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A new review has found that exposure to particular chemicals can, when combined, enhance damage to the liver.
The researchers of the July 2025 review, published in Toxicological Sciences, found that both alcohol and PFAS chemicals—a group of widely-used compounds—damage the liver in similar ways.
This could be "causing fat buildup, inflammation, and oxidative stress," Vasilis Vasiliou, one of the authors of the review, and chair and professor of environmental health sciences at Yale School of Public Health, told Newsweek.
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While alcohol is a well-established cause of liver disease, PFAS chemicals may "act as a 'second hit,' especially in people who already drink alcohol or have other liver risk factors," he added.
PFAS chemicals, also known as "forever chemicals" or Per- and polyfluoroalkyl substances, have been classified by the International Agency for Research on Cancer as a Group 1 carcinogen—with studies since finding the chemicals can cause a wide range of effects on public health.
These chemicals can be found across various industries and consumer products, from nonstick cookware, waterproof clothing and stain-resistant furniture, to food packaging and even smartwatch wristbands. They can also be found in drinking water sources across the country.
According to the review's researchers, detectable levels of PFAS chemicals have been found in over 98 percent of the human population.
Meanwhile, more than half of all Americans drink alcohol—with 17 percent binge drinking, meaning, for women, they have four or more drinks on one occasion, while for men, they have five or more drinks, according to Centers for Disease Control and Prevention (CDC) data.
Per the CDC's data, 6 percent also drink heavily, meaning, for women, they have eight or more drinks in a week and for men, they have 15 or more drinks.
According to the review's researchers, while global consumption of alcohol has been decreasing since 2010, in the U.S. there has been an increase in consumption, meaning it is now nearly double the global average.
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What The Review Found
When people are exposed to both alcohol and PFAS chemicals, these "effects can add up or even multiply, leading to more serious liver injury," Vasiliou said. He added that vulnerable populations, or those with limited health care access, are particularly at risk.
"Our review suggests that PFAS exposure may worsen the damage already caused by alcohol, raising the risk of progression from fatty liver to more severe conditions like cirrhosis or liver cancer," he said.
The review noted that around two million deaths a year are estimated to occur due to advanced liver disease, predominantly cirrhosis and hepatocellular carcinoma, with alcohol consumption being a significant risk factor for these conditions. Alcohol contributed to nearly half of all cirrhosis deaths and over 150,000 new cases of liver cancer globally in 2016.
"The findings are not unexpected," Dr. Suthat Liangpunsakul, a professor of medicine and of biochemistry and molecular biology at the Indiana University School of Medicine, told Newsweek.
"Both alcohol and PFAS have independently been shown to affect the liver through mechanisms such as oxidative stress, lipid dysregulation, and mitochondrial dysfunction," Liangpunsakul said.
"Given these overlapping pathways, the possibility that combined exposures may exacerbate liver injury is a reasonable hypothesis," he added.
Dr. Alan Ducatman, a professor in occupational and environmental health sciences at the West Virginia University School of Public Health, told Newsweek that he also believed the review's findings were "not surprising."
"It is another example of many, for PFAS and other exposures, that sensitive populations—those with additional risk factors—are more at risk. This is not unique to PFAS," he said.
As an example, he added that those with higher body mass indexes or larger waist circumferences were also more at risk.
"The risk is not limited to the sensitive populations, however—it is also apparent in those without the risk factor," Ducatman said.
Liangpunsakul said the study therefore "brings together existing evidence in a way that highlights the need for further investigation."
It adds to the "body of literature suggesting that multiple exposures, including lifestyle and environmental factors, can interact in complex ways to affect liver health," he said.
However, "further research, particularly in human populations, will be important to better characterize these interactions and their potential clinical implications," he added.
Vasiliou said that he and the other researchers in the laboratory are continuing to investigate the impact of PFAS chemicals on the liver in animal models and intend to expand research to human studies.
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How PFAS Chemicals And Alcohol Could Harm The Liver
PFAS chemicals may harm the liver by "disturbing fat metabolism, damaging mitochondria, increasing oxidative stress, and triggering inflammation," Vasiliou said, adding these were many of the same processes affected by alcohol.
