WTF Are Forever Chemicals?

Carolyn L. Todd

You may have noticed the vaguely ominous phrase “forever chemicals” popping up in the news lately. These chemicals are showing up in the water at schools in Massachusetts. Home Depot will stop selling rugs containing them. States are filing lawsuits against their makers. Congress is interrogating manufacturers about them.

But what the hell are forever chemicals, exactly? And what do we know about how they can affect our health?

“There is a lot we know about these chemicals and quite a bit we don’t know as well,” Rachel Rogers, Ph.D., a senior environmental health scientist at the Agency for Toxic Substances and Disease Registry (ATSDR), a division of the Centers for Disease Control and Prevention (CDC), tells SELF.

“They’re just starting to get the attention of the general population, but we’ve used these chemicals for decades now,” Joseph Allen, M.P.H. Sc.D., assistant professor of Exposure Assessment Science in the Department of Environmental Health at the Harvard T.H. Chan School of Public Health and co-author of Healthy Buildings: How Indoor Spaces Drive Performance and Productivity, tells SELF. Although much more research is necessary, “We know enough that we should be very concerned,” Allen says.

So...not exactly reassuring. But many environmental experts are also pushing for change that could benefit us all. Here’s what we do and don’t know about forever chemicals.

What even are forever chemicals?

The technical name for these chemicals is “per- and polyfluoroalkyl substances,” or PFAS. PFAS are a broad class of around 5,000 different synthetic chemicals that various industries have used widely since the 1940s, according to the U.S. Food and Drug Administration (FDA). Like, really widely.

Here are some of the items we use in our daily lives that can contain PFAS, according to the ATSDR: nonstick pots and pans, grease-resistant food packaging (like fast food wrappers and containers, microwave popcorn bags, and pizza boxes), water-resistant clothes, cleaning products, shampoo, dental floss, eye makeup, fabrics coated with stain repellents (like carpets and upholstery), paints, varnishes, and sealants. Another major source is a specific kind of foam used to fight fires, according to the Environmental Protection Agency (EPA).

What these 5,000-odd PFAS compounds all have in common is the carbon-fluorine bond that forms their molecular backbone. “This is one of the strongest bonds in all of organic chemistry,” Allen explains. So, while environmental elements like heat, sunlight, and water may help break down other chemicals, that’s not the case for PFAS, Jamie DeWitt, Ph.D., an associate professor of Pharmacology & Toxicology at the Brody School of Medicine at East Carolina University, tells SELF. This makes PFAS compounds ideal for producing slick raincoats, keeping your hands grease-free while you’re eating a hamburger, and saving your carpet from wine spills. It also means that although the “forever” moniker might sound a little extra, it’s actually pretty scientifically accurate, says Allen.

Once PFAS enter an ecosystem, “They’re there to stay,” DeWitt says.

We don’t know for sure how long it would take for various PFAS to break down, DeWitt says. The ATSDR said “years to decades” in a Senate testimony earlier this year. DeWitt speculates it could be hundreds or thousands of years, while Allen says it may be more like millennia.

“In that sense, yes, they are forever, at least in our lifetimes,” says DeWitt.

How do forever chemicals get into our bodies?

Most individuals in the United States have at least one PFAS in their bloodstream, according to the ATSDR. (As part of the National Health and Nutrition Examination Survey, the CDC has been using blood testing to measure the levels of two specific PFAS—PFOS and PFOA—in the U.S. population since 1999.) With the continual exposure most people are subject to and the slow rate at which PFAS are excreted, these chemicals gradually build up in the body over time, according to the National Institute of Environmental Health Sciences (NIEHS). Awesome!

While some of this exposure happens through the use of products like the ones we mentioned above, PFAS have been shown to migrate into our air, soil, and water, according to the ATSDR, making them relatively easy for us to ingest. This contamination starts around sites where PFAS are made or used, like manufacturing plants that make PFAS chemicals or make products using PFAS, as well as facilities where firefighters are trained, like military bases. (For instance, the Department of Defense has identified 401 active and former military installations with a known or suspected release of PFAS.) From there, PFAS can seep into ground or surface water supplies, Rogers explains.

Overall, the most concerning source of PFAS exposure is contaminated water, Rogers says, given that we all (should) drink water every day and it’s as direct a form of exposure as you can think of. “Recently, it’s become more and more clear that ingestion of PFAS-contaminated water seems to be a significant exposure pathway for people across the U.S.,” Rogers says.

Over the past several years, an increasing number of communities have detected PFAS in their water as state authorities prioritize and mandate testing. For instance, almost two dozen water agencies in Southern California found “reportable levels" of PFAS in their wells after the state began ordering testing this year, according to the Orange County Register. As another example, a 2018 statewide testing effort in Michigan revealed PFAS in the water supply of at least 60 schools, day cares, and Head Start centers that get groundwater from private wells, according to MLive.com, a local news outlet. States like Vermont, Washington, and Wisconsin have also dealt with PFAS-contaminated water.

