overwhelming majority — 87% — of 1,054 who attempted a vaginal delivery after cesarean section at home were successful.

Researchers recently conducted an international meta-analysis to evaluate the safety of home and hospital births with the primary outcome measurement of any perinatal or neonatal death. They chose 14 studies including approximately 500,000 intended home births attended by a midwife.¹⁰

The information was pulled from outcomes from eight Western countries, including the U.S., in studies published since 1990.¹¹ What they found fit many of the previous studies:¹² "The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital." Eileen Hutton from McMaster University, one of the researchers, commented:¹³

"More women in well-resourced countries are choosing birth at home, but concerns have persisted about their safety. This research clearly demonstrates the risk is no different when the birth is intended to be at home or in hospital."

Conditions Best Addressed at the Hospital

Of course, there are high risk pregnancies better served inside a hospital environment. According to the U.S. Department of Health and Human Services, factors that potentially create a high-risk pregnancy include existing health conditions and lifestyle choices. While this list is not all-inclusive, these are factors your midwife or doctor will consider as you discuss your birth plan. Some include:¹⁴

High blood pressure — If this is the only risk factor and blood pressure is only slightly elevated, it may not be enough to stop a home delivery plan. However, uncontrolled blood pressure is dangerous to mother and baby.

Polycystic ovary syndrome (PCOS) — PCOS can increase the risk of gestational diabetes, cesarean section, preeclampsia and pregnancy loss before 20 weeks.

Diabetes — Moms who have diabetes are more likely to have babies that are larger than most; their babies may also have low blood sugar after being born.

Kidney disease — Depending upon the extent of the disease, it may impact fertility and the ability to carry a pregnancy to term. Nearly 20% of women with preeclampsia during pregnancy go on to be diagnosed with kidney disease.

Autoimmune disease — Medications used to treat autoimmune diseases may be harmful to the baby; such conditions also increase risks of pregnancy and delivery.

Thyroid disease — Uncontrolled disease may increase stress on the baby and cause poor weight gain, heart failure or problems with brain development.

Obesity — Obesity before becoming pregnant is associated with high risk and poor outcomes, including large for gestational age babies, difficult birth and a risk for heart defects.

Age — Teens and first-time moms over 35 fall into high-risk categories.

Lifestyle factors — Alcohol, tobacco and drug use increase the risks to mom and baby during the pregnancy and delivery.

Pregnancy conditions — Women carrying multiples, who have had a previous premature birth or who have gestational diabetes, preeclampsia or eclampsia are at high risk.

Comparing the Risks of Home and Hospital Births

The decision to give birth at home or in a hospital is a personal one. While ACOG claims the hospital is the safest place, research evidence shows low-risk pregnancies delivered at home or in a hospital with a qualified midwife have the same risks and outcome potential. Just as important are the risks for low-risk women who give birth inside a hospital setting.

For instance, while a home birth rarely if ever includes the use of drugs or interventions to speed delivery, many women who are hospitalized may receive Pitocin, a synthetic form of oxytocin. The drug is used to induce labor or start contractions and it may be used to intensify labor contractions to speed the process.

However, the use of the medication must be balanced against outcomes, such as a higher rate of analgesia and cesarean section,¹⁵ both of which affect mother and baby. In any pregnancy, oxytocin may also increase the risk of fever in the woman, low pH values in the umbilical cord and a shorter first stage of labor.¹⁶

Data from the CDC show the rate of cesarean sections in 2018 were 31.9% of all births.¹⁷ However, this includes a number of cesarean sections considered medically unnecessary. The rate for Nulliparous, Term, Singleton, Vertex (NTSV) Cesarean Birth Rate is 25.9%.¹⁸

This means that of all the women who had a cesarean section, 25.9% were having their first baby, beyond 39 weeks gestation and carrying one child who presented normally, in the vertex position with the head down.¹⁹

Having had a first cesarean section nearly guarantees the following births will also be a cesarean section as the repeat rate is 86.7%.²⁰ As explained by the American Pregnancy Association, cesarean section introduces multiple risks for mother and baby. For the mother, these include infection, hemorrhaging, injuries, lengthy stays in the hospital and emotional reactions as well as those related to medicine.

Moms can also have adhesions, or scar tissue that causes a blockage in the stomach area. Babies can have a low birth weight, a low APGAR score, breathing difficulties and even injuries.²¹

Type of Birth Influences Future Health

As you likely know, the gut microbiome is an intricate living foundation for your immune system that plays a role in your risk of chronic disease, weight management and how well your body absorbs nutrition. As you may imagine, during a vaginal birth a baby's microbiome is first “seeded” and developed.

