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Developed in the 1940s, per- and polyfluoroalkyl substances (PFAS) are a family of over 9,000 chemicals with many industrial and cosmetic uses.

They were a breakthrough in technological advancements at the time, improving textiles by making them water- and stain-resistant, adding flame retardant properties, and enhancing chemical stability for longer-lasting products.

Their uses have since extended throughout the cosmetic and food industries.

PFAS are found abundantly in:

• contaminated drinking water
• non-stick cookware
• food packaging material
• water- and stain-resistant coatings for clothes, furniture, and carpets
• personal care products
• cosmetic products, such as foundation makeup
• fire-fighting foams
• fast foods, loading dose bactrim ds meat, fish, and shellfish
• some take-out coffee and tea in the United States
• processed foods including microwave popcorn
• low-fiber, high-fat grain products, such as bread and pasta
• indoor dust.

Safety concerns

Yet PFAS are a double-edged sword — the chemical properties that make them excellent for industrial use are the same properties that threaten environmental and human health.

They have a long half-life, which makes them “persistent” chemicals. This means that they do not easily break down, so they subsequently accumulate throughout the environment, including in animal and human tissues.

Humans become exposed to PFAS predominantly through diet, as well as through contaminated drinking water, skin contact from cosmetic and personal care products, indoor and outdoor air pollution, and early-life exposure during pregnancy or breastfeeding.

Although some research shows that PFAS may be found in low and potentially non-hazardous levels in the environment, their overwhelming presence in common products and build-up in the human body pose significant safety and toxicity concerns.

In fact, a 2022 review indicates that PFAS are found in the blood of nearly all U.S. adults, and they accumulate in the liver.

Health risks

In addition to being persistent chemicals in the environment, PFAS are endocrine-disrupting chemicals (EDCs), which are compounds that interfere with the normal functions of hormones in the body.

Here are some of the documented health risks of PFAS.

Liver damage

In the body, PFAS predominantly accumulate in liver tissue, making liver damage one of the most-researched health effect of PFAS.

The 2022 review mentioned above — which looked at studies in both animals and humans — shows that exposure to PFAS is associated with signs of liver damage and an increased risk of developing conditions like non-alcoholic fatty liver disease (NAFLD), which can in turn lead to more serious conditions such as cirrhosis.

NAFLD is a spectrum of liver disorders and one of the leading causes of chronic liver disease and potentially liver failure.

Its exact mechanism is unclear, but some experts believe that PFAS disrupts fat processing and storage in the body, increasing the deposits of fat in the liver that subsequently damage this organ, and inducing other metabolic disorders.

Endocrine and metabolic disorders

As endocrine-disrupting chemicals, PFAS are associated with metabolic disorders, including obesity, thyroid disorders, and diabetes.

A 2016 review suggests that prenatal exposure to PFAS was later associated with excess adiposity and an increased risk of childhood overweight and obesity.

Observational studies also support the link between PFAS and compromised thyroid health, which, during pregnancy, disrupts glucose and insulin levels, increasing the risk of developing gestational diabetes.

Gestational diabetes occurs when blood sugar levels become too high during pregnancy, and may be harmful to the parent and baby.

Reproductive health

PFAS may disrupt reproductive health from as early as puberty by potentially impairing the function of the ovaries.

A 2020 review highlights research that found associations between exposure to PFAS and delayed start of the menstrual cycle, irregular or longer cycles, early onset of menopause, and hormonal imbalances of estrogen and androgens.

In addition, exposure to PFAS during pregnancy poses long-term health risks to the fetus, but may also lead to low birth weight or the life-threatening condition, preeclampsia.

However, findings regarding PFAS and reproductive health have been inconsistent, and more research in humans is warranted.

Other risks

Although there is little evidence to date, ongoing research continues to elucidate the potential role of PFAS exposure in cancer risk and development.

Researchers have already observed associations between PFAS exposure via drinking water and the development of testicular and kidney cancers.

Other research determined that PFAS increase the risk of developing kidney cancer such that the greater the PFAS exposure, the greater the cancer risk, adding to the evidence that PFAS are renal carcinogens.

Avoiding PFAS

Government regulations and changes in manufacturing practices have aimed to reduce human exposure to PFAS.

For instance, the Government of Canada‘s list of prohibited toxic substances includes some classes of PFAS, and in the U.S., the Centers for Disease Control and Prevention (CDC) have listed PFAS in their toxic substance registry.

However, PFAS is a family of over 9,000 chemicals, not all of which have been clearly categorized and researched, making widespread exposure a public health concern.

Regardless, there may still be some steps that you can take to reduce exposure to PFAS and subsequent health risks:

• filter drinking water
• read labels on packages for PFAS chemicals to know what to avoid
• avoid non-stick cookware
• choose PFAS-free food packaging — more likely with recyclable paper, glass, bamboo, or stainless steel
• choose personal care and cosmetic products free of PFAS
• skip water-resistant makeup
• limit or avoid highly processed foods like fast foods and fried meat or fish
• make popcorn on the stove-top or air pop instead of microwave popcorn
• maintain a regular cleaning schedule to avoid dust build-up indoors
• avoid stain- and water-resistant fabric coatings.

Occupational exposures occur, too, such as with fire training. Have a discussion regarding protective gear to avoid skin contact and inhalation of PFAS-containing compounds.

The bottom line

PFAS are a family of over 9,000 chemicals with many industrial uses that offer water- and stain-resistant, adding flame retardant and chemical stability properties to textiles.

They are also found in contaminated drinking water, fast foods, personal care and cosmetic products, and some non-stick cookware.

These PFAS accumulate in tissues in the body and are associated with compromised liver, thyroid, kidney, and reproductive health, and an increased risk of testicular and kidney cancers.

The abundance of PFAS makes them difficult to avoid, but choosing PFAS-free food packages, filtering drinking water, avoiding stain- and water-resistant coatings and makeup, and limiting highly processed foods may reduce exposure and long-term health risks.

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