Beyond just drinking the water, this exposure can happen when brushing your teeth or using water to cook food, Rogers says, along with things like eating fish caught in PFAS-contaminated water. (PFAS don’t seem to penetrate the skin well, so stuff like showering or bathing shouldn’t be a major source of exposure, per the ATSDR.)

How harmful are forever chemicals?

Okay, so we know that these chemicals are pretty ubiquitous and that we’re most likely being exposed to them a lot. But is there any research to suggest that being exposed to these common chemicals is actually bad for us?

The science here is still in progress, but based on the few specific PFAS we’ve studied (including PFOS, PFOA, PFHxS, and PFNA), they have the potential to be pretty bad for people at high enough exposure rates. “Some, but not all, of the studies looking at the relationships between PFAS exposure and health effects indicate they might impact a number of different systems in the body,” Rogers says. With that said, the negative health associations we’re about to cover have largely been found in communities that had extremely high, acute PFAS exposure. “We don’t know that much yet about the consequences of broad, chronic, lower-level exposure” that the majority of people are more likely subject to, Elsie M. Sunderland, Ph.D., Gordon McKay Professor of Environmental Chemistry at the Harvard John A. Paulson School of Engineering and Applied Sciences and in the Department of Environmental Health at the Harvard School of Public Health, tells SELF.

With that said, let’s walk through some of the science here. According to the ATSDR, studies have shown that PFAS exposure may be responsible for a long list of health effects: affecting infants’ and children’s growth, learning, and behavior; lowering a person’s chance of getting pregnant; interfering with the body’s hormones; increasing cholesterol levels; affecting the immune system; and increasing the risk of cancer.

The most consistent finding from observational studies of humans is elevated cholesterol levels among exposed populations, according to the EPA. (High cholesterol puts you at increased risk of health issues like heart disease.) The findings are more limited when it comes to the other health effects listed above, like an increased risk of cancer and hormone disruption. Even with increased cholesterol, the data aren’t definitive. Some epidemiological studies have found statistically significant associations between increased blood levels of PFOA and PFOS and higher cholesterol levels in workers exposed to PFAS and people living in communities with high levels of PFOA in the drinking water, according to the ATSDR. Others have found no association between increased PFAS in the blood and elevated cholesterol levels.

Some of the most convincing data come from The C8 Health Project, a massive epidemiological study of 69,030 adults living around Parkersburg, West Virginia, where a DuPont manufacturing plant that made Teflon contaminated the drinking water with PFOA (also known as C8) from the 1950s until 2002. Tracking levels of PFAS exposure and disease among this population, scientists found a “probable link” between elevated PFOA blood levels and high cholesterol, ulcerative colitis, thyroid function, testicular cancer, kidney cancer, preeclampsia, and elevated blood pressure during pregnancy, according to the ATSDR. (You can read all the reports on those potential disease links as well as the many associations researchers did not find here.)

Like all the human studies on PFAS, these studies are observational, meaning we’ve only observed a correlation, not proven cause and effect. Lots of other factors that go into the development of these health issues could be in play, and as Rogers noted, not all studies in these areas have suggested that PFAS could have negative health effects. We obviously don’t have randomized controlled trials comparing a large group of people who had zero PFAS exposure to another big group of people who were uniformly subjected to the same exact PFAS in terms of exposure route, intensity, and frequency. It’s all incredibly complex to study, which makes black-and-white scientific evidence like “this chemical increases your risk of cancer by 25 percent” hard to come by.

However, we do also observe some of these same health effects in controlled studies of animals exposed to PFAS, points out DeWitt. “That gives us confidence in the fact that [PFAS] really are causing these effects,” she says. Here’s an example of how scientists have pieced together evidence from human and animal studies to draw a reasonable conclusion about the risk of PFAS: The National Toxicology Program (NTP) did a systematic review evaluating the evidence on exposure to PFOA or PFOS and immune-related health effects. They found a moderate level of evidence that PFOA and PFOS suppress the antibody response in humans, as well as a high level of evidence to this effect from animal studies. Combining the observed outcomes, the NTP concluded that PFOA and PFOS are presumed to be an immune hazard to human beings.

As for proving how these chemicals could be influencing so many different body systems in humans? “That’s a question that is very much still being investigated,” Rogers says, adding that there are likely multiple mechanisms in play. “We're starting to study how these compounds work in the body and see how human cells respond,” says DeWitt, whose lab is investigating how PFAS exposure impacts the immune, nervous, and endocrine systems of biological organisms.

So, uh, how much should you freak out about forever chemicals?

Not a ton, honestly. Yes, all of the above may sound scary, but experts aren’t clear on how much exposure to PFAS is too much. “Obviously, not everybody who gets exposed is going to experience a problem,” DeWitt explains. Otherwise, we’d probably all have all of the health issues we just described. So, you really don’t need to panic immediately.

“It’s something we want on our radar, but it’s not a life or death situation where you should be going to your doctor or be [lying] awake at night,” Sunderland says.

And, as we mentioned, these negative effects have been found in communities with extraordinarily high levels of exposure to PFAS. For instance, people living around the DuPont plant in West Virginia had blood concentrations of PFOA that were 500 percent higher compared to a representative sample of the U.S. population, according to the ATSDR.