During the process a baby is passed the mother's microbiome, which is why it's so important for the woman to have a healthy gut before, during and after pregnancy. The makeup of the mother's gut will influence how the baby's microbiome grows.

A cesarean section bypasses this important step, which may be compounded by bottle feeding, a lifetime of processed foods and an overuse of antibiotics. These factors all have led to a steep loss of biodiversity in the human gut making many vulnerable to disease. Skin-to-skin contact after birth and breastfeeding are two ways to pass along a healthy microbiome if you've had a cesarean section.

For more information about how to more effectively help seed your baby's gut microbiome see "How the Method of Birth Can Influence Lifelong Health."

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Prolonged stress can have life-threatening consequences not only for adults but also for children. Research shows adverse childhood experiences (ACEs) can predispose them to any number of health problems later in life.

In the early days of mankind’s evolution, the stress response saved our lives by enabling us to run from predators or take down prey. Today, however, such dire circumstances are few and far between, yet we still turn on the same “life-saving” reaction to cope with countless everyday situations.

Constantly being in a stress response may have you marinating in corrosive hormones around the clock, which can raise your blood pressure, add fat to your belly, shrink your brain and even unravel your chromosomes.¹

Stress disrupts your neuroendocrine and immune systems and appears to trigger a degenerative process in your brain that can result in Alzheimer’s disease. Stress can also accelerate aging by shortening your telomeres, the protective genetic structures that regulate how your cells age. In the words of Dr. Lissa Rankin, author of “Mind Over Medicine”:²

“Our bodies know how to fix broken proteins, kill cancer cells, retard aging, and fight infection. They even know how to heal ulcers, make skin lesions disappear and knit together broken bones! But here’s the kicker — those natural self-repair mechanisms don’t work if you’re stressed!”

Childhood Stress and Mental Health

In a March 2020 Newsweek article,³ Adam Piore discusses the work of Dr. Nadine Burke Harris, founder of a children’s medical clinical in one of San Francisco’s poorest neighborhoods.

A surprisingly large portion of her young patients struggled with symptoms of attention deficit hyperactivity disorder (ADHD), the hallmarks of which include an inability to focus, impulsivity and abnormal restlessness. Many also had severe health problems and depression. Piore writes:

“Burke Harris noticed something else unusual about these children. Whenever she asked their parents or caregivers to tell her about conditions at home, she almost invariably uncovered a major life disruption or trauma.

One child had been sexually abused by a tenant, she recalls. Another had witnessed an attempted murder. Many children came from homes struggling with the incarceration or death of a parent, or reported acrimonious divorces. Some caregivers denied there were any problems at all, but had arrived at the appointment high on drugs.”

Alarmed by the obvious trend she was witnessing in her clinic, Harris began searching for answers in the medical literature. Was childhood trauma responsible for the poor state of health of so many of her young patients?

“Childhood stress can be as toxic and detrimental to the development of the brain and body as eating lead paint chips off the wall or drinking it in the water — and should be screened for and dealt with in similar ways, in Burke Harris' view. As California's first Surgeon General … she is focusing on getting lawmakers and the public to act,” Piore writes.⁴

Adverse Childhood Experiences Screening

In 2020, California is allocating $105 million to promote screening for ACEs, which have been shown to trigger toxic stress responses and epigenetic changes linked to a variety of health problems. As reported by Piore, the biological switches flipped during ACEs increase a child’s risk for:⁵

Nicotine, alcohol and drug abuse	Heart disease
Suicide	Cancer
Mental illness	Dementia
Impaired immune function

What’s more, these stress-induced epigenetic changes can be passed on to future generations. Indeed, you will often find that childhood trauma “runs in families,” with each subsequent generation playing out the same interpersonal dramas as their parents. According to Harris, "The social determinants of health are to the 21st century, what infectious disease was to the 20th century."⁶

The ACE Study

Much of what we now know about ACEs are the result of the 1998 ACE Study,⁷ which examined the relationship between childhood trauma and subsequent risky behaviors and diseases in adulthood. Categories of ACEs examined included:^8,9

Psychological abuse	Physical abuse
Sexual abuse	Violence against the mother
Living with household members who were substance abusers	Living with mentally ill or suicidal household members
Living in a household in which a member has been or is imprisoned	Early death of a parent
Neglect	Separation or divorce

Of the 13,494 adults who received the questionnaire and had completed a standard medical evaluation, 70.5% responded. Of those, more than half reported experiencing at least one ACE; one-fourth reported two or more.

