Key Takeaways
Among the most sinister and widespread threats to public health in the United States is a class of toxic chemicals called polyfluoroalkyl and perfluoroalkyl substances, or PFAS.
This ever-expanding group of more than 4,700 chemicals is also known as “forever chemicals” because of their tendency to remain in the human body and environment indefinitely.
Most Americans have been exposed to PFAS, especially perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA).They’re used in day-to-day products like nonstick pans, fast food wrappers, and cosmetics. The manufacturing process can leach PFAS into soil and waterways, contaminating wildlife and drinking water.
When these chemicals enter one’s bloodstream, they can circulate and reach major organs, leading to adverse health effects such as cancer, liver and thyroid diseases, as well as developmental deficiencies in babies.
In October, the Environmental Protection Agency (EPA) announced a new road map for regulating these toxic chemicals, the first federal attempt to reduce PFAS through enforceable limits.
The EPA will also consider designating certain PFAS as hazardous substances and require polluters to pay for clean-up efforts under the Superfund law.
But some environmental and health advocates say the EPA’s plan is too little, too late. The Public Employees for Environmental Responsibility criticized the roadmap in astatement, saying it merely put forth “promises of planning to plan” and relied on “voluntary stewardship programs that have consistently failed the American public.”
“We’ve got worldwide contamination of this man-made toxin in our water, in our soil, in our blood, in animals—in virtually every living creature on the planet,” he added. “And we’re still waiting to get things done at the federal level to protect people.”
Recognizing the Dangers of Forever Chemicals
Since the 1940s, major manufacturers like DuPont and 3M have used PFAS for their resistance to liquids, heat, grease, and staining. These properties are helpful for products such as food wrappers, raincoats, pizza boxes, fire retardants, carpets,waterproof mascara,and more.
PFAS can enter water and airways when manufacturers unsafely dispose of them at industrial sites. Firefighting foams used at airports and military bases can also pollute the groundwater, affecting surrounding communities.
In 2015, the EPAbannedthe production of PFOA and PFOS—two of the most harmful PFAS. Still, more than 200 million Americans receive tap water containing PFOA and/or PFOS.
Over the followingdecades, Bilott and others sued DuPont and 3M for contaminating American communities with toxic substances. At the request of EPA, an independentpanelverified the harmful effects of PFOA through dozens of peer-reviewed studies. Today, onlyfive stateshave enforceable water limits for the compound.
“Even with all that data finally out, we’re still waiting for regulations and for final activity at the federal level, just on that one chemical,” Bilott said.
Now hundreds ofindependent investigationslink PFAS to reduced kidney function, thyroid disruption, various cancers including in the prostate and liver, adverse pregnancy outcomes, elevated cholesterol levels, and more.
The compounds can also decrease immune response to vaccines and infectious disease resistance—an outcome that may make an individual more susceptible to COVID-19, according to the Centers for Disease Control and Prevention.
Studies indicate that PFAS is linked adverse pregnancy outcomes like lower birth weights and higher odds of preterm birth. Chemicals circulating in the mother’s blood can be passed to the child through breastfeeding as well, increasing the risk of cognitive developmental problems.
Still,experts saythe benefits of breastfeeding infants outweigh the possible risk of PFAS exposure.
Due to their chemical structure, these compounds have a long half-life, meaning the compounds can take hundreds or thousands of years to decompose. Over years of repeated exposure, they can accumulate in the body and potentially damage organs.
“The principle in toxicology is that if you can get the foreign chemical from your body out, the fewer chances you have for toxicity. If you have a chemical that stays there for seven years, you can speculate that you’re going to have some damage,”Vasilis Vasiliou, PhD,chair of the department of environmental health sciences at Yale School of Public Health, told Verywell.
Researchers have tested several solutions, including putting patients ondialysisand usingcholestyramine, but none has proven largely effective or been widely adopted.
Exposure to PFAS doesn’t inevitably lead to adverse health outcomes, and it’s difficult for researchers to pin down the exact ways in which PFAS chemicals impair human health. As is true when studying most toxicants, researchers can’t simply expose subjects to PFAS in a clinical trial and observe the effects.
The chemicals can interact with other nutritional or behavioral inputs, which have a “synergistic or additive effect,” Vasiliou said. For instance, liver disease can arise from both PFAS exposure and other factors like excessive alcohol consumption.
“Unfortunately, we’re probably going to keep identifying groups that have been unaware of these exposures that need to be studied,” Bilott said.