While the lack of certainty here is not exactly comforting given that what we do know about PFAS is not good, in many ways, “we’re very much in the discovery phase of this problem,” Sunderland says. That’s why developing a clearer understanding of these potential health effects and determining safe levels of exposure to PFAS is a priority for the ATSDR, Rogers says.

What can you do with this information?

First things first: Since contaminated drinking water is the experts’ biggest concern here, you can get in touch with your local water supplier (which should be listed on your water bill) and request a “Consumer Confidence Report” that summarizes the quality of your water, the EPA says. You can also ask them specifically for information about how much PFOA and PFOS are in the water you use. (If you get water from a private well, you can reach out to your local public health department to ask for guidance on testing your water supply for contaminants.)

If your drinking water does contain significant levels of PFAS, you can look into installing treatment technologies in your home. The EPA has found several strategies to be effective for removing PFAS from drinking water, including special filtration membranes. It may be possible to put these systems into effect at places where water enters your home or even in spots like the kitchen faucet. (Of course, cost is a big consideration here.) You can read more about the EPA’s research into the efficacy of these technologies here.

Then there’s the question of avoiding PFAS in the stuff you buy. “Anyone who’s concerned can take steps to reduce their exposure,” Rogers says. That includes choosing products with PFAS-free labels when purchasing things likely to contain them, Sunderland says, like stain-resistant carpeting. You can also avoid certain kinds of products altogether, like nonstick pans. (While there are brands of nonstick cookware that will claim to be free of certain PFAS like PFOA, it’s very difficult to know for sure if something with a nonstick coating is free of all PFAS, DeWitt notes.)

The truth is, “It's really challenging from a consumer perspective because so many products contain [PFAS] and we might not even know what they are,” DeWitt says. “I work with these chemicals, and I still struggle to find out what products they're in.”

The only major way to significantly reduce our exposure on a grand scale is to find out where drinking water contamination is happening, warning people in those communities, and preventing it from happening in even more areas. “We’re placing a very high priority on this,” says Rogers. “We [at the ATSDR] have a lot of ongoing projects and studies.” For instance, the ATSDR and its partners at the state level are investigating PFAS exposure in more than 30 communities across the United States.

The EPA is also on it. “Taking action to address [PFAS] is a top priority,” an agency spokesperson tells SELF. In February, the EPA released a PFAS Action Plan that “identifies short-term solutions for addressing these chemicals and long-term strategies that will help provide the tools and technologies that states, tribes, and local communities need to provide clean and safe drinking water to their residents and to address PFAS at the source,” the spokesperson says.

Of course, this all requires government regulation. The EPA has established drinking water health advisory levels for PFOA and PFOS at 70 parts per trillion, but these levels are non-enforceable and non-regulatory. This is basically a technical bulletin meant to provide safety recommendations to health officials, but nothing they actually need to abide by. (Also, many scientists studying the problem believe 70 parts per trillion is too high, according to Sunderland.) The EPA plans to propose a regulatory plan by the end of the year to establish a national primary drinking water standard for PFOA and PFOS, according to the EPA spokesperson, who adds, “The agency is also gathering and evaluating information to determine if regulation is appropriate for other chemicals in the PFAS family.”

Still, Allen, Sunderland, and DeWitt all expressed a lack of confidence in the current presidential administration to prioritize PFAS regulation. As Sunderland explains, the Trump administration has decimated the EPA’s regulatory oversight for these types of issues. She also cites the chemical industry’s susceptibility to industry lobbying. “[PFAS are] used so prevalently in so many products that there’s a very large commercial interest in keeping these chemicals in use,” she says.

Recent history has shown us that there is still reason to be at least a little hopeful. Since 2006, eight major chemical manufacturers have stopped using PFOA and other PFAS under the EPA’s PFOA Stewardship Program. “We almost immediately saw the response: a very rapid decline in [blood] serum concentrations of those chemicals,” Sunderland says. From 1999 to 2014, the level of PFOA and PFOS in people’s blood declined by over 60 percent and 80 percent, respectively, according to the CDC. “It’s not hopeless,” Sunderland says. “We shouldn’t feel disempowered.”

The problem is that even if one or two PFAS become regulated, like PFOA or PFOS, they can just be replaced with the 5,000-ish other PFAS chemicals that aren’t subject to regulation because they haven’t been studied yet. “One bad actor chemical is swapped [out for] one of its chemical cousins that has a similar toxicological profile,” Allen says. It’s essentially like “chemical whack-a-mole,” he explains.

This is why the academic community is urging regulation to meaningfully reduce our exposure to all PFAS as a chemical class in one fell swoop, not just one or two at a time.

“We know enough to know we need to act now,” Allen says. “The positive news is that there's growing awareness that this is an issue among the general public, especially in the past year or so.” DeWitt is similarly optimistic. “We have a really big network of scientists working together—at universities, state and federal government facilities, and in the industry—to find solutions so that the general public doesn't have to be concerned about these chemicals.”

Related:

Originally Appeared on Self