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Comment by capkutay | Hacker News Reader

Sounds like she was using a neti-pot. I thought most of the neti-pot products made it pretty clear that you're supposed to use previously boiled or distilled bottled water. Maybe they need to make it more clear that the consequences of using tap water can be pretty dangerous.

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In the case of Neil-Med, the documentation I have retained says to use previously boiled or properly filtered water (they provide some examples) when mixing. And they say not to use tap water. But they don't inform the user of the potential hazard of using otherwise safe-to-consume tap water.

Worse, the bottle (mine is a squeeze bottle) doesn't have any reminder not to use tap water, at all. It would seem this would be worth a large placard on the back of the bottle. The likelihood is low but the danger high; this is the worst kind of risk because it doesn't happen often enough to serve as a reminder.

Doesn't this company direct you to use their salt packets as well?

Does the salt kill amoebas?

Using a normal saline solution of 0.9% NaCl is much more comfortable, doesn't sting the sinus membranes at all. I wouldn't count on it to kill anything

If the amoebas thrive inside the body, they certainly won't be harmed by a saline solution.

> But they don't inform the user of the potential hazard of using otherwise safe-to-consume tap water.

Devil's advocate: if they did, odds are consumers would consider it as if the company is peddling conspiracy theories rather than actual science. Or "maybe it's true for tap water where the pots are made, but I trust my tap water and I know it's safe". If such explanations are more likely to harm a company's perception than to protect consumers, then what value do they have?

The good that that does is saving lives, even if it harms the companies reputation. It sounds like you're suggesting that a companies reputation is worth more than the potential death of unknowing, innocent people.

Of course the company has a moral obligation to protect their consumers, which is why the company warns against using tap water in the first place. The question isn't whether or not it's worth it for the company to try and save lives, it's whether an additional explanation will actually save more lives. The fact that there's a real potential image hit to the company makes the case that much more difficult to make to decision makers.

This person may have had a poor immune system. I mean, people do put plenty of unsterilized compounds up their noses regularly, without drying from brain-eating amoebas... Though I suppose brain-eating amoebas don't typically thrive in powdered chemicals, making the users more safe from this one potential risk.

They do, but I am never sure how that is supposed to be practical. You need to use warm water, which is easy with tap water, but hard to do quickly with distilled or boiled water.

I know it has risks, but I still use normal tap water. From what I have read, all of the cases are from people using well water, never from city provided, chlorinated water. It actually says this in the article, too.

Whenever I use a neti pot, I use distilled water and heat it for a brief time in the microwave, adding additional room temp distilled afterward if it comes out too hot.

Exactly this. Putting it in the bottle and microwaving for 38 seconds (experimentally determined, your <microwave> may vary) makes it a nice, comfortable temperature for use.

In practice you don't need to use warm water. I do twice daily saline sinus washes with distilled water and it's pretty low maintenance. Tap would be easier but I've always found the idea of using tap water for this to be gross so it's never been an attractive idea.

Oh man, if the water is room temperature it really hurts my nose.

Do you use the saline packets? That makes it much easier on your nose. I only have to use mine a few times a year but I have a bottle of distilled water that I just use at room temperature and its fine.

Yes, I use the saline packets. It REALLY hurts without those. But even with them, it hurts at room temperature.

It's actually quite practical: boil water then stick a thermometer in it. Go do other stuff and check the temp; as it comes down and matches your body temp, it's perfect.

Can you explain why you use a neti-pot? I don't know anyone who uses one and I don't really understand the reasons behind it.

My wife uses one to clear out her sinuses when they are stuffed due to a cold. Sinus infections cause her pain. Her doctor recommended it. She uses a squeezable bottle.

I made sure she only uses distilled water. She dissolves a saline powder in it.

It relieves the symptoms of sinusitis. Painful pressure can build in your sinuses, and rinsing can help open passages and equalize the pressure as well as soothe the pain a bit.

I also like to think I'm removing bad stuff and helping with the healing process, and maybe killing bad stuff by flushing it with salt water, but this is my own personal myth.

I use a version* of a net-pot to flush out my sinuses after surfing. If I don't, especially if I surf in a red tide, I get a nasty sinus infection (surfers sinusitis or acute sinusitis). I even had sinus surgery to reduce my turbinates and increase my sinus ducts which helps, but still doesn't prevent the problem.

* I use NeilMed's sinus flush which basically is a sealed bottle with a straw I can use to force flush my sinuses, vs. just using gravity.

I had to use one after a sinus surgery (to remove a not-so-tiny bone spur and then put things back where they belong) to flush out dried blood and whatnot.

I've used it a few times after when I have a severe head cold to open things up a bit. Easier and less invasive than going through the background check needed to buy cold medicine.

