PA Health Advisory: PFAS
The Pennsylvania Department of Health (PADOH) issued an important health advisory alert last month warning medical providers and health systems about the threat patients may encounter from PFAS chemicals found in food, water, and consumer products. The alert comes after the National Academies of Science, Engineering and Medicine documented numerous adverse health effects in children and adults from PFAS exposure. (Read the full report from NASEM here. The PediaBlog previously examined the role of PFAS chemicals in promoting obesity and cancer.)
Here is what PADOH wants doctors, nurses, and other health providers to know about these so-called “forever chemicals”:
• Per- and polyfluoroalkyl substances (PFAS) are human-made chemicals that don’t appear in nature unless people put them there. There are more than 12,000 different compounds that make up this class of chemicals.
• PFAS are referred to as “forever chemicals” because the carbon-fluorine bonds that form their structure are exceedingly strong and don’t break down easily (and when they do break down, they form other PFAS). As they accumulate and move through the environment, PFAS chemicals persist and bioaccumulate in humans and other creatures, leading to an array of health problems (see below).
• Because of their anti-stick, anti-grease, water-resistant, and flame-retardant properties, PFAS chemicals are highly useful to industries and consumers. Since the early 1950s, PFAS have been used in thousands of consumer products such as non-stick cookware, water- and stain-repellent fabrics (featured in clothing, flooring, and furniture), food packaging, dental floss, cosmetics, fire-fighting foam, and more. PFAS is useful to automotive and aerospace industries, construction, electronics, and the oil and gas industry, where it has been used in tens of thousands of drilling and fracking operations in 6 western states, Colorado, Ohio, and Pennsylvania).
• Routes of exposure in humans include:
∗ Ingestion of PFAS-tainted food, water, and other beverages, including infant formula made with contaminated water. Across the country, bodies of water, public water sources, and private water wells have been contaminated with PFAS, mostly from industrial activities, spills, and waste disposal. Communities surrounding airports and military bases have been contaminated with PFAS chemicals present in firefighting foams used in actual fires or during training exercises.
∗ Inhalation of PFAS-containing dust and chemicals most commonly results in occupational exposures. PFAS released into the air from landfills, petrochemical plants, and incinerator facilities pose inhalation risks for residents living nearby.
∗ Mother-to-fetus transfer of PFAS through the placenta, and mother-to-infant transfer through breastfeeding has been observed.
• Health effects: As the graphic below indicates, PFAS chemicals are systemic toxicants affecting multiple organs and body systems.
∗ They can directly damage major organs like the liver.
∗ PFAS are oncogenic (tumor-forming) and strongly associated with the development of testicular cancer in men and kidney cancer. There is some evidence showing a link to breast cancer.
∗ PFAS can act as endocrine disrupting chemicals at extremely low concentrations, causing hormone dysfunction and thyroid disease, increasing blood cholesterol levels which can lead to coronary heart disease, and promoting obesity. Exposure during pregnancy leads to poor birth outcomes and adverse impacts on fetal and infant growth and development. Studies have highlighted concerns of possible impacts on human reproduction. And there is good evidence showing that PFAS chemicals interfere with childhood responses to vaccines.
European Environment Agency via Wikimedia Commons
• More than 99% of Americans have detectable PFAS levels in their blood. Some PFAS can remain in the body for years, perhaps even throughout a person’s lifespan.
• Children are especially susceptible to the harmful effects of PFAS, pediatrician Alan D. Woolf reminds us:
Children are more vulnerable to environmental pollutants like PFAS than adults because of breathing space closer to the floor, lower body weight, differences in water and food intake, developing organ systems and longer lifespans during which toxic effects might manifest.
• There are no medically approved treatments to remove PFAS from the body. The best way to reduce the amount of PFAS in the body is to avoid new exposures. Pediatrician Lauren Zajac describes how families can reduce their risk of toxic exposure:
While it is not possible to completely eliminate exposure to PFAS, since they are so widespread in the environment, there are ways to reduce your family’s exposure:
• Drinking water: If you live in a community with water contamination, use a water filter that is certified to remove PFAS. Keep in mind that these filters need to be carefully maintained to be effective (check the manufacturer instructions). You can also check with your local water system to find out if the PFAS levels in your community have been reduced through filtration or changing the water source.
∗ Infant formula: If you live in an area with PFAS concerns, use pre-mixed baby formula or mix it using alternative water sources that do not have PFAS.
• Local fish and game advisories: Check your local fish advisories before eating locally-sourced fish or seafood or wild game.
• Dust control: Since PFAS (and other chemicals) can build up in household dust, dust regularly using a wet mop or wet cloth on solid surfaces, and vacuum carpets.
• Consumer Products:
∗ Cookware: Get rid of any nonstick (“teflon”) pots and pans that are cracked or chipped. Safer alternatives for cooking include stainless steel and cast iron.
∗ Popcorn: Instead of popcorn from microwavable bags, buy corn kernels and pop them on the stovetop or in a microwavable glass popcorn popper.
∗ Food containers: Cut back on fast food and takeout containers, since many are coated with PFAS.
∗ Textiles: Avoid buying stain-resistant carpets and upholstery.
PFAS chemicals are everywhere they shouldn’t be — in the water we drink, in the air we breathe, in the soil we share, in the food we eat, in the products we buy, and in us. That is why the PADOH is sounding alarm bells in its health advisory alerting medical providers to consult the NASEM’s report for guidance on PFAS exposure, testing, and follow-up. It’s why in June, the Environmental Protection Agency drastically lowered the federal health advisory level for PFAS in drinking water. And it’s why this one pediatrician told Karen Mansfield last month that it’s time for everyone to pay attention to this slow-moving environmental health disaster:
Dr. Ned Ketyer, medical adviser of Environmental Health Project, who moderated an Oct. 19 webinar regarding the health risks of PFAS, said, “I’m very pleased that the issue of PFAS in our drinking water, in our food, in our products and in our lives is finally getting the urgent attention it deserves. People are realizing there is no safe level of PFAS. This is a ‘stop the presses’ moment when we learn how PFAS is in everything, even in rainwater everywhere on the planet. It’s a manmade chemical we’ve allowed into everything, and it appears to have had significant health impacts and will continue to have significant health impacts moving forward.”
Read the PADOH’s November 15, 2022 Health Alert Network (HAN) advisory to medical providers and health systems regarding PFAS here.
Read “Health Impacts of PFAS on the Body” from Environmental Health Project here, PADOH’s Fact Sheet on PFAS here, and info from the CDC here.
Find more information on PFAS exposure and impacts to help guide medical providers here, here, and here from the PFAS Exchange and the National Academies of Science, Engineering, and Medicine.
The American Academy of Pediatrics covers PFAS here and here.
source http://www.thepediablog.com/2022/12/15/pa-health-advisory-pfas/
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