PFAS has been constantly in the headlines in recent years. Yet few physicians are aware of it or understand the health risks. If you live in an area with high PFAS, you are expected to navigate the complex range of studies out there. And all too often, physicians will dismiss your health concerns.
What is PFAS?
PFAS stands for per- and polyfluoroalkyl substances. PFAS is a collective name for a family of chemicals that have been in widespread use since at least the 1950s. When they were first discovered, scientists noticed they had unique properties that helped them shed water and oil. This saw them being almost anywhere a manufacturer wanted to make something waterproof, stain resistant, or grease proof. They were also used in more specialized applications, such as firefighting foams.
Why is PFAS in the news?
PFAS is rapidly becoming as infamous as asbestos. For at least the last 30 years, researchers have known that PFAS is damaging to human health. It is proven to cause cancers in several organs including the kidneys, liver, and pancreas. It is a key cause of high cholesterol and the associated cardiovascular disease. It is linked with developmental issues, such as premature birth. Studies show it suppresses the immune system and makes vaccines less effective.
How common is PFAS exposure?
For the last 25 years, the CDC has been monitoring levels of PFAS in the US population. Shockingly, their NHANES study has found that almost every adult has some level of PFAS in their blood. This varies from trace amounts (a fraction of a nanogram per milliliter of blood) up to concentrations of 10s of nanograms per milliliter. According to the National Academies of Science, Engineering and Medicine (NSAEM), any level over 2 ng/mL is of some concern, and over 20 ng/mL significantly increases the risk.
Why is PFAS exposure so common?
PFAS compounds are remarkably resistant to breaking down in the environment. That’s because the carbon-fluorine bond at their heart is one of the strongest chemical bonds there is. As a result, PFAS pollution has now been detected in every continent (including Antarctica). The problem is, PFAS is readily dissolved in water, and can even be found in rainfall. Much of that pollution comes from industrial uses of PFAS. However, a major source is the use of sewage sludge for land management. An estimated 30-40% of all US drinking water is polluted with PFAS. As a result, water treatment works concentrate PFAS. The resulting sludge is a major source of PFAS which then leaches from the fields, back into the ground water. In effect, this perpetuates the PFAS cycle.
Why are physicians so unaware of PFAS?
The science of PFAS exposure and health effects is complex. Although PFAS is proven to be linked with major health problems, scientists are still trying to understand the exact mechanisms at work. Increased exposure over time is certainly a risk factor, but it is remarkably hard to quantify the exact risks.
This makes it hard for physicians to know how to react if a patient comes to them with worries about PFAS. In response to this, both the NASEM and CDC have issued guidance to physicians.
NASEM guidance
In 2022, NASEM issued a detailed Guidance on PFAS Exposure, Testing, and Clinical Follow Up. This was intended to act as a definitive guide for physicians seeing patients with concerns about PFAS. They define PFAS risk in terms of the combined level of several PFAS compounds in human blood (the compounds that the CDC tracks in their NHANES program).
- Low (under 2 ng/mL)
No special requirements. Your physician should provide you with the usual standard of care
- Medium (between 2 and 20 ng/mL
Reduce PFAS exposure especially if pregnant. In addition to the usual standard of care, your physician should:
- Prioritize screening for dyslipidemia with a lipid panel
- Screen for hypertensive disorders of pregnancy at all prenatal visits
- Screen for breast cancer
- High (above 20 ng/mL)
Identify sources of PFAS exposure and reduce if possible. This is especially important if you are pregnant. In addition to the usual standard of care and the items for medium PFAS exposure, your clinician should also:
- Prioritize screening for dyslipidemia with a lipid panel
- Conduct thyroid function testing
- Assess for signs and symptoms of kidney cancer
- Assess for signs and symptoms of testicular cancer and
- Assess for signs and symptoms of ulcerative colitis
CDC ATSDR guidelines
In 2024, the CDC Agency for Toxic Substances and Disease Registry (ATSDR) issued guidance for clinicians. The following is a brief summary:
- Ingesting contaminated food and water is a primary exposure route for PFAS.
- Associated health effects include increased cholesterol, decreased birth weight, reduced vaccine response, kidney and testicular cancer, pregnancy-induced hypertension, preeclampsia, and altered liver enzymes.
- Clinicians can use exposure history to identify reduction opportunities and determine if PFAS testing is appropriate, considering factors like patient risk and whether results inform exposure reduction.
- However, PFAS blood tests don't predict future health issues or guide treatment, and there are no approved medical treatments to reduce PFAS in the body.
What to do if you are worried?
If you are worried about PFAS, there’s a few things you can do.
- Research PFAS pollution in your neighborhood. There are thousands of known sources of PFAS pollution around the US. Resources like the EWG PFAS map will show you known sites near your house. If you live in an area with reported high PFAS, you definitely should consider additional steps.
- Check how much PFAS is in your water. In most cases, drinking water is the biggest single source of harmful PFAS exposure. If you are in an area with known high PFAS in drinking water, you can skip this, but if you are in an area with no recent test data, or if you rely on well water, you should buy a test.
- Get a blood test. If you are being exposed to PFAS, or if you are just worried, you should consider an at-home PFAS blood test. This will give you details of how much PFAS is currently in your blood and can show if you are at risk.
Disclaimer: This article is for educational and informational purposes only. Nothing in this article or on the web site represents medical advice or an offer of medical, diagnostic, or treatment products or services. Anyone concerned about their health should consult a licensed medical professional.
