Health Effects of Exposure to PFAS
It is important to keep in mind that exposure to PFAS does not always mean a person will have health effects. Whether or not a person gets sick from exposure to PFAS depends on how long a person was exposed (duration), how often they were exposed (frequency), and how much PFAS they were exposed to (dose). Personal factors like age, lifestyle, and other illnesses may also determine whether or not a person gets sick from exposure to PFAS.
There are many chemicals in the PFAS family, and they may cause different health effects if you are exposed to them. The health effects of PFOS, PFOA, PFHxS, and PFNA have been more widely studied than other per- and polyfluoroalkyl substances (PFAS).
Some, but not all, studies in humans with PFAS exposure have shown that certain PFAS may:
- Affect growth, learning, and behavior of infants and children;
- Lower a woman’s chance of getting pregnant;
- Interfere with the body’s natural hormones;
- Increase cholesterol levels;
- Affect the immune system; or
- Increase the risk of certain cancers.
Scientists are still learning about the health effects of exposures to mixtures of PFAS.
For the most part, laboratory animals exposed to high doses of one or more of these PFAS have shown changes in liver, thyroid, and pancreatic function, as well as some changes in hormone levels. Because animals and humans process these chemicals differently, more research will help scientists fully understand how PFAS affect human health.
The available data suggest that PFAS are not metabolized nor do they undergo chemical reactions in the body. Perfluoroalkyls are primarily excreted in the urine. There are substantial differences in the time it takes for PFAS to be eliminated from the human body and animal species. The estimated time to reduce PFAS in the human body by 50% is 2.1-8.5 years for PFOA, 3.1-7.4 years for PFOS, 4.7-15 years for PFHxS, and 2.5-4.3 years for PFNA. Much shorter timeframes for elimination have been estimated in experimental animals.
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Ways to Reduce Exposure to PFAS
Because PFAS are so widespread in the environment, it is difficult to avoid all exposure to PFAS chemicals. You may be able to reduce your exposure by avoiding water that is known to be contaminated with PFAS chemicals.
If PFAS are present in drinking water, filtering the water or using an alternative source can reduce exposure to PFAS.
PFAS are present in many consumer products. Be an informed consumer and research if manufacturers are using PFAS in packaging or the manufacture of products (i.e. clothing, carpet). If you want to reduce your family’s exposure, consider limiting the use of household products that were made using chemicals in the PFAS family.
Some of these products include:
- Nonstick cookware, like pots and pans
- Furniture and carpet that is stain-resistant
- Clothing treated with water, stain, or dirt repellant
- Non-stick food packaging, like French fry cartons, microwave popcorn bags, and pizza boxes
- Makeup and other personal care products that have ingredients with “fluoro” or “perfluoro” in the name
Note: not all non-stick coatings are PFAS-based.
The federal Food and Drug Administration provides additional information on PFAS in food and food packaging at: fda.gov/food/chemicals/and-polyfluoroalkyl-substances-pfas.
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Pregnant and Nursing Women
Pregnant and nursing women may be more susceptible than the general population to the health effects of PFAS. As a precautionary measure, pregnant and nursing women may want to consider treating their water source to remove the type of PFAS present or use an alternate water source for drinking, making ice, brushing teeth and preparing food. Women who are planning to become pregnant may wish to take steps to reduce their exposure to PFAS, due to the slow elimination of PFAS from the human body.
Unborn babies may be exposed to PFAS through their umbilical cord blood if their mother ingests PFAS before and while she is pregnant, and babies may be exposed through breastmilk. Research suggests that fetuses and infants are more vulnerable to exposure to PFAS. Long-term exposure to PFOA, PFOS, and PFHxS leads to a buildup of these chemicals in women of child-bearing age that results in more exposure to the fetus and breastfed infants. Breastfeeding provides many health benefits to both a mother and infant. ODH recommends that women currently breastfeeding, and pregnant women who plan to breastfeed, continue to do so. For information about breastfeeding, see the Ohio Department of Health Breastfeeding webpage.
Bottle-fed infants are also of concern because they drink more water per body weight than adults. If you are concerned about exposure through bottle feeding, consider using an alternative water source or filtered drinking water for making formula. This can lower exposure to PFAS for your infant.
Please consult with your healthcare provider with any concerns.
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Children have different exposure circumstances that make them especially sensitive to environmental contaminants, like PFAS. Understanding these differences is key for evaluating potential for environmental hazards from pollutants. Children consume more of certain foods and water relative to body weight than adults. That means the same glass of water with the same PFAS concentration level results in greater exposure to a child versus an adult, even though they are drinking the same amount. Children also do not excrete chemicals as easily as adults, because the enzymes in their bodies that break down contaminants are still developing. That increases the chances for contaminants such as PFAS to interfere with a child’s growth and development. In addition, young children tend to play close to the ground and come into contact with contaminated soil outdoors. To ensure the protection of children and other sensitive populations, the Ohio PFAS Action Levels are set to protect the most sensitive populations, thereby protecting the health of all populations in Ohio.
