WHAT IS PFAS or "FOREVER CHEMICALS"?

Written by: Lennard M. Goetze, Ed.D / Leslie Valle-Montoya, MD / Carol Kelujian, PhD

Introduction

Per- and polyfluoroalkyl substances (PFAS)—better known as the “forever chemicals”—represent one of the most pervasive environmental health challenges of our time. Their extraordinary stability and resistance to degradation have allowed them to accumulate in water, food, consumer goods, and even human tissue. Beyond their persistence, mounting research reveals profound implications for human health. Dr. Angela Mazza, whose clinical work has long focused on endocrine balance and the cascading impact of hormonal disruption, underscores the concern that PFAS are not simply industrial byproducts but endocrine-active agents capable of altering essential physiological systems.

 

Studies now link PFAS exposure with female reproductive dysfunction, including later onset of menarche, irregular or prolonged menstrual cycles, earlier age of menopause, and disrupted levels of sex hormones (1,2). These disruptions extend further to thyroid dysfunction, metabolic disorders, adrenal disturbances, and compromised immune responses, painting PFAS as silent yet powerful disruptors of multiple regulatory networks. Such findings emphasize the urgency of addressing PFAS not only as chemical pollutants but as contributors to the growing burden of chronic hormonal and systemic disorders across populations.

 

Widespread Use

PFAS have been applied in a wide variety of industries since the 1940s. They are commonly found in nonstick cookware, waterproof clothing, stain-resistant carpets, greaseproof food packaging, cosmetics, and firefighting foams (3). Because of their versatility, PFAS have spread into nearly every corner of modern consumer life. Industrial sites, airports, and military bases where firefighting foams were used heavily are now recognized as hotspots of environmental contamination (4).

Pathways of Exposure

Human exposure to PFAS occurs through several everyday routes:

1. Drinking water – Contamination from industrial runoff, firefighting foam, and wastewater treatment discharges is a leading source (4).

2. Food – PFAS accumulate in the tissues of fish, livestock, and crops grown in contaminated soil or irrigated with polluted water. Packaging materials treated with PFAS also contribute (3).

3.  Consumer products – Items like nonstick pans, dental floss, waterproof sprays, and cosmetics can be direct exposure sources (2).

4. Occupational settings – Firefighters, chemical plant workers, and textile manufacturers are at elevated risk due to frequent contact with PFAS-laden products (5).

    

PFAS and Metabolic Disorders: An Endocrinology Perspective

From the standpoint of endocrinology, one of the most concerning dimensions of PFAS exposure lies in its association with metabolic disorders. Research increasingly links these chemicals to conditions such as obesity, insulin resistance, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD) (6,7). These disorders, once thought to be driven largely by lifestyle factors, now appear to be influenced by environmental exposures that interfere with hormonal and metabolic pathways.

 

Endocrinologists are uniquely positioned to identify and monitor these effects. In clinical practice, blood tests are used to screen for per- and polyfluoroalkyl substances in individuals suspected of exposure or presenting with unexplained metabolic dysfunction. The gold standard method—liquid chromatography-tandem mass spectrometry (LC-MS/MS)—enables highly sensitive detection of PFAS in serum, providing valuable data that can guide both diagnosis and ongoing management (8).

 

Dr. Mazza, who has treated hundreds of patients with complex endocrine and metabolic imbalances, emphasizes the growing trend she sees in her practice:

“More and more patients are coming to me with unusual and difficult-to-explain metabolic abnormalities. When you begin to look closer, many of these cases align with what we now understand about PFAS exposure—obesity that doesn’t respond to standard interventions, unexplained fatty liver disease, and blood sugar regulation issues in otherwise low-risk individuals. It reinforces the need to view these ‘forever chemicals’ not only as environmental pollutants but as active drivers of endocrine dysfunction.”

This growing recognition from the endocrinology community underscores the need for routine PFAS testing in high-risk populations, particularly those presenting with atypical metabolic disorders. By pairing advanced detection methods with clinical vigilance, endocrinologists are playing a critical role in uncovering the hidden influence of PFAS on human health.

