A Doctors Perspective on PFAS

I watched as my cousin poured lemonade into a paper cup and handed it to her son. Then, my daughter’s friend took a chocolate bar out of a bag. She carefully unwrapped the obviously melted candy and held it up to her mouth. I watched with a little apprehension as she pushed her jaw forward and carefully scraped the melted chocolate off the wrapper, being careful not to get the messy goop on her chin.

Years ago, I didn’t think twice about such common behavior. I never questioned why paper cups don’t actually get wet when they are filled with water (or any liquid) or whether or not it was safe to eat stuck candy from a wrapper. In fact, I remember that I used to occasionally chew candy wrappers during childhood. But now, I am more aware of the industrial processes that are used to create everyday products.  Paper cups, food wrappers, and containers often contain toxic, bio-persistent compounds collectively referred to as per- and polyfluoroalkyl substances (PFAS), chemicals that have been produced in the US since the 1940s.

PFAS is a collective term that refers to over 5000 chemicals. On one hand, these compounds are really cool and make our lives easier and less messy. They repel water AND grease. What else can do that? But, on the flip side, many of these chemicals have caused documented negative health effects. The most infamous of the PFAS chemicals is perfluorooctanoic acid (PFOA), an ingredient used to make nonstick coatings on cookware. Have you seen the movie “Dark Waters”?

Microwave popcorn bags, pizza boxes, and candy wrappers are only a few of dozens, if not hundreds, of applications for PFAS. The pervasiveness of PFAS in food wraps became more widely known in 2017 when a study, performed by the environmental chemist Laurel Schaider, discovered PFAS in 38% of sandwich and burger wrappers and 56% of bread and dessert wrappers (Schaider, et al., 2017). PFAS is used in many industries, in addition to the food industry. These chemicals make our carpets and upholstery stain-resistant and first responder gear “high tech.” Heads up… it’s in our medical clothing too! 

Believe it or not, research from the environmental working group suggests that nearly 30,000 industrial companies may be releasing these chemicals into the environment and our nation’s waterways, contaminating our lakes, rivers, and streams. https://www.ewg.org/news-insights/news-release/2021/07/twelvefold-increase-suspected-industrial-dischargers-forever The chemicals are absorbed by the smallest forms of life in both contaminated fresh and saltwater, including plankton! (Casai, et al., 2017) PFAS bioaccumulate in the fish that eat plankton and further concentrates in larger fish that eat smaller fish. Animals that consume fish (including humans) then become reservoirs for PFAS.

Differing concentrations of PFAS are everywhere in the environment and have been found in life forms all over the globe. It would be unrealistic to think that we could avoid these chemicals completely by not wearing waterproof or stain-resistant fabrics and not eating meals from wraps and containers. It’s become a matter of limiting exposure as opposed to preventing exposure. With that being said, those of us who regularly consume processed foods, foods packed in takeout containers, and especially microwave popcorn have higher levels of PFAS in our bodies than those who make dinners at home (Susmann, et. al., 2019.)

Why should we care now?

These chemicals can target the placenta (Blake & Fenton, 2020) and have been linked to reproductive disorders, liver damage, renal impairment, cancer, and immune system dysfunction (Fenton, et al 2021). In 2016, a review by the National Toxicology Program of over 150 studies on PFOA and PFOS, both forms of PFAS, showed that these chemicals are an immune hazard for humans. https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/completed/pfoa/index.html There is a high level of evidence for antibody-suppressive response from PFAS exposure in animal studies and immunosuppression from human studies (DeWitt, et al., 2019). Human and animal studies also suggest that PFAS exposure may reduce the antibody response to the vaccine and may reduce infectious disease resistance (Granum, et al., 2013). This is certainly concerning given the ongoing pandemic.

Have PFAS chemicals compromised the immune systems and weakened antibody defense against COVID-19 in humans? The Agency for Toxic Substances and Disease Registry, a part of the CDC, issued a statement on the potential intersection between PFAS and COVID-19 and stated that research is needed to assess whether or not PFAS is exacerbating the pandemic.

Because of the now-known health damage that many of these chemicals cause, pressure is increasing for companies to phase out these toxins and put products in PFAS-free containers and wrappers. New York, Maine, Washington state, and the cities of San Francisco and Berkeley have bans on food packaging ladened with PFAS. Because each chemical in the PFAS class needs to be evaluated individually, our federal government has been slow to respond to this health threat, playing “whack a mole” with one chemical at a time. Industry protects itself as industries do.

We, physicians, dropped the ball. We have no problem engaging in “turf battles” with each other within the fields of medicine and surgery, competing for patient care, but as a collective, we have avoided turf battles with the other sciences.

