Why do some people who drink alcohol develop severe liver problems while others don’t?
A new study from the University of Louisville points to a surprising factor: “forever chemicals.” These man-made substances, formally known as per- and polyfluoroalkyl substances, or PFAS, are widely used in products like nonstick pans, fast-food wrappers and stain-resistant fabrics, and they don’t easily break down in the body or environment.
Nearly 95% of Americans have PFAS in their blood, according to national data, making exposure nearly unavoidable. At the same time, alcohol remains one of the leading causes of preventable death in the U.S., responsible for an estimated 95,000 deaths annually. While it’s well known that alcohol and PFAS can each damage the liver on their own, little has been understood about their combined effects.
“This work helps explain why two people with similar alcohol consumption may experience very different liver outcomes,” said Frederick Ekuban, Ph.D., first author and assistant professor of medicine at the University of Louisville. “Environmental exposures like PFOS may be the missing link.”
Using animal models, researchers simulated real-world exposures to both alcohol and one common PFAS, perfluorooctane sulfonate (PFOS). The combination caused significantly more fat accumulation, liver injury and disruption of protective repair systems compared with alcohol alone.
“While the liver typically has a remarkable capacity to recover from alcohol-induced stress, PFOS appears to push that resilience beyond its limits,” said Jennifer Schlezinger, Ph.D., co-author and professor of environmental health at Boston University.
The study also revealed that about 60% of PFOS exposure concentrated in the liver, the same organ most affected by alcohol. These findings highlight how environmental exposures may amplify the harm of lifestyle factors like drinking.
While more research is needed, the team offered simple steps to reduce PFAS exposure:
Opt for stainless steel or cast-iron cookware instead of nonstick
Use water filters, especially near industrial areas
Skip stain-resistant treatments for carpets and furniture
Limit packaged fast foods and microwave popcorn
Look for PFAS-free labels on household products
The study, published in Toxicological Sciences, was funded by the National Institutes of Health (including the National Institute of Environmental Health Sciences, National Institute of General Medical Sciences and National Institute on Alcohol Abuse and Alcoholism), the Federal Emergency Management Agency and the U.S. Department of Defense.