Not only did they find a direct “dose-dependent” relationship between the number of ACEs and future health problems and risky behaviors, childhood trauma appeared to be an independent risk factor for leading causes of death. According to the authors:¹⁰

“We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied.

Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity.

The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.”

Origins of ACEs

In the June 2019 issue of the American Journal of Preventive Medicine, (full text is behind a paywall)¹¹ Dr. Vincent J. Felitti commented on his 1998 ACE Study:

“The ACE Study was a direct outgrowth of significant counterintuitive findings derived from … the treatment of obesity in Kaiser Permanente’s Department of Preventive Medicine in San Diego, California. Unexpectedly, we discovered that such major weight loss was actually threatening to many patients.

Pursuing this, we came to realize that obesity, a major public health problem from a societal standpoint, was from the involved patient’s standpoint often an unconsciously chosen solution to unrecognized traumatic life experiences that were lost in time and further protected by shame, secrecy, and social taboos against exploring certain realms of human experience.”

Upon investigation, 55% of 286 patients enrolled in the Kaiser Permanente weight loss study acknowledged sexual abuse — an absolutely staggering statistic Felitti could hardly believe at first. Many of these patients also spoke about other childhood traumas.

Since these patients unconsciously used obesity as a defense mechanism, their weight loss efforts were often unsustainable, and they’d gain all the weight back. Since the publication of the 1998 ACE Study, Felitti and co-principal investigator Dr. Robert Anda have published more than 75 articles on its findings and other follow-up investigations.

The Importance of Sharing and Acceptance

Unfortunately, while interest in ACEs has grown, there’s been a strong resistance to using the information in clinical medical practice. For example, there were fears that questions about ACEs might enrage patients or trigger suicide.

However, when Felitti conducted an investigation, he found that when the ACE questions were included in an adult medical history intake, outpatient visits were actually reduced by 35% and emergency room visits declined by 11% in the subsequent year, compared to the year before the ACE questions were added.

They also found there was no rise in referrals to psychotherapy, so the reduction was not due to more people seeking psychiatric help. What they eventually discovered was that the mere ability to talk about their ACEs had a tremendously beneficial effect. Felitti writes:¹²

“We learned from patients that our apparent acceptance of them after hearing their dark secret was of profound importance. After lengthy consideration, we came to see that ‘Asking’ … followed up by face-to-face ‘Listening’ and ‘Accepting’ was a powerful form of ‘Doing.’

In other words, we had come upon a mechanism for reducing traumatic shame, which shame had the secondary effect of causing stress-related symptoms and hence doctor visits. Given our sample size, the economic implications of a reduction of this magnitude in medical utilization are in the multibillion-dollar range for any large organization.

Numerous legislatures, state and federal, have become involved because of the multibillion-dollar implications of the ACE Study findings for population health as well as medical care budgets.

The WHO has been collecting data annually with an International Version of the ACE Questionnaire in more than two dozen European and Asian nations, and the CDC has added since 2009 an ACE module to its annual Behavioral Risk Factor Surveillance Study, with almost all states currently participating.

Thus, in spite of the slow progress over the past 20 years, the international breadth and strength of interest in understanding the implications and extent of the ACE findings strongly suggest that our keynote AJPM article will ultimately have a major role in advancing well-being and medical care.”

Mind-Body Connection

In the two decades since the ACE Study came out, researchers have investigated the connection between childhood trauma and adult disease states from a variety of angles, looking for biological mechanisms to explain it.

One proposed mechanism involves the hypothalamic-pituitary-adrenal (HPA) axis, which controls stress reactions and regulates immune function, energy storage and expenditure, moods and emotions by way of hormones. A key hormone involved is cortisol, which plays a role in energy regulation. As explained by Piore:¹³

“When all is calm, the body builds muscle or bone and socks away excess calories for future consumption as fat, performs cellular regeneration and keeps its immune system strong to fight infection. In the case of a child, the body fuels normal mental and physical development.

In an emergency, however, all these processes get put on hold. The HPA axis floods the bloodstream with adrenaline and cortisol, which signals the body to kick into overdrive immediately. Blood sugar levels spike and the heart pumps harder to provide a fast boost in fuel …

When the emergency goes on for a long time — perhaps over an entire childhood of abuse — the resulting high levels of cortisol take a big and lasting toll.”

ACEs and Cortisol Dysregulation

Interestingly, researchers have discovered that different ACEs impact cortisol regulation in different ways. Children who experience severe emotional, physical or sexual abuse tend to have abnormally high cortisol levels first thing in the morning, while children experiencing severe neglect tend to have abnormally low morning levels.