Reduces incidents of mild sleep apnea in conjunction with nasal strips and sleeping on my side. (I determine occurrence of sleep apnea by checking if waking happens between or during sleep cycles.)

Also helps with voice work (I am a voice coach), makes for clearer mask resonance.

(An in-hospital sleep study confirmed my self-diagnosis of mild sleep apnea.)

What do you mean by mild? I did a study and had an AHI of 28, my doctors put me on CPAP. I'm not overweight and the machine is set to give hardly any pressure but it still seems to eliminate the issue, at least according to the machine's own counts. If I could fix it with just some nose strips and a neti pot, that would be amazing.

"Mild" used by doc prescribing me Modafinil after study. There were insurance cost concerns as well so I pursued other options.

I have to work at keeping my mouth closed, and some nights don't work out well, but most do. I also use alternating combinations of sedatives, and take them in stages (e.g. sometimes a partial pill embedded in a softgel taken after 3 hours of sleep). I'm overweight, and it did start for me after I gained weight

It REALLY clears out your sinuses if you have a lot of mucus (from allergies or a cold). You know how when you blow your nose, you never get everything out? Some of the mucus comes out, but some is driven up into your sinuses because the air is coming from the middle (imagine a tube full of water,and you blow into a hole in the middle... half the water will be blown in each direction)

Neti pot will get all of the mucus out (especially when i do it first thing in the morning, before blowing my nose). It comes back, of course, but having a few minutes of mucus free breathing when you have a bad cold or allergies is amazing.

For me it basically cured a several-years long bout of hay-fever symptoms (constant congestion, could never get it all the mucus out) over a period of just a couple weeks of usage. I use it now just a few times of year whenever I get a cold that causes congestion, because its such a relief to get that crap out of your nasal and sinus passages.

Sinus pain can be excruciating. In my mid-20s, pretty much any cold or flu I got started being followed by a sinus infection. Most of them are relatively mild, but a couple of them have been truly debilitating. Pseudoephedrine brings some relief, but has side effects. Neti pot brings additional relief, and is free of side effects. (And is much cheaper than PSE.)

You shouldn't be using water from the hot tap even just for drinking or cooking, let alone putting in a neti pot. Water from a hot water tank can contain high levels of dissolved contaminants since it sits in your plumbing system for extended periods at high temperatures.

No cooking? Even, say, boiling potatoes? I always use filtered water if I'm planning to consume it, but I thought I could get away with the sink if I was throwing it out.

That's news to me, I'll have to boil cold water from now on.

I wouldn't worry as much about boiled potatoes as I would something like soaking/cooking grains. It's a matter of your level of concern. I rinse dry goods and and vegetables with tap water, and steam with tap water, but I use expensive water for anything else. Mostly because I don't discard the water. Either the food absorbs all the water, or I accept a mushy, stewy, or soupy consistency.

Steaming is better if you're going to use tap water and discard it. With the food out of the water there's less contamination as well as less nutrient loss.

Filters are not perfect. Reverse osmosis or distillation is better (in theory). Anyone using a filter should pay attention to what it filters. Some filters don't even claim to filter lead. I think Brita and Pur still have multiple filter types that filter different things, and one type isn't a strict subset of the other.

After some googling, I concluded that filters in good-tap-water neighborhoods do more harm than good -- they filter out nutrients that we do need from water.

What nutrients does tap water have in it? Fluoride?

Various minerals and electrolytes such as calcium, magnesium, potassium. I don’t count fluoride as a nutrient.

All kinds of minerals and such. In fact totally clean water, without them, is harmful and poisonous:

"Drinking absolutely pure water can kill you. All the water we normally drink – from taps, from bottles, from the garden hose – contains impurities which affect a property of water called tonicity. This is the ability of a solution to draw or repel water from ajacent solutions when separated by a membrane. Solutions that are hypertonic gain water, while hypotonic solutions lose water. Drinking water, which we usually think of as pure, really contains a whole mess of salts and sugars which make it slightly hypertonic. They also give water its taste. The cytoplasm in the cells of your body also have a tonicity. So, when they are exposed to hypertonic solutions, the cells themselves lose water and shrivel up. When they are in hypotonic solutions, they gain water, swelling up and bursting like a balloon. Absolutely pure water -with no impurities at all – is the most hypotonic solution. So, if you drink enough of it, your cells will start absorbing water. This disturbs the balance of electrolytes (electrically conductive ions) in your body. This is most seriously a problem in the brain, where water poisoning can lead to brain damage, coma and even death."

> I rinse dry goods and and vegetables with tap water, and steam with tap water, but I use expensive water for anything else. Mostly because I don't discard the water. Either the food absorbs all the water, or I accept a mushy, stewy, or soupy consistency.

