A neti pot is like a teakettle you fill with salt water, and then stick the spout up your nose.  And when I say that, people think I’m joking.  Seriously: salt water goes in one nostril, and comes out the other.  

Ideally, one does not do this at the dinner table.

Using a neti pot may seem like a fad, but it’s certainly not a newfangled one.  The practice of jala neti (literally “cleansing water”) has been around in India for thousands of years.  Even in this country, in just a decade, it’s gone from an almost unheard-of, cultic practice; to an underground phenomenon; to a mainstream public health measure, the subject of numerous clinical trials.  Neti pots have gained so much traction in popular culture that the New York Times referenced them in its “New Slang Terms of 2007” review.  (The term, incidentally, was “nose bidet.”)

Well, popularity can be fleeting, and research can be fickle, and what’s touted today can be forgotten, debunked, or disavowed tomorrow.   The neti pot, however, appears here to stay.  Unlike other “newest” things hyped by pyramid marketing, spam e-mails, and the discerning medical minds on the Oprah show, neti pots have already stood the test of time – and the test of research. 

So what will a neti pot do for you?  Well, used as needed, jala neti helps with sinus problems, mostly the congestion that can accompany seasonal allergies, or an infection.  And it should reduce secondary symptoms to sinus problems – things like sore throat, snoring, post-nasal drip, sinus headache, etc.  Used over time, as a daily hygiene practice (like brushing your teeth), it will also reduce the risk of catching a cold.       

The standard filling for a neti pot is simple: plain salt and water.  That being said, getting the proportions of salt to water right is very important. 

The starting point for most people is called “physiologic saline,” water with the same salt concentration as human blood.  You can buy bottled physiological saline in a pharmacy, or you can make it yourself by adding a teaspoon of fine salt to three cups water.  You might not get the precise salt concentration (0.91% w/v) needed for an IV.  But it’ll be close enough for sticking up your nose.

So why is salt concentration so important?  Because salt is drawn to water, and water is drawn to salt.  As any cook knows, if you put salt on something moist – say, a piece of vegetable or meat – the salt will attract the moisture from the food, and you end up with a piece of dried-up, shriveled vegetable or meat.  On the other hand, if you put pure water on heavily salted food, the water will draw the salt out.  What’s really happening is that the salt is trying to disperse – the salt concentration inside the food is trying to equalize with the concentration outside the food.        

Now as I said, your blood and tissues are a little salty.  If you were to put pure water (which is not salty) up your nose, the salt concentration inside your tissues will try to equalize with the concentration in the water. And this can happen one of two ways: either salt will leave your tissues and enter the neti water, or water will leave the neti water and enter your tissues. 

Well, evolutionarily, salt was a lot harder to come by than water: the body is set up to try to hold on to its salt.  So it’s the water that’s going to move – from the neti liquid, right into the tissues.  And then the tissues get swollen.  Likewise, if you put too much salt in your neti solution, it will draw water out of your tissues, dehydrating them.

So the reason we normally use physiologic saline is because it won’t mess with our tissues, one way or the other.

Using a neti pot filled with physiologic saline should reduce all sinus and nasal symptoms of cold, flu, and allergy.  You can use it as often as you’d like – during really, really bad times, you might use it as often as every hour – but even using it once a day will accomplish plenty.  This is especially true for allergies, where using a neti pot will wash out the allergens that get stuck in our nasal mucous, triggering the allergic response. 

There are over two-dozen good human clinical trials here[1], in a variety of settings, looking at “normal” people with and without diagnosed conditions, on medication or not, people after sinus surgery, and even young children.  In almost all of them, jala neti flat-out works.  Some of the studies measure efficacy by counting how many times people choose to use standard medication for their sinus problems (they use less when they neti).  Others rely on questionnaires where patients fill out how they feel (they feel much better with a neti pot).  Still others rely on statistically quantified measures like the Sino-Nasal Outcome Test[2].

 While physiologic saline is the “default” contents of a neti pot, there are times you’re going to double or even triple the salt concentration.  The idea behind regular saline is that it won’t mess with the tissues lining the nose and sinuses.  The idea behind hypertonic saline is that it will.  Sometimes you want that.

Just like some people soak their feet in salt water to reduce swelling at the end of a long day, hypertonic saline will reduce swelling in the nasal and sinus passages.  This is not a daily hygiene practice, but rather something to do only when you’re really feeling stuffy and congested.

You want to keep the salt concentration to double – no more than triple – physiologic saline, as higher concentrations can temporarily stun the cilia (the microscopic “arms” that keep mucous flowing in the right direction) along the airways.  You’re also going to want to make sure to add ¼-½ teaspoon baking soda for each cup of neti water, which should offset the tendency of higher salt concentrations to sting.  (Let me say that again: baking soda, not baking powder). 

In a perfect world, you’d use pure distilled water.  In the real world, tap water is just fine, unless it’s very heavily chlorinated.  Get it to room temperature, or even better, body temperature.  Cold water won’t kill you, but it will shock you.  Hot water… do I really need to point out that putting boiling water up your nose is a bad idea? 

Your choice of salt does matter.  First, look for salt that that doesn’t contain any anti-caking additives like silica.  Second, try to get salt that doesn’t contain any added iodine.  There’s talk that Iodine might impair the action of our cilia[3].  (The small amount of naturally-occurring iodine in sea salt appears to be fine).   And it appears to be better to use the grey, unrefined “gourmet” salts for their more diverse mineral content. 

But don’t stress too much about using special salts.  If you don’t have the dark grey salt, plain, cheap, cooking salt will work just fine.  And despite the best efforts of the neti companies to convince me otherwise, I’m still going to tell you that their “Neti salt,” retailing at upwards of $10 a pound, is a ridiculous waste of your money (although for those who want it, we have it).  (There are some essential oil-infused salts out there that are worth it).   

You can also add a variety of antimicrobial, immune facilitating, and anti-inflammatory herbs to the pot; plus minerals like zinc or silver, or xylitol.  Buying a pre-made product can simplify things.  We sell a lot of one called “Neti Wash Plus.”  That being said, a half-dozen drops of herbal tincture added to a few cups of neti water is usually safe, as long as you have reasonable understanding of what the herb does.  Or put it this way: pretty much anything that’s in a nasal spray can go in a neti pot.  (Anyone have any experience using something unusual in your neti pot?  Let me know:

 

- For chronic sinus infections, try herbs that kill both bacteria and fungi.  Think Goldenseal (and other berberine-containing plants), Myrrh, or Pau D’Arco.  Five-ten drops per pint of saline. 

- For swollen congestion that doesn’t respond well to saline, consider adding homeopathic arnica liquid, about 10 drops per pint of saline.  (Note: I am referring to a homeopathic Arnica only!) 

- For chronic, painfully dry sinuses, add 2 Tbsp Aloe Vera juice to a pint of saline.  Juice, not gel. 

- Zinc also has a role in neti washes, to reduce viral adhesion and generally reduce inflammation in membranes.  That being said, there have been rare case reports of intranasal (that’s a fancy way of saying “up your nose”) zinc being linked to people losing their sense of smell permanently.  Nobody really knows if the zinc is actually causing this.  But since the loss appears to be irreversible (and there’s so much good to smell in the world!) I’d advise against taking the risk.

Xylitol (yes, the sweetener) is a nice contact antibacterial.    1-2 tsp per pint of saline.