PFAS “Forever Chemicals”: The Invisible Epidemic

The Bond That Won’t Break

Imagine a chemical so stable that nothing in nature — no bacterium, no enzyme, no amount of sunlight or water — can break it down. A molecule engineered by 3M in the 1940s using the strongest bond in organic chemistry: carbon-fluorine. That bond requires 485 kilojoules per mole to break. For comparison, the carbon-hydrogen bonds in your body require only 411 kJ/mol. You evolved to metabolize organic molecules. You did not evolve to metabolize perfluorinated ones.

Per- and polyfluoroalkyl substances — PFAS — are a class of over 12,000 synthetic compounds unified by this carbon-fluorine backbone. They repel water, oil, grease, and heat. That made them extraordinarily useful: nonstick cookware, waterproof jackets, food packaging, firefighting foam, dental floss, cosmetics, carpets, upholstery. That also makes them extraordinarily persistent: once in your body, once in the water, once in the soil, they stay. Hence “forever chemicals.”

PFAS contaminate the drinking water of an estimated 110 million Americans. They’ve been detected in the blood of 98% of the US population. They’re in the Arctic ice, in the deep ocean, in remote mountain lakes, in breast milk, in umbilical cord blood. This is not an emerging problem. It’s an existing catastrophe that’s only now being quantified.

Where You’re Exposed

Nonstick Cookware

Teflon — polytetrafluoroethylene (PTFE) — is a PFAS polymer. While intact PTFE is relatively stable, the manufacturing process historically used PFOA (perfluorooctanoic acid) as a processing aid, and overheated nonstick pans release PFAS gases and particles. Even newer “PFOA-free” nonstick coatings (like GenX) use replacement PFAS compounds with similar concerns. The safest approach: avoid all nonstick coatings entirely.

Waterproof and Stain-Resistant Textiles

Gore-Tex jackets, Scotchgard-treated furniture, stain-resistant carpets, water-repellent clothing. If fabric repels water in a way that seems too good to be natural, it’s probably PFAS. The outdoor clothing industry has begun transitioning (Patagonia, Arc’teryx) but PFAS remains standard in most waterproof gear.

Food Packaging

Microwave popcorn bags, fast-food wrappers, pizza boxes, takeout containers, butter wrappers — anything with a grease-resistant lining likely contains PFAS. Mamavation and Environmental Health News tested over 100 fast food and grocery packaging items and found PFAS indicators in the majority. The PFAS migrates from packaging into your food, especially with heat and grease.

Firefighting Foam (AFFF)

Aqueous film-forming foam — used at military bases, airports, and fire training facilities — is the largest point-source of PFAS environmental contamination. Communities near military bases and airports show dramatically elevated PFAS levels in drinking water and blood serum. The Department of Defense has identified over 700 installations with known or suspected PFAS contamination.

Personal Care Products and Cosmetics

A 2021 study by Whitehead et al. in Environmental Science & Technology Letters tested 231 cosmetic products and found PFAS indicators in 56% of foundations, 48% of eye products, 47% of lip products, and 82% of waterproof mascaras. PFAS provides the smooth, long-lasting, water-resistant properties that marketing departments love. These products are applied directly to your skin — a route of absorption.

Dental Floss

Oral-B Glide and similar “smooth” flosses use PTFE — the same polymer as Teflon. A 2019 study in the Journal of Exposure Science & Environmental Epidemiology (Boronow et al.) found that women who used Oral-B Glide had significantly higher serum PFAS levels than those who used other flosses.

Other Sources

Stain-resistant treatments on clothing (especially children’s clothing), nonstick baking sheets and muffin liners, some cleaning products, some paints, certain artificial turf (crumb rubber), some period-proof underwear, and contaminated drinking water.