 

Why They Are “Forever”

The term “forever chemicals” highlights both their near indestructibility and their persistence within human bodies. Once absorbed, PFAS can accumulate in blood, liver, and other tissues, with half-lives in humans measured in years. Their presence has now been detected globally—in rainwater, soil, wildlife, and even in human breast milk (2,9). This enduring persistence underscores why PFAS represent not just an environmental issue, but a generational public health concern.

 

Conclusion

PFAS illustrate the paradox of human innovation: chemicals designed for convenience and industrial benefit have become global contaminants with long-term health risks. Their presence in water, food, consumer goods, and workplaces reflects both the complexity of modern life and the need for stricter regulation, safer alternatives, and proactive health monitoring. The endocrinology community’s growing recognition of PFAS’s metabolic, reproductive, and hormonal impacts marks an important step in shifting public health policy toward protecting future generations.

 

References

1.     Sunderland, E. M., Hu, X. C., Dassuncao, C., Tokranov, A. K., Wagner, C. C., & Allen, J. G. (2019). A review of the pathways of human exposure to PFAS and present understanding of health effects. Journal of Exposure Science & Environmental Epidemiology, 29(2), 131–147.

2.     Yale Sustainability. (2023). Yale experts explain PFAS: forever chemicals. Retrieved from https://sustainability.yale.edu/explainers/yale-experts-explain-pfas-forever-chemicals

3.     U.S. FDA. (2023). Per- and polyfluoroalkyl substances (PFAS) in food. Retrieved from https://www.fda.gov/food/environmental-contaminants-food/and-polyfluoroalkyl-substances-pfas

4.     World Health Organization. (2023). PFAS in drinking water. Retrieved from https://www.who.int/teams/environment-climate-change-and-health/water-sanitation-and-health/chemical-hazards-in-drinking-water/per-and-polyfluoroalkyl-substances

5.     EPA. (2024). Our current understanding of the human health and environmental risks of PFAS. Retrieved from https://www.epa.gov/pfas

6.     Liu, G., Dhana, K., Furtado, J. D., Rood, J., Zong, G., Liang, L., ... & Hu, F. B. (2018). Perfluoroalkyl substances and risk of type 2 diabetes: A prospective cohort study. Diabetologia, 61(5), 1319–1330.

7.     Verywell Health. (2023). PFAS exposure and fatty liver disease. Retrieved from https://www.verywellhealth.com/pfas-exposure-fatty-liver-disease-5270707

8.     U.S. CDC. (2022). National Report on Human Exposure to Environmental Chemicals: Laboratory methods for PFAS testing. Retrieved from https://www.cdc.gov/exposurereport/pfas

9.     The Guardian. (2025). Forever chemicals exposure linked to gene activity changes in firefighters. Retrieved from https://www.theguardian.com/environment/2025/aug/15/forever-chemicals-pfas-exposure-gene-activity

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PART 2 — Seeing the Unseen: Ultrasound Evidence of PFAS in the Body

By Robert L. Bard, MD, Radiologist

INTRODUCTION

We have irrefutable laboratory proof that PFAS circulate in human blood; the question I answer in clinic is where—and how—they leave their mark. My approach pairs serum PFAS quantification (LC-MS/MS) with high-resolution, Doppler, elastography, and contrast-enhanced ultrasound to visualize the organ-level footprint of exposure. Ultrasound does not “see” a PFAS molecule; it reveals the structural and microvascular consequences PFAS are linked to—evidence patients and clinicians can track over time.

SUBDERMAL & DERMAL MAPPING (18–24 MHZ)

In exposed patients, high-frequency probes often demonstrate punctate hyperechoic micro-reflectors (“white specks”) within the superficial fat and along fascial planes, typically non-shadowing and clustered around small vessels. Power Doppler may show peri-lesional hyperemia, consistent with low-grade inflammatory response. I document these as a count per field and map their distribution for follow-up.