Liangpunsakul also said that PFAS chemicals "can accumulate in the liver" and cause the same problems mentioned by Vasiliou.
PFAS chemicals can cause higher total cholesterol and LDL-cholesterol, Ducatman said. They can cause higher liver enzymes such as alanine aminotransferase and probably cause higher uric acid, he added.
Therefore, "it appears increasingly likely that underlying these outcomes are metabolic processes that lead to steatosis, or increased fat in the liver," he said, adding that PFAS chemicals may also "increase insulin resistance and the risk for a triad that is called 'metabolic syndrome.'"
Meanwhile, "alcohol has long-established and well-characterized hepatotoxic effects, particularly in the setting of chronic use," Liangpunsakul said.
Therefore, the "real danger lies in their combined impact," Vasiliou said. "Together, they can accelerate liver damage in ways that neither might do alone."
The harm from PFAS chemicals also "occurs at really small dosages," Ducatman said, adding that for alcohol, harm occurs at much higher levels of exposure.
While alcohol is "voluntary, except for all the complex social interactions and the addiction," he said, exposure to "PFAS is involuntary, for the most part."
"For most of us, alcohol is a choice, we usually know when we are ingesting it, and easier to avoid," he said.
Liangpunsakul added that it is difficult to compare the "relative toxicity" of alcohol and PFAS, "as they operate under different exposure contexts and time courses."
However, based on the review, he said that "PFAS may contribute additional stress to the liver, particularly in individuals with other risk factors such as alcohol use."
While PFAS chemicals are in a wide range of everyday products, the most common way people are exposed to PFAS chemicals is through ingestion, Vasiliou said.
"PFAS often enter our bodies through contaminated drinking water; food, especially fish [and] meat; fast-food packaging; and household products like nonstick cookware or stain-resistant fabrics," he said.
Once ingested, PFAS chemicals can "circulate in the blood and accumulate in the liver, where they can persist for years due to their resistance to breakdown," he added.
Those who are also occupationally exposed to the chemicals due to their work, such as firefighters or factory workers, may also "inhale PFAS or absorb them through the skin," he said.
How Could The Research Shape The Treatment of Liver Disease?
Liangpunsakul said the review highlights a growing area of scientific interest—"how environmental exposures might interact with more traditional risk factors like alcohol."
He said that while "it is too early to say how this will influence clinical practice," the findings "may help guide future research into liver disease progression and its multifactorial drivers."
"Improved understanding of co-exposures could eventually contribute to more refined risk assessment strategies," he added.
Ducatman said that when considering liver disease, it is "important to treat the cause," through means such as minimizing exposure to the problem.
It is also vital to "hasten excretion" via a healthy diet, and for those with very high exposures, it may be worth considering whether a medication that "can hasten excretion should be discussed with the patient."
He added that it was worth recognizing "we will never have a designed clinical trial of a large population that proves that hastening excretion with medications actually results in a net health gain."
The research also suggests that increasing awareness on individual PFAS exposure may become an important part of maintaining health.
"For people with liver risk factors, such as alcohol abuse use or obesity, minimizing PFAS exposure could be especially important," Vasiliou said.
However, "avoiding PFAS completely is difficult because they are so widespread, but people can take steps to reduce exposure," he added.
He said individuals can use PFAS-free cookware and personal care products, filter drinking water with systems certified to remove PFAS, and check local advisories about contaminated water or fish.
On a broader level, Vasiliou said that "stronger policies and better regulation are needed to reduce PFAS in our environment."
Reference
Arthur D Stem, Ricardo Scheufen Tieghi, Vaia Lida Chatzi, Nicole Kleinstreuer, Damaskini Valvi, David C Thompson, Vasilis Vasiliou, (2025). Synergistic Toxicity in Alcohol-Associated Liver Disease and PFAS Exposure, Toxicological Sciences, https://academic.oup.com/toxsci/advance-article-abstract/doi/10.1093/toxsci/kfaf110/8219475?redirectedFrom=fulltext&login=false
Update 8/6/25, 3:46 a.m. ET: This article has been updated with comment from Dr. Alan Ducatman.
Update 8/8/25, 4:16 a.m. ET: This article has been updated with additional comment from Dr. Alan Ducatman.
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