What PFAS Does in Your Body

Extremely Slow Elimination

Unlike most environmental toxins that the liver can process and the kidneys can excrete in hours to days, PFAS resist metabolism. The biological half-lives are measured in years:

PFOS (perfluorooctane sulfonate): 5.4 years
PFOA (perfluorooctanoic acid): 3.8 years
PFHxS (perfluorohexane sulfonate): 8.5 years

This means that after a single exposure, it takes 5.4 years for your body to eliminate just half the PFOS. After 10.8 years, you still have 25% of the original dose. If you’re continuously exposed (and you are), levels accumulate steadily over your lifetime. The average 50-year-old has 50 years of PFAS accumulation in their blood.

PFAS circulates bound to albumin in the blood, concentrates in the liver and kidneys, and undergoes enterohepatic recirculation (recycled through bile and reabsorbed in the intestines — the same loop that recycles bile acids and some hormones).

Thyroid Disruption

PFAS structurally resembles thyroid hormones (both contain halogen atoms on a carbon backbone) and interferes with thyroid function at multiple levels:

Competes for binding on thyroid transport proteins (transthyretin, TBG)
Disrupts thyroid hormone receptor signaling
Alters TSH regulation
Associated with hypothyroidism, particularly in women (Melzer et al., 2010, Environmental Health Perspectives)

Clinically, patients with unexplained subclinical hypothyroidism or thyroid antibodies should have PFAS exposure considered as a contributing factor.

Immune Suppression

This is one of the most well-documented and clinically significant effects. Philippe Grandjean’s landmark 2012 study in JAMA followed children in the Faroe Islands and found that each doubling of PFAS serum concentration was associated with a 49% reduction in antibody response to childhood vaccines (diphtheria and tetanus).

Read that again. PFAS didn’t just reduce vaccine effectiveness marginally — it halved it.

The National Toxicology Program (NTP) concluded in 2016 that PFOA and PFOS are “presumed to be an immune hazard to humans.” The immune suppression extends beyond vaccine response to general immunosurveillance, potentially affecting cancer defense and infection resistance.

Cancer

The C8 Health Project — the largest epidemiological study of PFAS-exposed populations — followed 69,000 people in communities near DuPont’s Washington Works plant in West Virginia, where PFOA contaminated drinking water for decades. The C8 Science Panel found “probable links” between PFOA exposure and:

Kidney cancer: odds ratio 1.1-1.7 depending on exposure level
Testicular cancer: significantly elevated in high-exposure groups
Thyroid disease: consistent association
Ulcerative colitis: confirmed association
Pregnancy-induced hypertension/preeclampsia: confirmed association
High cholesterol: one of the most robust and dose-dependent associations

IARC classified PFOA as a Group 1 carcinogen (carcinogenic to humans) and PFOS as a Group 2B carcinogen (possibly carcinogenic) in 2023.

Cholesterol Elevation

Multiple studies show a consistent dose-response relationship between PFAS serum levels and total cholesterol, including LDL. The mechanism likely involves disruption of bile acid metabolism (PFAS interferes with cholesterol-to-bile acid conversion in the liver) and altered lipid transport. Clinicians seeing unexplained hypercholesterolemia, especially in patients resistant to dietary interventions, should consider PFAS as a contributing factor.

Liver Damage

PFAS accumulates in the liver and causes hepatocellular damage, steatosis (fatty liver), and altered liver enzyme levels. The liver is the primary site of PFAS accumulation and the organ most directly affected.

Reproductive and Developmental Effects

Reduced fertility in both men and women
Altered hormone levels (testosterone, estrogen)
Pregnancy complications (preeclampsia, gestational diabetes)
Low birth weight
Altered breast development in girls (Lopez-Espinosa et al., 2011)
Disrupted lactation

Endocrine Disruption

PFAS acts as an endocrine disruptor across multiple axes — thyroid, reproductive, metabolic. It’s been associated with insulin resistance and obesity (dubbed “obesogens”), particularly concerning for prenatal and early-life exposure.