LIVER: STEATOSIS AND STIFFNESS—QUANTIFIED

Given PFAS associations with NAFLD and metabolic disruption, the liver is a prime target for imaging. I quantify:

· Attenuation coefficient (dB/cm/MHz) as a surrogate for fat burden (higher values indicate steatosis).

· Shear-wave elastography (kPa or m/s) to assess stiffness (fibrosis/inflammation).

· Hepatic Doppler indices (portal vein velocity; hepatic artery resistive index) to capture perfusion shifts.

In patients with elevated serum PFAS, I frequently record attenuation elevations consistent with fatty change and mild stiffness increments; when combined with labs and clinical risk, these provide a numerical baseline for intervention monitoring.

THYROID & ENDOCRINE TARGETS

PFAS-linked endocrine effects often coincide with heterogeneous, hypoechoic thyroid parenchyma, micro-nodularity, and increased vascularity on color Doppler. I grade vascularity (VI%) and shear-wave values of the gland to objectify change—particularly helpful when patients report menstrual irregularities, metabolic symptoms, or autoimmune markers.

LYMPHATIC/IMMUNE READOUTS

Cervical/axillary nodes may display cortical thickening with preserved hila and subtle stiffness changes on elastography—an imaging pattern compatible with reactive immune activity. I record cortex thickness (mm) and strain/shear metrics to trend immune engagement alongside PFAS titers.

MICROVASCULAR & PERFUSION (CEUS/DOPPLER)

When indicated, contrast-enhanced ultrasound (CEUS) adds perfusion kinetics—time-to-peak, wash-in rate, area-under-curve—to flag microvascular dysfunction in liver or soft tissue beds. These quantitative curves frequently normalize as exposure is mitigated and metabolic control improves.

A PRACTICAL WORKFLOW

1.     Confirm exposure: serum PFAS panel via LC-MS/MS.

2.     Baseline multi-organ ultrasound: high-frequency skin/subcutis, thyroid, liver, targeted lymphatics.

3.     Quant sheet: attenuation, stiffness, Doppler/VI%, hyperechoic-foci count, CEUS kinetics.

4.     Re-scan at 3–6 months after exposure reduction or therapy to demonstrate directional change.

WHY THIS MATTERS

Patients deserve more than a lab number. Ultrasound supplies visual proof and actionable metrics of PFAS’ biological imprint—making risk tangible, guiding treatment, and validating recovery. In my practice, this imaging-plus-lab strategy turns an invisible toxicant into a trackable clinical target.

 

References

1.     Sunderland, E. M., et al. (2019). A review of the pathways of human exposure to PFASs and present understanding of health effects. Journal of Exposure Science & Environmental Epidemiology, 29(2), 131–147.

2.     Liu, G., et al. (2018). Perfluoroalkyl substances and risk of type 2 diabetes: A prospective cohort study. Diabetologia, 61(5), 1319–1330.

3.     Hu, X. C., et al. (2016). Detection of poly- and perfluoroalkyl substances (PFASs) in U.S. drinking water linked to industrial sites, military fire training areas, and wastewater treatment plants. Environmental Science & Technology Letters, 3(10), 344–350.

 

EXCERPT FROM THE SOURCE

Every image tells a story—but it takes a master interpreter to translate it into action. The Eye Within is more than a chronicle of Dr. Robert Bard’s work; it is a study in the art of diagnostic interpretation. In an era where technology captures more data than ever, Dr. Bard demonstrates that true clinical value comes from the trained eye and the disciplined mind that sees beyond the image. His expertise in ultrasound interpretation transforms scans into predictive tools, guiding treatment and saving lives.

This book is a testament to technical mastery, clinical leadership, and the irreplaceable human capacity to discern meaning from patterns that machines alone cannot explain. The Eye Within reminds us that interpretation is not just a skill—it is the cornerstone of precision medicine.