A ‘Whack-A-Mole Game’
“This becomes essentially like a whack-a-mole game,” Bilott said. “In other words, we have to start that whole process all over again, and then wait another 20 years and let people get sick and see how many people get cancer and die in the meantime.”
“It takes years of scientific research and advocacy to phase out or regulate just one chemical. And most likely it will be replaced with another chemical that’s very similar in function structure, and unfortunately toxicity,”Arlene Blum, PhD, executive director at the Green Science Policy Institute, told Verywell.
Even as water utilities attempt to filter the region’s drinking water, the chemicals are nearly impossible to scrub from the environment, Blum said. Chemicals spewed from smokestacks can stay airborne or settle in trees, washing into the water and contaminating animals when it rains.
“Once they’re out in the world, it’s really expensive just to give people clean drinking water, but you can never really clean up the environment. Rivers, lakes, oceans, and soil get contaminated,” Blum said. “It’s important to turn off the tap and stop the unessential use in products.”
The EPA has allowed these forever chemicals to accumulate for decades without imposing stringent regulations. In 2016, the agency set a non-enforceable health advisory of 70 parts per trillion for PFOS and PFOA in drinking water. But the agency recentlyadmittedthat the threshold is far too high to prevent negative health effects, and the limit needs to be much lower.
To date, the EPA has not set a legal limit for PFAS in drinking water after missing a self-assigned deadline in 2019.
Can You Avoid PFAS Exposure?
Avoiding PFAS entirely is nearly impossible at this point. Since the class isn’t regulated, manufacturers aren’t required to report the chemicals on ingredient lists or product labels. But some organizations have created resources to help consumers make safe decisions.
Here are some steps you can take to reduce your exposure:
Unlike other products and substances, many people can’t avoid drinking tap water. Minimizing the pollution of drinking water before it reaches households, Vasiliou said, is important to limiting PFAS exposure.
Activated charcoal can filter out some of the largest and most widespread chemicals in this class, such as PFOA and PFOS. But smaller PFAS chemicals can easily slip through such filters.
A newdigital toolfrom the Environmental Working Group lets users learn whether water from local utilities is contaminated with PFAS and other toxic chemicals.
Reducing PFAS exposure requires actions like holding manufacturers accountable and imposing strict nationwide limits on contaminants in drinking water, products, and the environment, Blum added.
“[The EPA] just hasn’t gotten that far—this is the beginning. There’s a lot more to be done,” Blum said.
Ultimately, the onus is on U.S. manufacturers to minimize PFAS risk, Bilott said.
“These are man-made chemicals. They don’t exist in nature,” he said. “If we find them in your water, soil, air, animals, in you, there are fingerprints back to a very small group of companies that made these and profited enormously for decades—billions and billions of dollars—over making and pumping these toxins out into our world. They should be responsible for the costs involved in responding to this.”
What This Means For YouAlthough the EPA plans to set legal limits for safe levels of PFAS in drinking water, environmental activists and researchers say the agency must adopt even stricter and broader regulations to adequately protect Americans from the deleterious effects of PFAS exposure.
What This Means For You
Although the EPA plans to set legal limits for safe levels of PFAS in drinking water, environmental activists and researchers say the agency must adopt even stricter and broader regulations to adequately protect Americans from the deleterious effects of PFAS exposure.