Are there really brain eating amoebas in my neti pot?

March 18, 2013 5:58 AM

I've read about amoebas that enter your brain through your sinuses and possibly killed two women in Louisiana in 2011. I live in a major metropolitan area (NYC) and my hot water comes to me through the same system that heats our big pre-war apartment building. The hot water pipes are actually too hot to touch.

I know, I know, better safe than sorry, but I'm wondering whether there was any update on that case (updates are much less sensational, but I couldn't find any) or insights on whether I really need to be boiling my neti pot water in the city.

posted by amandabee to Health & Fitness (34 answers total)

1. Is the Mail a legit source? I've heard no
2. If it is a legit source, that only applies to snortin' tap water through your nose, as per the article
3. If NYC residents were gettin' eaten by amoebas, there would be some major NY press outlet covering it.
posted by angrycat at 6:09 AM on March 18, 2013

Considering how fluoridated and chlorinated NYC water is, I doubt it's a cause for concern.
posted by EmpressCallipygos at 6:10 AM on March 18, 2013

Also, consider that the link states that only two cases have been reported, compared to how many people around the world use Neti Pots.
posted by EmpressCallipygos at 6:11 AM on March 18, 2013

To be safe just use distilled water. Or boil it in the neti pot in the microwave.

Indeed there was a woman in Louisiana who suffered this fate, have you BEEN to Louisiana? I wouldn't drink the tap water, much less get it in my sinuses.

I live in Georgia and I use distilled water that I warm in the pot in the microwave.

Is this a thing you really want to screw with?
posted by Ruthless Bunny at 6:12 AM on March 18, 2013

Is the Mail a legit source?

I wouldn't trust most newspapers for science/health news in general, and the Daily Mail is frequently amongst the worst for making up/mis-reporting/mis-representing science/health news.
posted by EndsOfInvention at 6:14 AM on March 18, 2013

I bought a jug of distilled water for some cheap amount of money when I had The Thing in January and was using a neti pot for the first time. My immune system was already struggling, I figured, so why potentially make things harder for it?
posted by rtha at 6:16 AM on March 18, 2013

I do a tea kettle and then filtered water to cool it down - just in case.
posted by k8t at 6:18 AM on March 18, 2013

I use water that I've run through a Brita filter, then boiled in my electric kettle and left to cool. The Brita helps with the chlorine smell (my tap water smells like a freshly-shocked swimming pool sometimes), the kettle is just for a little peace of mind on the brain-eating amoeba. I'm in Georgia, incidentally.
posted by deadmessenger at 6:25 AM on March 18, 2013

I only use distilled water for nasal irrigation. Tap water makes my sinuses burn!
posted by missriss89 at 6:26 AM on March 18, 2013

The brain eating amoebas are real (but extremely rare) and they do get to your brain through your nose. Your risk is probably lower than being struck by lightning, but it is pretty gross. Distilled water is about $2 per gallon, and that's what I'd use if I was going to pour water into my nose. I bet a gallon would last a while.
posted by steinwald at 6:26 AM on March 18, 2013

I drive a car and I am slightly overweight. If you look at actual statistical risk, those two things are by far the most dangerous things in my life. I do nasal irrigation with water straight from the tap because it seems like a totally acceptable level of risk for me.
posted by selfmedicating at 6:27 AM on March 18, 2013

Here is a link to the CDC Website.

This is absolutely true, BTW.
posted by Ruthless Bunny at 6:27 AM on March 18, 2013

You should never trust the Daily Mail for anything. But in this case, the deaths actually happened.

I always use distilled or pre-boiled water in my Sinus Rinse system.

It's not a good idea to consume hot water (or stick it up your nose) from a hot water tap, either.
posted by grouse at 6:28 AM on March 18, 2013

CDC on Naegleria fowleri.

The same story was reported by NPR, ABC, and other news sources.

More on Raoult Ratard, the state epidemiologist quoted in the Daily News story.

So yes, I think I'd take this seriously.
posted by bunderful at 6:32 AM on March 18, 2013

As a side note, I would be very surprised if your heating water and hot water were the same system. While it's possible that they could use the same boiler (and hence the same system), almost all hot water or steam water systems are closed loop with recirculated water. If they use the same boiler the boiler is heating two distinct sets of pipes, one to feed a hot water heater and one to feed the heating system. This would be especially true for a pre-war NYC heating system whether steam or hot water (I've lived there). It would be unusual enough that I'd like to hear more about it to make sure something isn't really unsafe with your setup.
posted by true at 6:34 AM on March 18, 2013

Under Ruthless Bunny's "to be safe" measure, you should never swim in any lakes since that's the source of 95% of these microbe infections.

I imagine it's a non-zero risk. Do you walk on sidwalk grates and cellar doors? There's a nonzero chance of falling through the sidewalk when one gives way, and so I guess it's rational to go around them, but most city-dwellers don't.

