Death by Neti Pot | Hacker News Reader

Death by Neti Pot

arstechnica.com

29 pointssertsa43 comments

10 cases in several years, and "in all of the cases, the people had some sort of immune-compromising condition, mostly cancer, but also solid organ transplant and HIV. This likely put them at higher risk for infection and severe outcomes."

So yes, use distilled water... but in terms of risk factor, I don't think it's too high.

I don’t get it. Doesn’t this “dangerous” tap water get in our eyes, mouths, nostrils (at least as steam or spray) every single day when we shower? I’m having a hard time getting too worried about this.

The nose has the olfactory epithelium, and the eyes and mouth do not.

The olfactory epithelium allows external substances deeper into the body tissue than other boundaries in order to enable the sense of smell.

You can inhale (or be exposed by a wound in the skin) a single droplet of water containing Acanthamoeba and get sick and die. That would be a rare occurrence, but it does happen.

You can drink 10,000 liters of water full of it and never get sick, it rides down the slip-and-slide of your throat into your stomach where your stomach acid destroys it. It is likely that half of all people in the United States drank some today.

Several types of bacteria are like this, like staph and legionella, you can eat and drink them but the second they get in your nose or lungs (or blood via a cut or scrape): no bueno.

Unless, like the article suggests, you have an immune-compromising condition you have very little to be afraid of.

Just don't go swimming in warm stagnant water no matter how healthy you are.

Thank you for the explanation - I appreciate it. But I still don’t understand - if just a single droplet can do kill, and half of American’s probably drank some, why aren’t we dropping dead from droplets getting into our nose during showers? There is either way, way less of this stuff in our drinking water, or some other protection in the nose. Or … ?

It wasn't clear from the article if there were only 10 cases during this time, or if they only looked at 10 cases, but there were more during this period. Kind of an important detail!

Yeah, I think this was just a sample. There’s no mention of naegleria fowleri[0], which will definitely kill you even if you’re healthy. Wikipedia cites nasal irrigation as the source for about 9% of infections. Still not super high risk, but still a risk that I’ll happily avoid.

[0]https://en.m.wikipedia.org/wiki/Naegleria_fowleri

This is just propaganda put out by Big Distilled Water.

They’ll never get my $0.99!

In order of safety.

- Used distilled water. - Used boiled water.

Use the salt packets with both. It has been amazing for me during the allergy season. But have to be careful.

> In order of safety

To prepend to that list for completeness: Using distilled water and boiling it.

Arguably overkill, though.

If you use a CPAP with a humidifier, it’s clearly advised you use distilled water. However, when you clean one, how are you supposed to clean the tubing. Using distilled water would be both expensive and difficult.

The hottest tape water you have and then vinegar is what I was told (and use). I use cleaning vinegar specifically.

A CPAP humidifier is a distiller. You could use muddy swamp water in it and the vapor that goes into your lungs would still be pristine.

However, that would make the machine prone to bacterial and scale buildup, and hard to clean. Ease of cleaning is the real reason to use only distilled water in CPAP machines.

You should use distilled water to avoid volatiles in tap water, like chlorine.

I believe that may be due to scale build up. Can microorganisms survive vaporization?

I use tap water that I microwave. The problem with boiling is that you can't then use it immediately. You have to set it aside for 5-10 minutes while it cools down. I often leave it too long, and using water that is too cool is uncomfortable. If it gets close to the right temperature, I run cold water over the outside of the neti pot and then swirl it around to mix the water on the inside.

But I haven't found an efficient way to reliably boil and then cool water so that it's close to the right temperature at the end. I also haven't figured out a way to microwave water to a boil and then set an alarm for just the right amount of time.

If anyone has tips I'm all ears!

It doesn’t seem like this is a safe way to mitigate the risks discussed in the paper. If it cools faster, then it probably wasn’t boiling, and boiling is what kills the things you don’t want up your nose.

There are ways to cool it faster, but I haven't figured out one that is reliable enough. Put in the fridge? Depends on how full it is, what type of vessel it's in, etc. Put it in a tub of room-temperature water? Depends on the conductivity (not sure if that's the right word) of the vessel it's in, exactly how much room-temperature water you use, etc.

What temperature kills these amoebas? I use tap water, but I bring it to 203 degrees F (and let it cool) before using. I can't seem to find an answer.

The general pattern with these sorts of things is that it's a combination of temperature and time. For any given microorganism there's some temperature it thrives at, some temperature at which it will start dying and if left for long enough will completely kill it off, and some temperature at which you can be assured that even brief exposure will completely kill it off.

Most microorganisms start dying above 50C (122F) or so. Roughly an hour at 50C should sufficiently pasteurize water for drinking. Or around 15 minutes at 60C and so forth. As the temperature increases the required time decreases. The common advice to boil water to render it safe for drinking is conservative and is given for a number of reasons: to err on the side of caution; because there are extremophiles that can survive at higher temperatures; because water boiling is an easily visible cue; and because by the time water reaches boiling it is sterilized so there's no need to time it (which is something people can screw up).

