How much should you worry about PFAS "forever chemicals"?
What the evidence says about health risks, exposure, and drinking water
Lately, there’s been a lot of talk about PFAS, a group of man-made "forever chemicals" that are ubiquitous - in water, cookware, food packaging, cosmetics, fabrics, and more. There have been news of industry cover ups, regulations on drinking water contamination, and lawsuits against manufacturers.
Today, I’ll share the answer to my own question: how concerned should I be about these chemicals? We’ll also dive more deeply into health effects, exposure levels, and water filters - three topics I’ve researched for
. Let’s start with definitions.What are PFAS?
PFAS (per and polyfluoroalkyl substances) are a family of man-made (synthetic) chemicals that have been used since the 1950s to create products that resist heat, water, and grease. They are found in firefighting foams, paints, and consumer products ranging from non-stick cookware (e.g. Teflon) to food packaging, stain-resistant fabrics (e.g. Scotchgard),waterproof makeup, water-resistant clothes, silky floss (e.g. Glide) and more. They are called “forever chemicals” because they persist for years in the environment and our bodies. Indeed, most of us have detectable PFAS in our blood (see US CDC data).
The PFAS family includes thousands of members, and can be grouped into subfamilies such as PFOA, PFOS, PFNA, PFHxS, PFBS, and “Gen X.” Other forever chemical families include PCBs (polychlorinated biphenyls) and DDT (dichloro-diphenyl-trichloroethane). These man-made chemicals don’t break down easily because there is no natural pathway to do so.
My bottom line
I am much more concerned about PFAS at a public health level than I am at a personal level. These chemicals can have a meaningful health impact in those who are highly exposed - typically through work or contaminated drinking water. I’m fortunate to not be highly exposed because the drinking water in my area is stellar and I don’t have a high risk occupation. For those in this boat, PFAS are unlikely to move the needle healthwise. The dose makes the poison, yet again!
I’m not losing sleep over the many small exposures that surround us, though I did toss my Teflon pans and switch to stainless steel or enameled cast iron for daily cooking.
Keep reading to better understand how PFAS may - or may not - be affecting you. Whether you come away reassured, or prepared to take action, it’s a win.
How do PFAS affect my health?
There is a large body of evidence, spanning hundreds of studies, showing that PFAS can be a health hazard to humans and animals (e.g. PFAS evidence map). The health effects with the strongest evidence are listed below, from a 2022 National Academies report.
Sufficient evidence:
decreased antibody response (in adults and children)
dyslipidemia (in adults and children)
decreased infant and fetal growth
increased risk of kidney cancer (in adults)
Limited or suggestive evidence:
increased risk of breast cancer (in adults),
liver enzyme alterations (in adults and children)
increased risk of pregnancy-induced hypertension (gestational hypertension and preeclampsia)
increased risk of testicular cancer (in adults)
thyroid disease and dysfunction (in adults)
increased risk of ulcerative colitis (in adults)
These risks merit our attention, but should not be seen as black-and-white relationships. It’s not as simple as PFAS exposure = disease. The term “increased risk” only tells us that a risk goes up - it doesn’t tell you by how much, or to what level. In many cases, the disease risk is still low, even for people with greater PFAS exposure. Let’s look at kidney cancer as an example.
People with higher exposure to PFAS often have more kidney cancer cases and deaths than expected, usually in the range of 10-50% more, depending on the study. If the average person’s lifetime risk of kidney cancer is 2%, and we estimate a 25% increase in risk, high PFAS exposure would increase the lifetime risk from roughly 2% to 2.5%. This risk increase won’t affect most people, but it takes a huge toll on the small fraction of people who are affected - and on a healthcare system serving millions of people.
Our understanding of PFAS and health is far from complete. We still have a lot to learn about each PFAS (there are thousands!), including how they affect us, what dose is unsafe, and in whom.
Read more about the health effects of PFAS in this Nerdy Girls post.
Who is most highly exposed to PFAS?
Jobs with higher PFAS exposure. Firefighters, ski wax technicians, and people who work in chemical manufacturing (with fluorochemicals) have higher PFAS exposure and higher blood levels of these chemicals because they are exposed through air and/or direct contact. Other jobs that may involve higher PFAS exposure include electroplating, floor waxing, painting, carpet installation and treatment, and jobs that require frequent handling of PFAS-containing food packaging.