EPA Regulatory Landscape

The regulatory response to PFAS has been glacially slow:

2016: EPA set a health advisory of 70 ppt (parts per trillion) for combined PFOA+PFOS in drinking water — non-enforceable
2022: EPA revised health advisories to 0.004 ppt for PFOA and 0.02 ppt for PFOS — essentially zero, acknowledging that no safe level exists
2024: EPA finalized enforceable Maximum Contaminant Levels (MCLs) of 4 ppt for PFOA and PFOS individually, with a hazard index approach for mixtures

For context, 4 parts per trillion is four drops of water in an Olympic swimming pool. The fact that even this infinitesimal concentration is considered harmful speaks to the extraordinary potency of these compounds.

Testing

Blood/Serum PFAS Panel

Available through Quest Diagnostics and LabCorp. Typically measures 7-14 individual PFAS compounds including PFOA, PFOS, PFHxS, PFNA, PFDeA, and GenX. The CDC’s NHANES data provides population percentile references:

PFOS median (US population): approximately 4.3 ng/mL
PFOA median: approximately 1.4 ng/mL
Levels above the 95th percentile warrant active reduction strategies

Water Testing

If you’re on municipal water, check your utility’s annual Consumer Confidence Report for PFAS data (if tested — many utilities don’t yet). For direct testing, SimpleLab (Tap Score) and Eurofins offer PFAS-specific water panels. Cost: $150-300.

Reduction Strategies

Water Filtration (Highest Priority)

Drinking water is the primary route of continuous exposure for many people.

Reverse osmosis: removes 90-99% of PFAS. The most effective point-of-use option.
Granular activated carbon (GAC): removes 60-80% of longer-chain PFAS (PFOA, PFOS). Less effective for short-chain PFAS. Quality matters — cheap pitcher filters remove very little PFAS.
Ion exchange resins: highly effective, often used in whole-house systems. Can be combined with carbon for comprehensive treatment.
NSF/ANSI 53 certification: look for filters specifically certified for PFAS removal. Not all carbon filters qualify.

Cookware Swap

Replace all nonstick cookware with cast iron, stainless steel, ceramic, or glass. This eliminates a direct-contact PFAS source and eliminates the risk of overheating-related PFAS gas release.

Food Packaging Awareness

Avoid microwave popcorn (one of the highest single-exposure sources)
Minimize fast food and takeout (packaging contamination)
Use glass containers for food storage
When ordering delivery, transfer food to your own plates/containers promptly
Avoid “grease-resistant” paper products

Personal Care and Cosmetics

Check products on EWG Skin Deep for PFAS
Avoid products marketed as “long-lasting,” “waterproof,” or “smoothing” unless verified PFAS-free
Switch from PTFE dental floss (Oral-B Glide) to natural waxed floss or PFAS-free alternatives
Look for “PFAS-free” or “PTFE-free” labeling

Textiles and Household

Choose natural-fiber waterproofing alternatives (waxed cotton, silicone-based DWR treatments)
Skip stain-resistant treatments on furniture and carpets
Avoid carpet entirely when possible
Check for PFAS in period underwear and children’s clothing (some brands have voluntarily removed PFAS; others haven’t)

Detox Support

The hard truth: PFAS is one of the most difficult environmental toxins to actively detoxify because the carbon-fluorine bond resists enzymatic metabolism. The body primarily eliminates PFAS through renal excretion (slow) and biliary excretion with enterohepatic recirculation (much of what’s excreted in bile gets reabsorbed). The following strategies aim to interrupt this recirculation and enhance whatever elimination pathways exist.

Bile Acid Sequestrants

Cholestyramine (4-8 grams, 1-2 times daily, taken away from food and medications): a prescription bile acid binder that interrupts the enterohepatic recirculation of PFAS. By binding PFAS in the gut before it can be reabsorbed, cholestyramine effectively increases fecal excretion. Originally developed for cholesterol reduction, its PFAS-binding properties make it the most rational pharmaceutical intervention. Must be prescribed and monitored by a physician — can affect absorption of nutrients and medications.

