Exposure to chemicals and toxins has become ubiquitous. Identifying sources can enable a smart approach to minimizing their impact. Two common exposure vectors are through drinking water and food packaging. For example, per- and polyfluoroalkyl substances (PFAS) are used in a number of commercial and industrial applications. Standard filtration and treatment procedures of wastewater treatment plants do not remove PFAS from water, and contaminants eventually leach into the soil and water, affecting food, water, and animals (domesticated and undomesticated).1 These substances are associated with cancer, developmental toxicity, immune suppression, endocrine disruption, hypercholesterolemia, and obesity.1,2
IFM Educator Robert Rountree, MD, describes how he thinks about contaminants in drinking water.
There are many toxins in drinking water. PFAS are particularly important to consider because they persist in the human body over time, and yet patients may not know that they have been exposed. Sampling of water sources in communities near industrial plants reveals higher concentrations of PFAS in the groundwater compared to surface water. In one such area, residents of Decatur, AL, were found to have statistically higher serum and urine levels of perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS), both at the time of initial exposure and nine years after the release of contaminants into a wastewater treatment plant.3
When speaking to patients about toxin exposure, their place of residence can be an important clue. In a collaborative study conducted by Harvard University and others, high concentrations of PFAS were also present near civilian airports and military fire training areas utilizing aqueous film-forming foams.1 Testing drinking water may uncover these exposures.
Another key area of toxin exposure is in the patient’s diet. PFAS are still used to make grease-resistant packaging. In one study, fluorine was detected in 46% of food contact papers and 20% of paperboards sampled.2 Since these products are primarily used in processed and fast food, patients can reduce their total toxic load by avoiding foods with these types of packaging.
PFAS are just one type of common toxin. When you see patients with concerns about toxins, or when you suspect high total toxic load, an expanded toolkit can help. IFM’s Detox Advanced Practice Module (APM) frames common sources of exposure, individualized assessment, and personalized treatment to improve overall health.
- Hu XC, Andrews DQ, Lindstrom AB, et al. Detection of poly- and perfluoroalkyl substances (PFASs) in U.S. drinking water linked to industrial sites, military fire training areas, and wastewater treatment plants. Environ Sci Technol Lett. 2016;3(10):344-50. doi:10.1021/acs.estlett.6b00260.
- Schaider LA, Balan SA, Blum A, et al. Fluorinated compounds in U.S. fast food packaging. Environ Sci Technol Lett. 2017;4(3):105-11. doi:10.1021/acs.estlett.6b00435.
- Worley RR, Moore SM, Tierney BC, et al. Per- and polyfluoroalkyl substances in human serum and urine samples from a residentially exposed community. Environ Int. 2017;106:135-43. doi:10.1016/j.envint.2017.06.007.