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Since many household pets are smaller than people, they also consume more of certain foods and water relative to their body weight than people. That means that the same bowl of water with the same PFAS concentration results in greater exposure to household pets, even though they may be drinking the same amount. As a precaution, if you have elevated levels of PFAS in your water, you should consider using alternative water for your household pets.
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Testing your blood for PFAS
While a PFAS blood test measures how much of specific PFAS are in a person’s body at the time of the test, there are limitations. A PFAS blood test cannot:
- Tell you where or how you were exposed to PFAS found in your body;
- Tell you what, if any, health problems might occur or have occurred because of PFAS in your body; or
- Be used by your doctor to guide treatment decisions.
Measuring a person’s exposure to PFAS and monitoring potential impacts on human health is best addressed through consultation with a physician. ODH has and will continue to provide information and recommendations to healthcare providers to help providers and patients make informed decisions about what PFAS exposure might mean for an individual’s health. There is no recommendation from ODH or the Centers for Disease Control and Prevention (CDC) that clinicians should test patients for PFAS. Please consult your healthcare provider if you have concerns regarding PFAS exposure.
PFAS Testing for Individuals
ODH does not generally recommend testing your blood for PFAS. Physicians will not be able to treat a specific health issue using the result from this test. Please consult your healthcare provider if you have concerns regarding PFAS exposure.
A blood test for PFAS can tell you what your levels are at the time the blood was drawn, but not whether levels in your body are “safe” or “unsafe.”
- Most people in the U.S. have measurable amounts of PFAS in their body because PFAS are commonly used in commercial and industrial products.
- The PFAS blood test is not a clinical test and cannot tell you whether your health has been or will be affected.
- Many health issues associated with PFAS, such as increased cholesterol and decreased thyroid hormone levels, commonly occur in the population as a whole – even when not associated with high levels of PFAS in the blood.
- These health issues can be caused by many factors, and there is no way to know or predict if PFAS exposure has or will cause your health problem.
- If you have specific health concerns, please consult your doctor for the best treatment choices for you.
- It is complicated to get a PFAS blood test.
- It is not a routine clinical test, so you would need to contact a private lab directly to arrange the test and it is unlikely that insurance would cover the cost.
- There are hundreds of PFAS around us. Labs can only test for a small number of PFAS in blood.
Laboratories that Offer PFAS Testing
ODH is aware of three private laboratories that offer PFAS testing in blood. ODH does not recommend specific labs and does not know specifics regarding the different tests they offer. The cost for PFAS blood testing is in the $500-800 range, not including fees that a clinic might charge for drawing and shipping the blood.
What you can do with your test results
You can compare your levels to those in groups of people nationwide. The National Biomonitoring Program by the U.S. Centers for Disease Control and Prevention (CDC) tests a very large group of people for PFAS and other chemicals and tells us about average exposures in the U.S. population. These studies can be used to compare your blood test result to what is known about levels in people throughout the country.
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Home Treatment Options
Water treatment in a home to reduce levels of PFAS can be:
- At the point of entry (POE) where treatment all of the water entering the household plumbing system occurs, or;
- At the point of use (POU) which is often at the kitchen sink or primary source of water for drinking or cooking (potentially also including a water line to the refrigerator if it has a plumbed in water line).
Either type of water treatment has pros and cons that should be considered before selecting the best treatment option for a home. The type of treatment system chosen should consider the volume of water that will be used in the home, the number and location of sites where water is consumed in the home, and the type of PFAS chemical identified in the laboratory result.
If water for drinking, cooking and making ice is primarily obtained from the kitchen sink, then the installation of a treatment unit below the sink or on the sink faucet is an option. If drinking water and ice are obtained from the refrigerator, then it is important to consider treating the water line to the refrigerator also.
If drinking water is obtained from multiple locations in a home, then a point of entry, or whole house treatment system may be preferred.
If possible, it is important to choose a treatment system that has been tested and certified to remove the PFAS present in the water based on data provided from the public water system provider or from a laboratory analysis.
Certified Water Treatment Products to Remove PFOA and PFOS
Currently, certified products are only for point of use (POU) treatment, which means they are products designed to treat the water at only one or two locations, usually at the kitchen sink and possibly the refrigerator if it has water connected. Certified products are either granular activated carbon (GAC) filtration or reverse osmosis (RO) treatment systems. It should be noted that some of the products certified to treat water at the point of use are counter-top products or pour through (like a pitcher filter that you fill from the tap yourself as needed).
NSF International and the Water Quality Association are independent third-party testing agencies that currently test and certify products to remove the specific PFAS PFOA and PFOS.
Look for products identified as certified to NSF International’s Standard P473. The NSF International consumer information team can also be contacted at firstname.lastname@example.org or 1-800-673-8010 for assistance in finding a certified product.
Products tested and certified by the Water Quality Association can be found here: https://www.wqa.org/find-products#/.
NSF Standard P473 was retired in March of 2019 when the testing protocol was incorporated into existing water treatment standards, so new products certifications are tested to meet either NSF/ANSI Standard 53: Drinking Water Treatment Units – Health Effects for the reduction of PFOA and PFOS with granular activated carbon filtration systems or to NSF/ANSI Standard 58 Reverse Osmosis Drinking Water Treatment Systems for the reduction of PFOA and PFOS with reverse osmosis systems. There is currently not a standard for certification of other types of treatment systems.