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.PFAS in the U.S. population. Updated June 24, 2020.Centers for Disease Control and Prevention.What are PFAS?Updated November 18, 2021.Environmental Protection Agency.PFAS strategic roadmap: EPA’s commitments to action 2021–2024. Published October 15, 2021.Kotthoff M, Müller J, Jürling H, Schlummer M, Fiedler D.Perfluoroalkyl and polyfluoroalkyl substances in consumer products.Environ Sci Pollut Res. 2015;22(19):14546-14559. doi:10.1007/s11356-015-4202-7Whitehead HD, Venier M, Wu Y, et al.Fluorinated compounds in North American cosmetics.Environ Sci Technol Lett. 2021;8(7):538-544. doi:10.1021/acs.estlett.1c00240Andrews DQ, Naidenko OV.Population-wide exposure to per- and polyfluoroalkyl substances from drinking water in the United States.Environ Sci Technol Lett. 2020;7(12):931-936. doi:10.1021/acs.estlett.0c00713Grandjean P, Heilmann C, Weihe P, et al.Estimated exposures to perfluorinated compounds in infancy predict attenuated vaccine antibody concentrations at age 5-years.J Immunotoxicol. 2017;14(1):188-195. doi:10.1080/1547691X.2017.1360968Centers for Disease Control and Prevention.Potential health effects of PFAS. Updated June 24, 2020.Blake BE, Fenton SE.Early life exposure to per- and polyfluoroalkyl substances (PFAS) and latent health outcomes: a review including the placenta as a target tissue and possible driver of peri- and postnatal effects.Toxicol. 2020;443:152565. doi:10.1016/j.tox.2020.152565Genuis SJ, Curtis L, Birkholz D.Gastrointestinal elimination of perfluorinated compounds using cholestyramine andChlorella pyrenoidosa.ISRN Toxicol. 2013;2013:657849. doi:10.1155/2013/657849Centers for Disease Control and Prevention.Per- and polyfluoroalkyl substances (PFAS). Updated July 7, 2021.Temkin AM, Hocevar BA, Andrews DQ, Naidenko OV, Kamendulis LM.Application of the key characteristics of carcinogens to per and polyfluoroalkyl substances.Int J Environ Res Public Health. 2020;17(5):1668. doi:10.3390/ijerph17051668Hekert N, Merrill J, Peters C, et al.Assessing the effectiveness of point-of-use residential drinking water filters for perfluoroalkyl substances (PFASs).Environ Sci Technol Lett.2020;7(3):178-184. doi:10.1021/acs.estlett.0c00004
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.PFAS in the U.S. population. Updated June 24, 2020.Centers for Disease Control and Prevention.What are PFAS?Updated November 18, 2021.Environmental Protection Agency.PFAS strategic roadmap: EPA’s commitments to action 2021–2024. Published October 15, 2021.Kotthoff M, Müller J, Jürling H, Schlummer M, Fiedler D.Perfluoroalkyl and polyfluoroalkyl substances in consumer products.Environ Sci Pollut Res. 2015;22(19):14546-14559. doi:10.1007/s11356-015-4202-7Whitehead HD, Venier M, Wu Y, et al.Fluorinated compounds in North American cosmetics.Environ Sci Technol Lett. 2021;8(7):538-544. doi:10.1021/acs.estlett.1c00240Andrews DQ, Naidenko OV.Population-wide exposure to per- and polyfluoroalkyl substances from drinking water in the United States.Environ Sci Technol Lett. 2020;7(12):931-936. doi:10.1021/acs.estlett.0c00713Grandjean P, Heilmann C, Weihe P, et al.Estimated exposures to perfluorinated compounds in infancy predict attenuated vaccine antibody concentrations at age 5-years.J Immunotoxicol. 2017;14(1):188-195. doi:10.1080/1547691X.2017.1360968Centers for Disease Control and Prevention.Potential health effects of PFAS. Updated June 24, 2020.Blake BE, Fenton SE.Early life exposure to per- and polyfluoroalkyl substances (PFAS) and latent health outcomes: a review including the placenta as a target tissue and possible driver of peri- and postnatal effects.Toxicol. 2020;443:152565. doi:10.1016/j.tox.2020.152565Genuis SJ, Curtis L, Birkholz D.Gastrointestinal elimination of perfluorinated compounds using cholestyramine andChlorella pyrenoidosa.ISRN Toxicol. 2013;2013:657849. doi:10.1155/2013/657849Centers for Disease Control and Prevention.Per- and polyfluoroalkyl substances (PFAS). Updated July 7, 2021.Temkin AM, Hocevar BA, Andrews DQ, Naidenko OV, Kamendulis LM.Application of the key characteristics of carcinogens to per and polyfluoroalkyl substances.Int J Environ Res Public Health. 2020;17(5):1668. doi:10.3390/ijerph17051668Hekert N, Merrill J, Peters C, et al.Assessing the effectiveness of point-of-use residential drinking water filters for perfluoroalkyl substances (PFASs).Environ Sci Technol Lett.2020;7(3):178-184. doi:10.1021/acs.estlett.0c00004