Communities with higher PFAS exposure. People who live near facilities that manufacture, use, or handle PFAS may face higher PFAS exposure than average. These PFAS “hot spots” include some factories, military bases, airports (especially military airports and firefighting training areas - due to use of AFFF (aqueous film-forming foam)), wastewater treatment plants, and farms where sewage sludge is used for fertilizer, landfills, or incinerators. These communities are exposed to PFAS through contaminated water, air, soil, and food. Blood levels of PFAS in these communities vary greatly, but are often elevated and overlap with levels seen in higher PFAS occupations.
Learn more about populations with high PFAS exposure in this post.
Does my water have unsafe levels of PFAS?
In the United States, roughly 5-10% of public water supplies have elevated PFAS levels (above the US EPA limits). The other 90-95% have either no PFAS or such low levels that further reducing them isn’t meaningful. It's a similar story in Canada - most drinking water has negligible PFAS levels but a small fraction have concerning levels (note: Health Canada is currently revising their PFAS limits in drinking water).
To scout out your PFAS levels, consider these options:
Pay for PFAS water testing. The most direct way to find out the PFAS levels in your water is to pay a certified lab for testing. Unfortunately, this is expensive: typically costing $300 or more, which isn’t far from the price of many water filters!
Contact your municipality. PFAS testing and reporting varies regionally and may require some sleuthing. It took some digging to find this report on water quality here in Vancouver; I’m happy to share that my local PFAS levels are well below the most conservative limits.
Use PFAS contamination maps. There are several interactive dashboards showing known PFAS contamination in the United States, Europe, Canada and elsewhere. When using dashboards, use filters to focus on contamination sites with levels above safe limits (detectable does not always mean harmful!).
Learn about PFAS “hotspots”. PFAS “hot spots” include some factories, military bases, airports (especially military airports and firefighting training areas where AFFF (aqueous film-forming foam) is used), wastewater treatment plants, and farms where sewage sludge is used for fertilizer, landfills, or incinerators - and places that are downstream of these “hot spots”
Learn more about PFAS levels in drinking water in this Nerdy Girls post. I also recommend this post on the new US EPA guidelines, by
.Which type of water filter is best?
Water filters are a wise investment if your tap water has potentially harmful levels of PFAS. To remove PFAS from your water, you’ll need to invest in a water treatment system, costing a few hundred to a thousand dollars.
The most effective way to remove PFAS at home is with a reverse-osmosis system under the sink. Ion exchange and activated carbon filters can also remove some PFAS, but are not as effective. None of these systems perfectly remove every type of PFAS, and they all have a range of performance depending on the type of PFAS (short chain PFAS vs long chain PFAS vs GenX), the condition of the water being treated, where it’s installed, maintenance status, and more.
When choosing a water filter, ensure that it’s certified to remove PFOA and PFOS (two key types of PFAS). Look for NSF/American National Standards Institute (NSF/ANSI) 53 or NSF/ANSI 58 certified in the product specifications.
Learn more about PFAS levels in drinking water in this post.
Closing thoughts
I hope this article helped you evaluate your PFAS risk level and take action where it makes sense for you. Thankfully, we’re now seeing more research and action from government and industry, so the impact of these chemicals should decrease for everyone.
As always, I urge you to keep these risks in perspective and not lose sight of the major health factors that deliver a huge bang for your buck (e.g. vaccines, diet, exercise, not smoking).
Thanks for joining me in my lifelong learning journey. I’m planning to unplug for the rest of summer to focus on family, fitness and fun. I hope you also get a chance to unplug and enjoy this glorious season!
Best,
Resources
PFAS overview (by NIH National Institute of Environmental Health Sciences)
PFAS and Your Health (by Health Canada)
Meaningful and Achievable Steps You Can Take to Reduce Your Risk from PFAS (US Environmental Protection Agency)
PFAS exposure sources and reduction (by US National Academies of Science, Engineering and Medicine)
Does that mean you deem the risk for non stick cookware high enough to avoid? Is there anything else (water proof mascara or anything) you feel could be worth avoiding if we can/want to? Ty so much 🙏