Important:
Clarification of instructions for practicing neti
July 2019

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Neti is a profound and important technique of awakening the body of energy. In particular, it has a stimulating and awakening effect on the third eye. However, only certain types of water are safe for use in neti, and the following are some guidelines on what these are.

What types of water are safe to use for neti?

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You must not use tap water for neti as tap water may contain pathogens that can cause infections. To make your water safe for neti, the safest way is to use only water that is distilled, sterile or previously boiled.
The U.S. Center of Disease Control and Prevention (CDC) currently have the following recommendations for safe neti use[1]:
A. Use boiled or distilled water (preferred method)
Boiled water: Use water that has been previously boiled for one minute and left to cool to lukewarm. (Please note that the U.S. Food and Drug Administration (FDA) recommends boiling the water for even longer. They recommend three to five minutes.[2])
Do not dilute the boiled water with cold tap water to bring it to lukewarm temperature since that can contaminate the water if the tap water is contaminated. At elevations above 6,500 feet, boil the water for at least three minutes.
Distilled water: Another option is to buy and use water with a label specifying that it is distilled or sterile water.
B. Use an approved water filter (if boiled or distilled water is not available)
If boiled, sterile or distilled water is not available, use a water filter designed to trap potentially infectious organisms. The CDC recommendations for effective water filters are[3]:
- The filters must be tested and certified to “NSF/ANSI 53” or “NSF/ANSI 58” for “cyst removal” or “cyst reduction”. Even if water filter manufacturers claim that their filters are NSF 53 certified, you must check whether that certification is for cyst removal or reduction.
- If you choose to buy a filter that is not labeled “NSF/ANSI 53” or “NSF/ANSI 58” for cyst removal or reduction, select a filter with an “absolute pore size of 1 micron or smaller”. (Please note that filters with "nominal" or "mean" pore size of 1 micron or smaller are not effective at removing the relevant pathogens.)
- Some manufacturers of nasal rinsing devices recommend using 0.2 micron absolute pore size filters. Follow the manufacturer recommendations if 0.2 micron absolute filters are recommended.
The CDC recommends boiling water over using filtered water as water filters may have manufacturing defects at times, or the filters may fail if there is poor filter maintenance or if they are not regularly replaced.

How to use and care for your neti bowl or device

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The FDA currently recommends the following for the care of your neti bowl or device[2]: Wash and dry your hands.
Check that the device is clean and completely dry.
After using the neti device, wash it and dry the inside with a paper towel, or let it air dry between uses.
Although the FDA does not suggest this, it is recommended that you wash the neti device with water that has been boiled, distilled or filtered as outlined above.

Risks and exposure

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Tap water is not safe for use in neti as it may contain low levels of bacteria and protozoa, including amoebas. These, if introduced through contaminated water into our systems through the nose, may cause potentially serious infections, and in very rare cases, fatal infections[4].
Please note that the reported cases of fatal amoebic infections linked to neti use are extremely rare and they all involved neti water that was not treated according to the CDC/FDA safety guidelines. It is therefore imperative that you strictly follow the CDC and FDA guidelines for safe neti use as outlined above.

Notes:

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[1] See https://www.cdc.gov/parasites/naegleria/sinus-rinsing.html
[2] See https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm316375.htm
[3] See https://www.cdc.gov/parasites/crypto/gen_info/filters.html
[4] The main pathogen known to cause fatal brain infections through improper neti use is an amoeba called Naegleria fowleri. Balamuthia mandrillaris is another amoeba that has been linked to fatal brain infections through improper neti use. These amoebas do not, however, usually cause a problem when swallowed through drinking contaminated water as they are usually killed by stomach acid. For more information on these infections and pathogens, please see:
https://www.cdc.gov/parasites/naegleria/ritual-ablution.html#three
https://www.cdc.gov/parasites/naegleria/general.html
https://www.cdc.gov/parasites/balamuthia/index.html