Low morning cortisol has been linked to delinquency and alcohol use, while high morning cortisol levels are associated with anxiety, depression and post-traumatic stress disorder.

Excessive amounts of cortisol also lower immune function, thus raising the risk of infection, and raises the risk of high blood pressure, insulin resistance, Type 2 diabetes, obesity and heart disease.

On the other hand, too little cortisol increases the risk of an inflammatory immune response and exaggerated inflammatory response to stress. “Sickness behavior” — lack of appetite, fatigue, social withdrawal, depressed mood, irritability and poor cognitive functioning — has also been shown to be related to insufficient cortisol, Piore reports.

Genetics Also Play a Role

Researchers have also discovered that the presence of ACEs is in and of itself not enough to trigger toxic stress. Genetics also appear to play a role, as does interpersonal intervention. If someone is around to offer soothing reassurance, a sense of safety can be restored, allowing cortisol levels to normalize.

The problem is that chronic abuse is typically because no one is intervening on the child’s behalf. “Adversity and stress without adequate buffering can turn on genes that flood the system with enzymes that prime the body to respond to further stress by making it easier to produce adrenaline and reactivate the fight-or-flight response quickly, which can make it harder for children with toxic stress to control their emotions,” Piore notes.¹⁴

Childhood Trauma Is a Significant Health Risk

In 2019, the U.S. Centers for Disease Control and Prevention analyzed data from 144,017 individuals in 25 states, finding:^15,16

• Nearly 1 in 6 adults (15.6%) has experienced four or more types of ACEs
• ACEs raise the risk of at least five of the top 10 leading causes of death
• Preventing ACEs could reduce adult depression rates by as much as 44%, asthma rates by 24% and stroke by 15%
• Preventing ACEs could also prevent up to 1.9 million cases of heart disease and up to 2.5 million cases of overweight or obesity

Interventions to Combat the Stress Response

The good news is that as the role of ACEs and toxic stress is becoming more widely recognized, doctors can begin to address these issues, which is what Harris is pushing for in California. Caregivers of stressed or traumatized children also need to be educated on the importance of emotional and physical buffering. Piore writes:¹⁷

“Buffering includes nurturing caregiving, but it can include simple steps like focusing on maintaining proper sleep, exercise and nutrition.

Mindfulness training, mental health services and an emphasis on developing healthy relationships are other interventions that Burke Harris says can help combat the stress response.

The specifics will vary on a case-by-case basis, and will rely on the judgment and creativity of the doctor to help adult caregivers design a plan to protect the child — and to help both those caregivers and high-risk adults receive social support services and interventions when necessary … ‘Most of our interventions are essentially reducing stress hormones, and ultimately changing our environment,’ says Burke Harris. "

A 2017 paper¹⁸ in Health & Justice delineates further “action steps using ACEs and trauma-informed care” to improve patient resiliency without retraumatizing them.

Resilience is the ability of your body to rapidly return to normal, physically and emotionally, after a stressful situation. One way to improve resilience is through breath work, as described in “Simple Techniques to Reduce Stress and Develop Greater Resiliency.”

The Health & Justice paper¹⁹ also highlights the importance of incorporating neuroscience concepts to trauma-informed care programs and therapies, and stresses the use of a resilience-oriented approach in order to move “from trauma information to neuroscience-based action with practical skills to build greater capacity for self-regulation and self-care in both service providers and clients.”

Problems and Challenges: ACE Score May Be Misleading

California’s Department of Health Care Services ACEs Aware Initiative kicked off January 1, 2020.²⁰ Health care providers in the state are encouraged to screen patients for ACEs that might influence their health, and connecting patients in need with the appropriate interventions and resources.

Some, however, including Anda, who helped develop the ACE score with Felitti, worry that the ACE score might not work well when applied to individual patients, as it does not take into account caregiver buffering and other factors that tend to be protective. Piore writes:²¹

“The problem with applying it to individual patients, he says, is that it doesn't take into account the severity of the stressor. Who's to say, for instance, that someone with an ACE score of one who was beaten by a caregiver every day of their life is less prone to disease than someone with an ACE score of four who experienced these stressors only intermittently?

On a population level, surveying thousands, the outliers would cancel each other out. But on the individual level they could be misleading.”

While screening tools can indeed be misused and lead to inappropriate labeling, recognizing the influence of ACEs in public health is an important step forward. In coming years, we’re likely to see more advances in screening methods as well.

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