Understanding the Role of Bile Acid Sequestrants in PFAS Elimination

Researchers from the University of Gothenburg have found that bile‑acid sequestrants cholestyramine and colesevelam accelerate elimination of per‑ and polyfluoroalkyl substances (PFAS) in people with high levels from contaminated drinking water. This pharmacokinetic effect suggests a potential exposure‑mitigation strategy, but clinical benefit remains unproven.

Pharmacokinetic changes point to interruption of enterohepatic recirculation, bile sequestration, and altered gastrointestinal binding as the likely mechanisms; fecal elimination rose and serum half‑life estimates fell. The trial used a within‑subject crossover design in a small human cohort with 12‑week treatment and non‑treatment periods. Taken together, the mechanism‑based data make a plausible case for meaningful reductions in systemic PFAS burdens over weeks to months in treated individuals.

The study documented accelerated elimination quantitatively but did not demonstrate clinical benefit; no reductions in cardiometabolic events, immune effects, cancer risk, or developmental outcomes were reported.

Safety and tolerability considerations include common gastrointestinal adverse effects and patient intolerance, potential drug–drug interactions through interference with oral absorption of concomitant medications, and specific cautions for pregnant people, children, and patients with severe hepatic dysfunction.