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.PFAS in the U.S. population. Updated June 24, 2020.Centers for Disease Control and Prevention.What are PFAS?Updated November 18, 2021.Environmental Protection Agency.PFAS strategic roadmap: EPA’s commitments to action 2021–2024. Published October 15, 2021.Kotthoff M, Müller J, Jürling H, Schlummer M, Fiedler D.Perfluoroalkyl and polyfluoroalkyl substances in consumer products.Environ Sci Pollut Res. 2015;22(19):14546-14559. doi:10.1007/s11356-015-4202-7Whitehead HD, Venier M, Wu Y, et al.Fluorinated compounds in North American cosmetics.Environ Sci Technol Lett. 2021;8(7):538-544. doi:10.1021/acs.estlett.1c00240Andrews DQ, Naidenko OV.Population-wide exposure to per- and polyfluoroalkyl substances from drinking water in the United States.Environ Sci Technol Lett. 2020;7(12):931-936. doi:10.1021/acs.estlett.0c00713Grandjean P, Heilmann C, Weihe P, et al.Estimated exposures to perfluorinated compounds in infancy predict attenuated vaccine antibody concentrations at age 5-years.J Immunotoxicol. 2017;14(1):188-195. doi:10.1080/1547691X.2017.1360968Centers for Disease Control and Prevention.Potential health effects of PFAS. Updated June 24, 2020.Blake BE, Fenton SE.Early life exposure to per- and polyfluoroalkyl substances (PFAS) and latent health outcomes: a review including the placenta as a target tissue and possible driver of peri- and postnatal effects.Toxicol. 2020;443:152565. doi:10.1016/j.tox.2020.152565Genuis SJ, Curtis L, Birkholz D.Gastrointestinal elimination of perfluorinated compounds using cholestyramine andChlorella pyrenoidosa.ISRN Toxicol. 2013;2013:657849. doi:10.1155/2013/657849Centers for Disease Control and Prevention.Per- and polyfluoroalkyl substances (PFAS). Updated July 7, 2021.Temkin AM, Hocevar BA, Andrews DQ, Naidenko OV, Kamendulis LM.Application of the key characteristics of carcinogens to per and polyfluoroalkyl substances.Int J Environ Res Public Health. 2020;17(5):1668. doi:10.3390/ijerph17051668Hekert N, Merrill J, Peters C, et al.Assessing the effectiveness of point-of-use residential drinking water filters for perfluoroalkyl substances (PFASs).Environ Sci Technol Lett.2020;7(3):178-184. doi:10.1021/acs.estlett.0c00004
Centers for Disease Control and Prevention.PFAS in the U.S. population. Updated June 24, 2020.
Centers for Disease Control and Prevention.What are PFAS?Updated November 18, 2021.
Environmental Protection Agency.PFAS strategic roadmap: EPA’s commitments to action 2021–2024. Published October 15, 2021.
Kotthoff M, Müller J, Jürling H, Schlummer M, Fiedler D.Perfluoroalkyl and polyfluoroalkyl substances in consumer products.Environ Sci Pollut Res. 2015;22(19):14546-14559. doi:10.1007/s11356-015-4202-7
Whitehead HD, Venier M, Wu Y, et al.Fluorinated compounds in North American cosmetics.Environ Sci Technol Lett. 2021;8(7):538-544. doi:10.1021/acs.estlett.1c00240
Andrews DQ, Naidenko OV.Population-wide exposure to per- and polyfluoroalkyl substances from drinking water in the United States.Environ Sci Technol Lett. 2020;7(12):931-936. doi:10.1021/acs.estlett.0c00713
Grandjean P, Heilmann C, Weihe P, et al.Estimated exposures to perfluorinated compounds in infancy predict attenuated vaccine antibody concentrations at age 5-years.J Immunotoxicol. 2017;14(1):188-195. doi:10.1080/1547691X.2017.1360968
Centers for Disease Control and Prevention.Potential health effects of PFAS. Updated June 24, 2020.
Blake BE, Fenton SE.Early life exposure to per- and polyfluoroalkyl substances (PFAS) and latent health outcomes: a review including the placenta as a target tissue and possible driver of peri- and postnatal effects.Toxicol. 2020;443:152565. doi:10.1016/j.tox.2020.152565
Genuis SJ, Curtis L, Birkholz D.Gastrointestinal elimination of perfluorinated compounds using cholestyramine andChlorella pyrenoidosa.ISRN Toxicol. 2013;2013:657849. doi:10.1155/2013/657849
Centers for Disease Control and Prevention.Per- and polyfluoroalkyl substances (PFAS). Updated July 7, 2021.
Temkin AM, Hocevar BA, Andrews DQ, Naidenko OV, Kamendulis LM.Application of the key characteristics of carcinogens to per and polyfluoroalkyl substances.Int J Environ Res Public Health. 2020;17(5):1668. doi:10.3390/ijerph17051668
Hekert N, Merrill J, Peters C, et al.Assessing the effectiveness of point-of-use residential drinking water filters for perfluoroalkyl substances (PFASs).Environ Sci Technol Lett.2020;7(3):178-184. doi:10.1021/acs.estlett.0c00004
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