I use roughly the same rule of thumb, but I've never been confident about applying it to beans. I often rinse and soak dry beans in bulk. I portion them out and freeze them after cooking, and don't really want to be freezing bean mush. They do absorb a lot of water, but between the rinsing/soaking/cooking process, it's also a lot of expensive water to be pouring out.

The lady in the article got the infection after using a water filter.

This leaves 2 possibilities that I can see.

1. The filter didn't do it's job. I thought that a good filter would filter all organisms (or like 99.9%). I'm told by people that you can drink out of a swamp or mud puddle with a good filter.

2. The filter does work, but she didn't maintain her filter. Maybe the dirty filter actually was a nice place to cultivate the amoebas? I would be curious if an unchanged filter can actually increase your chance of infection. At best though, the dirty filter wasn't able to filter this organism.

>I'm told by people that you can drink out of a swamp or mud puddle with a good filter.

"Good filter" is a relative term. Maybe you could do it if you "filtered" the water with a $10M reverse osmosis membrane? The filters I buy all say "do not use with unsafe water" or some similar phrase.

Filters for camping/outdoor usage are less than $100 and most of them are explicitly sold as suitable for use with dirty water. You get a disclaimer that they'll be slower and need to be replaced more often when used on dirty/cloudy water, and sometimes they also advise a chemical or UV treatment be used post-filtering if there are concerns about viruses. Eg. https://www.katadyn.com/us/us/428-8019160-katadyn-gravity-ca...

There’s a big difference between those and, say, a Britta filter.

Huh? If tap water is contaminated (by, say, metals or salts from plumbing system pipes), then boiling won't decontaminate it either.

The hot water in your water tank may contain an excess of salt deposits, leeched metals, and rusts that you don't want to consume.

Cold water has less solubility of most substances than hot water and it spends less time sitting in a hot container of those substances.

Therefore, use the cold water to make hot water on your stove and regularly clean the kettle: https://www.reddit.com/r/ThingsCutInHalfPorn/comments/7uu0jz...

> The hot water in your water tank may contain an excess of salt deposits

This is clearly impossible due to conservation of mass, unless you're claiming that the water heater is so hot that it causes nuclear reactions in the water.

Convervation of mass? What do that has to do with it.

Hot water tanks accumilate mineral sediment which might tear of as particles and follow the stream.

? I'm not quite a physicist, but I'm pretty sure this is wrong. The closed system under consideration here consists of both the solute (from the parts of the plumbing system the water has passed through) and the water. If hotter water dissolves more solute, then less solute remains in those parts. What part of this violates conservation of mass?

I would have had your perspective except that a few months ago I came back from vacation to find that my hot water smelled like windex. The apartment complex flushed my hot water tank, a whole lot of black sludge came out, and my water has been fine since. I assume that not using the hot water for a few weeks caused everything to collect in a concentration high enough to notice, but it makes me cringe to think of how much low level of windex-smelling stuff I drank previously. (Fortunately my hot water takes a minute or two to arrive, so I probably didn’t consume that much just because I didn’t want to wait long enough.)

This is what is in your hot water tank right now.

https://www.youtube.com/watch?v=kAzKts6Wp1Q&t=55s

If your water heater is malfunctioning and not heating up all the way to 140 degrees but it's still heating up to e.g. 100 degrees then it's a breeding ground for listeria. The temperature difference changes the solubility of minerals and salts dissolved in it as well as changing how quickly everything even slightly volatile leaches into the water.

Paradoxically if that is in the tank it means the water coming out must be purer than cold since the contaminats are left in the tank - on average.

In terms of dissolved minerals sure, but there's two important distinctions to make. The tank isn't just accumulating deposits, there's an anode rod inside that's designed as a sacrificial element to protect the tank itself from corrosion. That anode rod gets consumed over the course of a decade so while it's not much, it is being introduced into the water. Also those deposits provide a porous substrate for bacteria to grow on and the heat will help things along.

>> This is what is in your hot water tank right now

Does anyone think the inside of a ~20 year-old cold water feed pipe is going to look shiny and "clean"?

Go take an electron micrograph of the bacteria on your skin, or use a microscope to look closely at the living things inside your bed, in your sofa, or on your pet.

Then take a deep breath, check the causes of death tables if you really have to, and remember that - given we're all intelligent humans - none of these "eww, gross!" things really matter in the overall scheme of things.

Yeah the cold water side will look dramatically better. It certainly will have deposits accumulating but it's not going to be anything close to the amount of deposits that form inside of a water heater. Heating up hard water will chemically alter the water going through it. It's not that those calcium carbonate molecules were in solution before, it's pretty insoluble in water, it's that they were chemically formed when the water was heated.