Fiber and Gut Binders

Fiber (30-40 grams daily from diverse sources): supports bile acid excretion and provides binding matrix. Psyllium husk, ground flaxseed, oat fiber, and diverse vegetables.
Chlorella: 3-6 grams daily. A green algae with demonstrated heavy metal binding capacity and some evidence for organic pollutant binding.
Modified citrus pectin: 5-15 grams daily. Binds various toxins in the GI tract without significantly affecting mineral absorption.
Activated charcoal: 500-1,000 mg/day for short courses (2-4 weeks), taken 2 hours from food/medications. Non-specific binder.

Sauna

Genuis et al. (2013) published data in ISRN Toxicology showing that some PFAS compounds appear in sweat, suggesting that induced perspiration may be a viable elimination pathway. While the data is preliminary and the quantities in sweat are small relative to body burden, regular infrared sauna (20-40 minutes, 3-5 times weekly) supports overall detoxification and has virtually no downside when done safely.

Blood and Plasma Donation

This is counterintuitive but supported by data. Genuis et al. (2013) and a 2019 Australian study (Rotander et al.) found that regular blood donors had significantly lower PFAS serum levels than non-donors. The mechanism is straightforward: you’re physically removing PFAS-laden blood, and the body replaces it with new blood that draws from tissue stores at lower concentrations. Regular blood donation (every 8-12 weeks for whole blood, more frequently for plasma) may accelerate PFAS clearance.

This also means that blood banks are inadvertently collecting PFAS-contaminated blood — a separate public health concern, but for the individual donor, it represents an elimination pathway.

Liver Support

Since the liver is both the primary site of PFAS accumulation and the organ attempting to process it:

Glutathione support: NAC (600-1,200 mg/day), liposomal glutathione (500 mg/day), selenium (200 mcg/day as selenomethionine)
Milk thistle (silymarin): 200-400 mg/day — hepatoprotective, supports glutathione, may help mitigate PFAS-induced liver damage
Cruciferous vegetables and sulforaphane: upregulate Phase II detoxification enzymes
Adequate protein: the liver requires amino acids (particularly glycine, taurine, glutamine, and methionine) for conjugation reactions

Timeline Expectations

Given the multi-year half-lives, expect PFAS reduction to be a slow process. Even with aggressive interventions, meaningful serum reduction takes 1-3 years. Retest serum levels annually to track progress. The combination of reduced exposure + bile acid binding + sauna + blood donation represents the most comprehensive approach currently available.

Advocacy and the Regulatory Landscape

Individual action matters, but PFAS contamination is fundamentally a regulatory failure that requires systemic change:

PFAS Action Act: federal legislation aiming to designate PFAS as hazardous substances under CERCLA (Superfund), establish drinking water standards, and restrict new PFAS manufacture
State-level bans: Maine, Minnesota, and several other states have enacted bans on PFAS in food packaging, textiles, and other consumer products. Maine’s LD 1503 (2021) was the first state law to ban PFAS in all products by 2030.
European Union: proposing a blanket restriction on all PFAS — the most ambitious regulatory action globally
Corporate accountability: litigation continues to hold manufacturers responsible for contamination and health effects. The DuPont/Chemours settlements and 3M’s $10.3 billion settlement with public water systems mark the beginning, not the end.

The Generational Perspective

PFAS crosses the placenta and appears in breast milk. The child born today arrives with a PFAS burden inherited from their mother, who inherited some of hers from her mother. Three generations of accumulation before the first breath. This isn’t scaremongering — it’s biochemistry. The carbon-fluorine bond doesn’t care about political convenience or corporate profit margins.

The functional medicine response is characteristically dual: do what you can individually (filter your water, change your cookware, support your liver) while recognizing that individual action alone cannot solve a problem created by industrial chemistry and regulatory capture. Both levels — personal and political — require engagement.

Your body is remarkably adaptable. It handles insults that would destroy any machine. But adaptation has metabolic costs, and PFAS represents a cost that compounds silently over decades. The earlier you reduce exposure, the lower your lifetime accumulation. The earlier you start supporting elimination, the more years of reduced burden you gain.

Given that these chemicals are already in your blood and your children’s blood, what one change would you make today to begin turning the tide?