My bathroom and microwave are 3 floors apart, so there's no way I'm dealing with distilled water when I'm using my Neti pot almost every day (in dry months and/or when I'm stuffy). So I use tap water (but I do use purified salts). I decided it was a risk I was willing to take, because my sinuses are a total quality-of-life issue, and I'm not worried about our city water. But I think you can only decide this for yourself, based on your regional water quality and your personal comfort with risk.
posted by acm at 6:37 AM on March 18, 2013

Avoid all non-zero risks is not a sensible standard. "This weird and unfortunate thing can happen" does not mean that it is worth spending any time, energy or thought mitigating that risk when it is so fantastically low.
posted by yoink at 6:42 AM on March 18, 2013

My bathroom and microwave are 3 floors apart, so there's no way I'm dealing with distilled water when I'm using my Neti pot almost every day

Distilled water is different from just boiled (the steam is captured and collected). I'd love to be corrected, but I don't think there is a way to distill water using a microwave.
posted by stopgap at 6:58 AM on March 18, 2013

As grouse aludes to, the potentially larger risk is the exposure to lead in the drinking water if you use warm water from the faucet; warm/hot tap water leaches lead at a higher rate than cold water. NYC has known lead in drinking water issues, so I'd be more concerned about that.
posted by pie ninja at 7:01 AM on March 18, 2013

Actually I wouldn't use hot water from hot water pipes for this, just because it's been sitting in a hot water tank and god knows what's in there.
posted by showbiz_liz at 7:16 AM on March 18, 2013

It's not that hard to just boil the water on a stove or microwave it and just do this in your kitchen.
posted by discopolo at 7:23 AM on March 18, 2013

And I wouldn't use a neti pot at all.

Having a cold or nasal congestion can make people desperate, especially if it is chronic. The billion-dollar decongestant business says it all. It can be very satisfying to flush things out of there, and often gives temporary relief. The key word there, though, is temporary.

As with so many things to do with the sinuses, that hankering for temporary relief just ends up making the problem much worse -- see the rebound effect from chronic decongestant use, and the incidence of superinfections in people who blow their noses frequently.

Pushing stuff up your nose, whether it's cotton or water or nasal spray, for that matter, goes completely against how the nasal passages have evolved to function. You just end up forcing pathogens up into places they don't belong and where the body has a harder time fighting them.

Recurrent sinusitus and nasal congestion is, in most cases, an internal affliction (though in rare cases it can be a structural problem). What I mean by that is that increased production of mucus has as much to do with what you eat as anything else. I used to have this problem all the time, and it wasn't until I made major changes in my diet (dumping dairy and most grains) and corrected a vitamin D deficiency (wow) that I got any lasting relief. I considered this might be a one off, but then my girlfriend (who was an enthusiastic nasal irrigator) tried a similar approach and had the same results. Sure, n=2, but still: This has been studied and the evidence is clear that regular mechanical intervention is not the way to treat your misery. Our primate cousins don't irrigate, and it's a safe bet our homo ancestors didn't, either.

Needless to say, I don't waste my time (or money!) on nasal sprays anymore, and I sleep soundly with clear nasal passages, which is pretty amazing considering the asthmatic, sniffly, clogged mess I once was. I no longer think "milk does a body good."

Though this is probably a disease of modernity, it doesn't mean that medieval treatments are the way to fix it.
posted by rhombus at 7:51 AM on March 18, 2013

We actually had the water tested for lead when we moved in precisely because we know that's an issue. There was none, even in the hot tap water.

I know you have to boil water for something like 7 min to kill giardia -- I've noticed that none of the reporting (CDC, NPR included) says how long you should boil water for.

It is a pain the butt because I don't have a microwave and boiled water is too hot to irrigate with so I have to boil and then wait for it to cool. I guess I'll work out a system, though.

As for @rhombus, I actually am not treating mucus so much as dryness. When I'm genuinely congested, the neti just makes things worse, but when I'm getting a sore throat or lots of very dry boogers (sorry. TMI) I find it helps a lot.
posted by amandabee at 8:13 AM on March 18, 2013

It is a pain the butt because I don't have a microwave and boiled water is too hot to irrigate with so I have to boil and then wait for it to cool. I guess I'll work out a system, though.

Why not get a sterile glass jar, boil a lot of water at once, and keep it in the fridge? Then warm as needed.
posted by showbiz_liz at 8:14 AM on March 18, 2013

Did you read what the CDC has to say about preventing primary amebic meningoencephalitis?

"However, the risk of Naegleria fowleri infection is very low. There have been 32 reported infections in the U.S. in the 10 years from 2002 to 2011, despite hundreds of millions of recreational water exposures each year 10. By comparison, in the ten years from 1996 to 2005, there were more than 36,000 drowning deaths in the United States."