I'm not suggesting that those deposits are going to kill you or anything, but if things go wrong and the water isn't heated enough those deposits make a great substrate for harmful bacteria to grow.

Ideally you shouldn't use hot water for consumption even though normally it's safe. It also tastes different than cold water because of the change.

Isn't that pretty dependent on where you live? If you are in a newer house I doubt it would be an issue, since you have a personal water heater that gets cycled through pretty regularly.

If the water heater uses copper pipes, the copper still gets into the water. And even with plastic pipes the trace amount of plastic may still end in the water and nobody knows if drinking such water for, say, 40 years is safe.

So do not use hot water for cooking/drinking.

Pex is thermo stable.

You can buy food supplements containing copper explicitly, so I wonder how bad that could be.

Copper containers are actually great at killing bacteria.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312355/

But high levels can cause health problems, including kidney damage and possibly cancer.

https://www.canada.ca/en/health-canada/programs/consultation...

Between dying of dysentery and risking long term health issues it's a simple choice.

But unless your doctor specifically tells you to add more copper, you shouldn't be going out of your way to get it.

Yup. In houses that are not connected to the central heating, hot water travels through many more systems in your house than the cold water. Some of those systems can be pretty nasty e.g. when I disassembled my circulation pump, the water-immersed rotor assembly was leaking black goo.

Naegleria Fowleri were found in public water systems in Louisiana last year. I don't know of anyone dying because of it though.

https://www.ajc.com/news/national/brain-eating-amoeba-found-...

>They do, but I am never sure how that is supposed to be practical. You need to use warm water, which is easy with tap water,

Uh, 30-45 seconds in the microwave in a microwave-safe container.

I have a motorized unit, distilled water goes into a glass in the microwave for 45 seconds. Salt packet goes into the reservoir and a maybe 5 ounces of room temp distilled then the microwaved water.

Since these types of incidents are so rare I would not suddenly be afraid of using such a device.

I also wonder if she applied salt to the water (you should use saline) which also may help keep this stuff away if the concentration is right. But I don't know about that.

If you don’t use saline solution, it becomes very uncomfortable. Even accidentally using the wrong concentration is immediately noticeable.

I’d highly doubt many people would do that regularly.

what's the difference from washing your face? Doesn't some water go inside the nose /sinuses when you blow it, breathe as you wash? (I guess even 1mm3 would contain plenty of microbes.)

When I used neti pot long long ago, our instructor made it explicit that you should only use boiled and cooled lukewarm water mixed with salt, if you cannot find a readily available saline solution. She even gave the salt:water ratio which I've forgotten. The general consensus in the yoga community is to better be safe than sorry.

> The general consensus in the yoga community is to better be safe than sorry

The safe thing would be to avoid netting pots, which have no known benefit and several known risks.

Pain relief is a pretty nice benefit.

How is a neti pot worse than steam in the shower? I’m surprised at this.

By definition, steam has been heated to a high temperature and exists as stray molecules before condensing back to water droplets. I guess microbes can't easily survive or be carried along in this process.

That said, it seems it's possible that this kind of thing can happen [1], but it's rare (and though that article is confusingly written, it seems that the bacteria in that case came from the air, after the steam had re-formed as water droplets).

Anyway, the OP says this amoeba in a neti-pot scenario is rare too, so it seems we're always talking about fringe cases with this kind of stuff.

[1] http://www.cleveland19.com/story/33829012/doctors-warn-about...

We've got a neti-pot-like thing that comes with a built-in filter. I don't worry about it past that.

Going by this article, it seems like you should.

A filter is not good enough to remove microbes.

RTFM... When is the last time you’ve actually did it?

It’s a problem with user not understanding its own anatomy rather than product itself.

Not to mention, hot water tanks are a prime facility for some of these pests to grow while most people have no idea they should avoid their home hot water for anything other than washing. It should not be consumed in any way... this is why coffee makers specifically tell you to use cold water.

Pretty sure that is because of metals. Living things die when boiling anyway

The temperature of a typical hot water tank is 120-140 degrees Fahrenheit, which is significantly less than the boiling point of water, 212 degrees Fahrenheit. If the water tank temperature is just a little lower, at 115 degrees, it's the prime temperature for these buggers.

Also, this might be a fun read for you: https://en.m.wikipedia.org/wiki/Thermophile

Hot water tanks aren't hot enough to sterilize. In fact, they're a perfect temperature to grow many things.

Lead dissolving in hot water is the primary reason that one should not consume hot tap water. Nor should one wash their hands with hot water after lead exposure. Some gun ranges go so far as to remove the hot water tap from the bathrooms.

How's this for a disclaimer:

"There's almost no potential upside and a massive potential downside."

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