I found two sources on the temperature resistance of Naegleria fowleri. First the CDC [0] says it grows best at 46C (115F) and survives minutes or hours at 50-65C (122-149F). I also found a paper [1] which showed no detectable Naegleria fowleri after pasteurization at 68C (154F), unfortunately it didn't give a time though.

The upshot of all this is that Naegleria fowleri is somewhat temperature tolerant but isn't an extremophile; it's killed off on a temperature-time scale that's reasonably typical for water-borne pathogens. By the time water reaches 95C (203F) it is 100% dead and probably was already by the time the water reached 70-80C (158-176F).

[0]: https://www.cdc.gov/parasites/naegleria/pathogen.html

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057267/

From the article:

> For nasal rinsing, the CDC recommends using boiled, sterile, or distilled water. "If tap water is used, it should be boiled for a minimum of 1 minute, or 3 minutes in elevations >1,980 meters, and cooled before use,"

I wonder how they came to those numbers; on a typical stove, if you heat a pot of water to boiling, and then immediately let it cool off, it will spend almost 3 minutes at (or above) 200F (the boiling point of water at 1980 meters) so the sea-level recommendation seems more conservative than the altitude recommendation.

"one minute" is much easier to mentally estimate than "43 seconds" or whatever. Can even be readily timed with an old school analog clock... just wait for it move from one tick mark to the next.

Reminds me of a House episode.

Season 8 episode 17

Is there some major change we can make to our society, on a political and perhaps even social level, that might prevent these infections from spreading?

I want to blame the tap water, and also don't want to let the Neti off the hook here. And the Amoeba clearly isn't intelligent enough to be the culprit here.

Upvotes for whoever comes up with the most extreme response they can think of.

Better warning labels is all we need.

My nasal rinse has red text that says, "Warning: Do not use tap water unless sterilized by boiling." Given the absolute proliferation of useless warnings, we all ignore a dozen such notices on a typical day. What it should say is, "Warning: Death or serious injury may result from the use of tap water. Google species name for more information. The following options are safe..."

> Upvotes for whoever comes up with the most extreme response they can think of.

We should breed the amoeba and purposely add it to our water supply, making the chance of infection incredibly high while simultaneously raising awareness.

>Is there some major change we can make to our society, on a political and perhaps even social level, that might prevent these infections from spreading?

It's already widely know that distilled water is the way to use a neti pot. Doctors that recommended the neti pot to me were very explicit about only using distliled water with it. It's printed on the box and the instructions for the neti pots that it's for use with distilled water only. If people hear or read those words and then just fill it with tap water, then that's Darwinism at work.

Didn't you read the article?

It says that you can eliminate the risk by boiling the water. we need to require that all of these have an electric kettle element that raises the water temperature to boiling before it enters the nasal cavity.

How about mandating a big orange safety ball on the spout of the neti pot to prevent it going into nostrils?

I wish articles like this would clarify whether tap water with salt is still considered "tap water." Tap water that is boiled is no longer considered tap water.

I've read multiple articles like this and always wondered. I know at least one intelligent woman who assumes tap water meant just plain tap water. I'm not so sure.

If you read the article you're trying to criticise, you'll find this right at the end:

I’m well aware of what it says. I read it.

The point is that nobody uses tap water in their nose. They always do something to the tap water that changes it so dramatically that nobody would consider it tap water anymore. They use salt water, not tap water.

As such, these instructions don’t address them in their minds.

I'm unclear on your point. The small amount of salt that's added to nettipot water isn't enough to kill bacteria, so what does it matter if tap water with salt is or isn't called tap water?

Well then why in the world doesn’t any article about this actually say that?

I always use boiled water as it makes the salt crystals dissolve better.

Hari Om Tat Sat

I mean, doesn't everyone know to use distilled water? Pretty sure they even say it on the box.

That being said, I can't imagine it to help, I'm usually so stopped up I don't see how I wouldn't just waterboard myself.

There are a lot of compliance warning labels that don't really mean anything. When I first visited California, I was pretty alarmed by the Prop 65 warnings plastered all over everything. Now I can't even see them anymore.

Propositions and people covering their asses is different than ignoring instructions for using a medical device. When it says "ONLY USE DISTILLED WATER", then that should give a reasonable person pause. It doesn't mean use any old water, it means use distilled water only.

Seems Californians should repeal that useless and dangerous Prop (the exact reason you posted this [boy who cried wolf syndrome]),

instead of requiring distilled water on tap for Neti Pot users...

Prop 65 was incredibly dumb, since it never required the notice to quantify the risk.

My phone case and cigarettes are not in the same risk category, but they get the same prop 65 warning.

I don't use distilled water because boiled tap water is close to free, and is more environmental than buying water that someone else distilled and then trucked around the country.

I'm not a full nettipot convert, but last year I did start using the squeeze-bottle version during pollen season, and was able to get over my extreme aversion to waterboarding myself. It takes a try or two, but eventually you get the hang of it and it actually feels quite nice. And if you haven't done it in a while, the snot you blow out the first time will be quite dirty and gross.

It works wonders, even when totally stopped up, although you may have to push it along a touch.

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