That same CDC page has instructions on how to make tap water safe for Neti pot usage:

"If you are making a solution for irrigating, flushing, or rinsing your sinuses (for example, by using a neti-pot, sinus rinse bottle or other irrigation device), use water that has been:

-previously boiled for 1 minute (at elevations above 6,500 feet, boil for 3 minutes) and left to cool
OR
-filtered, using a filter with an absolute pore size of 1 micron or smaller
OR
- purchased with a label specifying that it contains distilled or sterile water

It's very rare for N. fowleri to eat your brain, even when you fling yourself into freshwater all the time. And you're afraid of something that's even rarer than that -- contracting it through obviously well-heated tap water. And as someone who has health anxiety issues, I would recommend trying not to be too afraid of lightning-strike illnesses. It's a massive waste of time, especially since your risk of N. fowleri is incredibly low.

Not that I don't understand your worries, because I had a brief bout of N. fowleri terror after those people in Louisiana died. (Other people have also died of brain amoebas due to shoving water up their noses, but it's still extraordinarily rare.) Just saying, you're already probably doing fine managing this risk. If it bugs you, follow the CDC's instructions for preparing your irrigation water.
posted by Coatlicue at 8:37 AM on March 18, 2013

Amandabee, they make a device that is designed to quickly and safely warm an 8 oz bottle of water to just about body temp. It's a baby bottle warmer! Not expensive, pretty compact, works perfectly.

Rhombus, I am currently having a chronic sinus infection managed very effectively by my local university hospital's otolaryngology clinic, and they recommend nasal irrigation / lavage to everyone who walks through the door. They have peer-reviewed data to back that recommendation up, too. This isn't some guy on the Internet or even a family practice doctor, this is a huge medical specialty clinic at a major research facility. Our ancestors didn't practice sterile technique or wear contact lenses, either; that doesn't make them terrible practices.
posted by KathrynT at 8:39 AM on March 18, 2013

If you are using a neti pot, you are more likely to run into trouble from mold forming in the pot than from the water you put into it, but honestly you are going to put in a lot of effort for not much payback anyway.

Frankly, I think neti pots are really over-rated. You'll get the same relief from an OTC saline nasal spray.

Even better, if dryness and congestion is a recurring concern, comsider running a vaporizer or humidifier to deal with the source of your problem (rather than the result). I prefer vaporizers because, again, you DO NOT want to add mold to your problems.
posted by misha at 8:55 AM on March 18, 2013

The instructions for a netipot specifically say to NOT use tap water.
Fill the NASAFLO® with 240 mL (8 fl oz) of lukewarm distilled, filtered or previously boiled water. Please do not use tap or faucet water to dissolve the mixture unless it has been previously boiled and cooled down.
posted by inertia at 8:59 AM on March 18, 2013

There were two cases and they both happened in Louisiana. Consider that two people had died using net pots in the history of neti pots. And then consider that you drive in a car everyday or walk up/down stairs everyday -- if you are scared of using a neti pot, you should be mored scared of those other activities, as many more people die doing those things.

The thought definitely crossed my mind about the neti pot because that amoeba thing sounds disgusting, but it's so incredibly unlikely that the fear is completely irrational.

Also, ever since my doctor prescribed me Azelastine Hydrochloride spray and Fluticasone Propionate spray, I use my neti pot far less because those sprays cured all my problems with allergies and rhinitis. You may want to see a doctor for whatever your trouble is - they may have something for it. Wish I had known about these sprays 15 years ago.
posted by AppleTurnover at 9:03 AM on March 18, 2013

Inertia, the instructions you quote do go on to say that you can use tap water that's been boiled.

And for the record, my own doctor (in NYC, natch) said that yeah, distilled water is always preferable, but tap water wasn't gonna kill you.
posted by EmpressCallipygos at 9:04 AM on March 18, 2013

I am a big advocate of nasal irrigation (I'm a NeilMed girl, though), and every ENT I have seen, including professors at fancy medical schools, is as well.

Boiling water is no big. You boil the water when you're making dinner, and let it sit in the teakettle or in a measuring cup with a cover over it, and then you're good to go when it's time to snorfle.
posted by Sidhedevil at 10:06 AM on March 18, 2013

It is a pain the butt because I don't have a microwave and boiled water is too hot to irrigate with so I have to boil and then wait for it to cool. I guess I'll work out a system, though.

half brita, half water that's just come out of my electric tea kettle = perfect neti pot temperature for my nose, and i've only had to wait a minute for the water to boil!
posted by lia at 10:09 AM on March 18, 2013

I know you have to boil water for something like 7 min to kill giardia

Incorrect, you just have to reach boiling. EPA says (pdf):

Cysts are killed in 10 minutes at a water temperature of 54C (130F). Raising the water temperature to boiling immediately kills cysts.
posted by ShooBoo at 10:10 AM on March 18, 2013

EmpressCallipygos, yeah I should have been more clear. I meant the water straight out of the tap, without boiling.

I always just use distilled, it's easier than boiling and cooling tap water.
posted by inertia at 11:16 AM on March 18, 2013