Treatment System Products to Remove other PFAS
There are currently no certified standards for removing PFAS other than PFOA and PFOS, however, consideration of the type of PFAS chemical can inform the selection of the best water treatment system. PFOA and PFOS are longer chain PFAS than other chemicals in the PFAS family. Longer chain chemicals are larger which makes it easier for a filter or membrane to trap them. Shorter chain PFAS are harder to remove with granular activated carbon treatment alone. Though there is no product certification standard at this time, research has shown that reverse osmosis treatment systems can effectively remove a wide range of PFAS, including the shorter chain chemicals in the PFAS family.
Considerations for point of use (POU) granular activated carbon (GAC) treatment:
- Physical filter cartridge traps contaminant(s) which is then removed and disposed of at the end of its rated lifecycle.
- Filter must be replaced on a regular schedule (identified by the manufacturer).
- Generally, granular activated carbon filters provide more water flow than a reverse osmosis system.
- May not effectively treat shorter chain PFAS if present in addition to the longer chain PFOA and/or PFOS.
Considerations for point of use (POU) reverse osmosis (RO) treatment:
- Typically requires pre-filtration to be installed to remove any sediment and small particles as well to maximize the life and effectiveness of the membrane.
- Large volumes of water are wasted in the treatment process. Typically, for every 10 gallons sent into the treatment unit, 7-8 gallons are sent down the drain as waste, and 2-3 gallons of treated water are produced.
- Membranes must be replaced on a regular schedule (identified by the manufacturer) in addition to any pre-filtration cartridges.
- Research has shown it to effectively reduce shorter chain PFAS in addition to the longer chain PFOA and/or PFOS.
Point of Entry Water Treatment
Point of entry water treatment is where all the water entering the home is treated for the removal of PFAS. Though there are not currently any products certified to treat all water that enters a home (also called point of entry or POE treatment) for removing any of the PFAS family of chemicals, research has shown that a point of entry granular activated carbon treatment can be effective if properly designed.
These systems are commonly referred to as a lead-lag granular activated carbon system. This system consists of two flow through vessels filled with granular activated carbon with a water sample faucet installed between the two vessels (after the lead vessel, before the lag vessel). Water samples are collected periodically and analyzed for PFAS to monitor the lifespan of the first carbon vessel. When the first vessel starts to lose its ability to remove PFAS, it is removed, the second carbon vessel which was in the lag position is moved to the lead carbon vessel position and new granular activated carbon media is placed into the other vessel, and it is moved to the lag position. This design relies on the lag vessel to provide protection for the water consumer in case the lead vessel is no longer able to trap the PFAS before periodic sample collection identifies that the lead carbon vessel is no longer able to perform effective PFAS removal.
The installation of a point of entry water treatment system to treat water received from a public water system may require a local plumbing permit. Please check with the local building or health department to determine if a plumbing permit is needed.
The installation of a point of entry water treatment system to treat water received from a private water system (water well, spring, pond, rainwater cistern or hauled water storage tank) will require an installation permit form the local health district. These treatment systems may only be installed by a private water systems contractor registered by the Ohio Department of Health. These contractors are bonded and the list of registered contractors may be found at: https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/private-water-systems-program/info-for-homeowners/.
There is currently no certification program for plumbers or contractors who install point of entry water treatment systems for PFAS. Please be an informed consumer and request complete information on the components that will be installed, product certification as applicable, the maintenance requirements and cost, and appropriate disposal of the treatment media.
An Ohio resident can find which local health jurisdiction they live in using the directory of local health districts: https://odh.ohio.gov/wps/portal/gov/odh/find-local-health-districts.
Water Treatment System Costs
Please note that testing a water sample for PFAS at a lab certified to perform analysis of drinking water by U.S. EPA Standard Method 537.1 varies by private lab but is estimated to cost approximately $400 per sample. Water samples should be collected and analyzed prior to the selection of an installed treatment unit to help size and select the appropriate treatment device. After the treatment device is installed, water samples should be periodically analyzed to ensure the treatment unit is working properly. Initial and on-going sampling will add to the cost of the installation of treatment systems. Countertop or pitcher type devices will not require routine sampling but media should be replaced in accordance with the manufacturers recommendations. U.S. EPA cost estimates for different types of treatment types are below:
||Approximate Initial Cost of Equipment
||Approximate Media Replacement Cost
|NSF P473 certified Point of Use Granular Activated Carbon (GAC)
||$200 - $300 each year
|NSF P473 certified Point of Use Reverse Osmosis (RO)
||$400 - $700
||$200 each year
|Non-certified Lead-Lag Point of Entry Granular Activated Carbon (GAC)
||$2000 each 3-5 years (depending on periodic testing results*)
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The Ohio Department of Health (ODH) provides information to Ohio residents on the health effects of exposure to chemicals in this Ohio Department of Health (ODH) – PFAS Factsheet
Many national health and environmental protection agencies involved in researching and setting regulations for PFAS have published helpful resources for the public.
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