Patients ask me about toxins more than they used to. Mold, heavy metals, microplastics, and increasingly the forever chemicals called PFAS. The key is avoidance of these, eating fiber and taking regular saunas. Now, we have a new option for PFAS.
What PFAS are
Per and polyfluoroalkyl substances are a family of several thousand synthetic chemicals built around carbon fluorine bonds. They repel water, grease and heat, which is why they are in nonstick cookware, waterproof clothing, stain resistant carpet, fast food packaging, including microwave popcorn bags, some cosmetics, and the foam used to fight fuel fires. The same bond that makes them useful makes them nearly impossible to break down in the environment or in your body.
Once absorbed, PFAS attach to albumin and other proteins in the blood and recirculate. The kidneys reabsorb them rather than clearing them. PFOS, one of the two best studied compounds, has a half life in humans of roughly 3 to 5 years. Surveys by the CDC detect PFAS in the blood of nearly every person tested in the United States.
Why this matters for the heart
The strongest human data comes from the C8 Health Project, which followed about 70,000 people whose drinking water had been contaminated by a chemical plant in West Virginia. The independent science panel that reviewed the data concluded there was a link between PFOA exposure and high cholesterol.
Other studies have added to the picture. In the Study of Women’s Health Across the Nation, women with the highest combined PFAS levels had meaningfully higher rates of new hypertension over the following years. Laboratory and cross sectional work links PFAS to endothelial dysfunction and oxidative stress.
The trial
Firefighters carry unusually high PFAS levels because of firefighting foam, which made them a good population to study. Researchers in Victoria, Australia recruited 285 fire service personnel with PFOS above 5 ng/mL and randomized them into three equal groups of 95.
The first group donated plasma every 6 weeks for 12 months. The second donated whole blood every 12 weeks for 12 months. The third did nothing. PFAS levels were measured at the start, at 12 months, and again 3 months after the donations stopped.
At 12 months, the plasma group’s PFOS had fallen by 30 percent from baseline. The whole blood group’s PFOS had fallen by 10 percent. The control group changed by 0.01 ng/mL, which is to say not at all. The plasma group averaged 6.4 donations over the year and the blood group 4.3. Results for PFHxS, another common compound, followed the same pattern.
The trial was published in JAMA Network Open in April 2022. It remains the only randomized trial demonstrating that any intervention lowers PFAS levels in humans. Though, I suspect plasmapheresis or apheresis would carry similar benefits.
Why plasma works better
Because PFAS travel bound to albumin, removing plasma removes PFAS. A plasma donation takes out roughly twice the plasma volume of a whole blood donation and returns your red blood cells, which is why it can be repeated every few weeks rather than every few months. Whole blood still works, just more slowly.
What the trial does not tell us
The authors were direct about this: they measured chemical levels, not health outcomes. Nobody has shown that lowering PFAS by donation prevents a heart attack or lowers blood pressure. Anyone telling you otherwise is ahead of the evidence, and that includes me if I ever get careless with the framing.
How I use it with patients
There are other benefits. Regular donation lowers ferritin, and iron is a strong oxidant and a contributor to atherosclerosis and inflammation.
If you want to know whether any of this applies to you, we can perform a urine triple toxin test. Knowing your number is the place to start.
Source: Gasiorowski R, Forbes MK, Silver G, et al. Effect of Plasma and Blood Donations on Levels of Perfluoroalkyl and Polyfluoroalkyl Substances in Firefighters in Australia: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(4):e226257.
Andrew Rudin, MD is a cardiologist and board-certified cardiac electrophysiologist who takes a natural, root-cause approach to heart health. He sees telehealth patients nationally and internationally through Natural Heart Doctor, and is licensed in Tennessee. He has been quoted as an expert source by Medscape and Men’s Journal, and was profiled in The Village Voice. More at andrewrudinmd.com.
This article is for general education and is not medical advice. It is not a substitute for care from your own physician, and nothing here should be used to start, stop, or change treatment on your own.
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