Why is it we received very little, if any, formalized education on how industrial chemicals and environmental toxins cause disease? Why is there no appreciable funding for this research, that is, besides on naturally occurring materials such as lead, asbestos, and radon, etc? The one exception I can think of is the anti-smoking/anti-tobacco campaign, which underwent incredibly prolonged legal battles. In addition, environmental toxins aren’t limited to biochemical compounds. We collectively know nothing about the harmful effects of non-ionizing radiation and have allowed physicists and industry execs to claim that non-ionizing radiation has no biological effect and cannot cause disease. Yet, thousands of papers have documented negative effects from this form of radiation. We sat back in collective ignorance as brain tumors became the most common “solid” cancer in our children! (Ostrom, et al., 2019) I would submit that environmental toxicity has become the major cause of underlying disease in our world. Our training only teaches us how to label disorders with a diagnosis and then offer rational treatment.

The worldwide dissemination of chemicals and wireless infrastructure has led to unprecedented worldwide contamination of dangerous environmental toxins. Rivers aren’t catching fire, but today’s pollution is beyond anyone’s comprehension. And, there’s no way to escape it. It’s time for physicians to have a broader understanding and sound research basis of how the body interacts with biochemical and energetic environmental toxins so we can keep our population healthy. Our politicians are not equipped to understand human physiology and have dangerously relied on industry to teach them. We need to become educated and assume this role immediately. Learn about the negative health effects of environmental toxins and consider starting an independent research project on your own or with colleagues. It’s time to band together and stand united against the chemical and wireless industries.

Citations:

Blake, B.E., & Fenton, S.E. (2020). 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. Toxicology, 443, 152565.

DOI: 10.1016/j.tox.2020.152565

Casal, P., González-Gaya, B., Zhang, Y., Reardon, A.J., Martin, J. W., Jiménez, B., & Dachs, J. (2017). Accumulation of perfluoroalkylated substances in oceanic plankton. Environmental Science & Technology, 51(5), 2766–2775.

DOI: 10.1021/acs.est.6b05821

DeWitt, J.C., Blossom, S.J. & Schaider, L.A. Exposure to per-fluoroalkyl and polyfluoroalkyl substances leads to immunotoxicity: epidemiological and toxicological evidence. J Expo Sci Environ Epidemiol, 29, 148–156 (2019).

DOI: 10.1038/s41370-018-0097-y

Fenton, S.E., Ducatman, A., Boobis, A., DeWitt, J.C., Lau, C., Ng, C., Smith, J.S., & Roberts, S.M. (2021). Per- and polyfluoroalkyl substance toxicity and human health review: current state of knowledge and strategies for informing future research. Environmental Toxicology and Chemistry, 40(3), 606–630.

DOI: 10.1002/etc.4890

Granum, B., Haug, L.S., Namork, E., Stølevik, S.B., Thomsen, C., Aaberge, I.S., Loveren, H.V., Løvik , M., and Nygaard, U.C. (2013) Pre-natal exposure to perfluoroalkyl substances may be associated with altered vaccine antibody levels and immune-related health outcomes in early childhood. Journal of Immunotoxicology, 10:4, 373-379

DOI: 10.3109/1547691X.2012.755580

NTP (National Toxicology Program). 2016. Monograph on immunotoxicity associated with exposure to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS). Research Triangle Park, NC: National Toxicology Program.

https://ntp.niehs.nih.gov/ntp/ohat/pfoa_pfos/pfoa_pfosmonograph_508.pdf

Ostrom, Q.T., Cioffi, G., Gittleman, H., Patil, N., Waite, K., Kruchko, C., and Barnholtz-Sloan, J.S. (2019). CBTRUS Statistical Report: primary brain and other central nervous system tumors diagnosed in the United States in 2012-2016. Neuro-oncology, 21(Suppl 5), v1–v100.

DOI: 10.1093/neuonc/noz150

Schaider, L.A., Balan, S.A., Blum, A., Andrews, D.Q., Strynar, M.J., Dickinson, M.E., Lunderberg, D.M., Lang, J.R., and Peaslee, G.F. (2017). Fluorinated compounds in U.S. fast food packaging. Environmental Science & Technology Letters, 4(3), 105-111.

DOI: 10.1021/acs.estlett.6b00435

Susmann, H.P., Schaider, L.A., Rodgers, K.M., and Rudel, R.A. (2019). Dietary habits related to food packaging and population exposure to PFASs. Environmental Health Perspectives, 127:10 CID: 107003

DOI: 10.1289/EHP4092