Following PFAS inside the body

Also: a year after Dr. Paul Farmer's death; positive news for some stroke patients [View in browser](    [❤️]( February 21, 2023 Hi CommonHealth reader, When I started working on[a couple of stories about PFAS]( there was one remarkably difficult question to answer: What do these toxic chemicals do once they get into our bodies? PFAS are a group of thousands of chemicals that were first invented in the 1930s. They became [widely used in the 1950s]( because they are really stable and good at repelling oil, water and grease. Now they’re in everything from dental floss to stain-resistant coatings on couches to microwave popcorn bags. Barbara Moran, my colleague on the environmental desk, and I started reading everything we could about these chemicals and spoke with many experts. We consistently found health concerns linked to PFAS without an explanation of the biological mechanism. But the list of concerns was long and wide-ranging: these chemicals are associated with a reduced immune response after childhood vaccinations, thyroid disruptions, kidney cancer, lower birth weights and a lot of other health issues. “It's pretty remarkable, in my opinion, that PFAS chemicals can affect so many parts of the body in adverse ways,” Patrick Breysse, the former director of the Agency for Toxic Substances and Disease Registry at the CDC, said during a [presentation]( a Massachusetts task force on PFAS. “Not many chemicals have such a breadth of effect.” As I heard pronouncements like this, I became more determined to understand what gives these chemicals such "remarkable" powers inside our body. Eventually, I found a handful of researchers who are working on this puzzle. It turns out that once inside the body, PFAS have at least three signature traits that make them so problematic. - 1. PFAS chemicals are extremely well absorbed, and they are very poorly eliminated. - “They are just virtually indestructible,” Angela Slitt, a professor at the University of Rhode Island College of Pharmacy, told me. "The body doesn't break them down." This has earned PFAS the nickname "forever chemicals." - Some of the most prevalent PFAS chemicals stick around in the body for years. (Compare that to BPA, that chemical in plastics, which stays in the body for a matter of hours.) - 2. PFAS bind to proteins in the blood. “And what that means is it's a really excellent delivery system to get all sorts of places in our body,” said Megan Romano, an epidemiologist at Dartmouth’s School of Medicine. - This is part of what gives PFAS their broad reach inside the body. - 3. PFOA (which is one of the best studied PFAS chemicals) looks a lot like fatty acids on a molecular level. The body needs fatty acids, but PFOA fools the nuclear receptors designed for fatty acids "into thinking it knows the secret handshake, and that's how it gets in the door," Romano said. - From there, it can mess with hormonal regulation and fat storage, among other things. There are still plenty of unknowns and huge gaps in the data, which isn’t surprising, given that there are thousands of types of PFAS chemicals and only a few have been well studied. But after weeks of reporting, I finally feel like I have a better sense of what is going on biologically with PFAS — and I hope you do, too. P.S.— If you want more details about what I learned, here is the [full story](. And I chatted about all of this last week on The Common, a daily podcast from WBUR. You can listen on the new and improved WBUR app. Learn more about the app [here]( and download the app on [iPhones and iPads]( or [Android devices](. 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