I purchased a neti-pot, which came with salt packets: how is this salt different from table salt? Any reference or support is always appreciated

UPDATE: My Bayer HyrdraSense Nasal Rinse Kit salt packets contain MgCl NaCl, CaCl Na-Bicarbonate KCl. Instructions include boiling tap water and then cooling it to room temperature.

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  • Mostly salt. I believe that they come in packets to ensure that they have a certain osmolarity/concentration. This insures that you do not dehydrate your mucous membranes. – CoffeeIsLife Nov 26 '19 at 18:38
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    Lack of iodine might be another answer, but we need to stop answering in comments. – Carey Gregory Nov 27 '19 at 4:57
  • Is that kit described anywhere online, and if yes, can you link to it? I added something at the beginning of my answer, anyway. – Jan Nov 30 '19 at 11:53
  • @Jan3 thanks for the questions. Video link and photo added to OP – gatorback Nov 30 '19 at 15:46
  • I explained that in my answer. – Jan Dec 2 '19 at 9:20

MgCl NaCl, CaCl, Na-Bicarbonate, and KCl can be all found in sea water and therefore in sea salt, which means that this salt appears similar to sea salt, but it is obviously not natural sea salt because the description of this HydraSense salt says:

The pre-measured and ready-to-mix salt packets contain: calcium chloride, magnesium chloride, potassium chloride, sodium bicarbonate and sodium chloride. Ingredients are not naturally sourced.

From this it's not clear if even NaCl itself is artificially produced or maybe they used sea or rock salt, purified it and added the mentioned ingredients.

Other sources (University of Missouri-Kansas City, Brown University) say that un-iodized salt (canning, kosher, pickling, or sea salt) can be used for Neti-Pot. This means salt without iodine, anti-caking agents (such as calcium silicate) or anything else added, which can be then mixed with baking soda (Na bicorbonate). So, "table salt" which typically contains iodine, anti-caking agents and other stuff should not be used. On Family Practice Notebook they say iodine can affect the function of small hair (cilia) in the respiratory tract. For the actual saline solution to be as little irritant to the nose as possible, it should be isotonic, that is 0.9% (9 g NaCl in 1 liter of water).

I've found 4 reviews, all of which say that nasal irrigation with Neti-Pot may be useful for chronic sinusitis and some other conditions in the upper respiratory tract without any significant side effects:

I have found no convincing evidence to say that certain "special" salt, which can be expensive, is better than table salt.

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Table salt contains additional unwanted ingredients.

What is neti-salt?

First link to vendor appearing in a websearch selling overpriced salt says:

Ingredients: Pharmaceutical grade sodium chloride (99.99%) USP.
Directions: Place a heaping 1/4 teaspoon in your Neti Pot and add warm water.

That is not to say that vendors opting for the name 'neti' aren't willing to also add 'exotic' stuff, that's then not beneficial either.

Regular kitchen table salt can be used but will cause problems because of all the additives.

Apart from possible unknown adulterations when using "funny" salts ('Himalaya' etc) just the usually allowed anti-caking agents for example are:

341 tricalcium phosphate 460(ii) powdered cellulose 470b magnesium stearate 500 sodium bicarbonate 535 sodium ferrocyanide 536 potassium ferrocyanide 538 calcium ferrocyanide 542 bone phosphate (i.e. Calcium phosphate) 550 sodium silicate 551 silicon dioxide 552 calcium silicate 553a magnesium trisilicate 553b talcum powder 554 sodium aluminosilicate 555 potassium aluminium silicate 556 calcium aluminosilicate 558 bentonite 559 aluminium silicate 570 stearic acid 900 polydimethylsiloxane

Some of these are listed in the Eu as E170, E504, E535, E536, E551, E559…

Table salt

Table salt is sodium chloride combined with iodine sources (for nutrition), stabilizers for the iodine, and anti-caking compounds to make it pour by preventing it from absorbing water from the air.

So supermarket bought regular table salt can be quite a bit too irritating for a nasal irrigation. Depending on jurisdiction not all ingredients have to be listed on table salt.

Nasal irrigation is based on warm saline solution, i.e. salt dissolved in lukewarm tap water. ... However, chemical anti-caking (aka “free-flowing”) additives used in common table salt (e.g. sodium silicoaluminate) produce an unpleasant burning sensation in the nose and are not advised medically or by Yoga instructors.
–– The problems of salt for neti - NetiNext

anti-caking agents or preservatives (these can be irritating to the nasal lining)
–– SALINE SINUS RINSE RECIPE 2019 American Academy of Allergy, Asthma & Immunology.

With just a little chemistry knowledge anyone can conclude: among other things nasal irrigation is used for reducing mucus viscosity. This is clearly not an outcome achieved if adding bentonite into a solution for the nasal cavity. While listed as non-toxic non-irritating, bentonite is used as cat litter, and hence it does in the nose what it does in the litter box: increases viscosity of mucus. This effect is there for all anti-caking agents. Some are directly irritating the membranes, all are doing the opposite of what one wants to achieve.

For the US salt for use in organic products:

Common anti-caking/free-flow agents that are allowed in the US table salt include:

• Calcium silicate • Ferric ammonium citrate • Sodium ferrocyanide • Magnesium silicate • Magnesium carbonate • Propylene glycol • Aluminum calcium silicate • Sodium aluminosilicate

USDA organic regulations (PDF)

Ordinary table salts may still contain (sodium and magnesium carbonate (E 500, E 504), sodium-, potassium- and calcium ferrocyanides (E 535, E 536, E 538), silicon dioxide, calcium- and magnesium silicates (E 551 – E 553), iron tartrate (E 534). Aluminium salts are officially no longer allowed in Europe as an additive, but can be a found in some salts.

Additives List, E numbers in Numerical Order, Food Safety of Ireland, 2019.

Main sources for bacterial contamination are neither the salts nor the water. Preparing a too large portion of solution in advance and letting it sit, and the pots used themselves are:

Although common and frequently based on potentially dangerous bacteria, contamination is considered a false problem by some experts. They think that the nasal cavity is naturally full of bacteria and the addition of new pathogens is not clinically relevant.

The problem of sterility of the solutions and devices has been debated.

Solutions are at risk of contamination when large volumes of solution based on distilled water, bottled water, or boiled water are prepared at home, maintained in containers and used each time when NI is needed by withdrawing the required amount of liquid. Devices can be contaminated when they are continuously used without adequate cleaning. Lee et al. reported that after one and two weeks of use, irrigation bottles used by adults undergoing endoscopic sinus surgery that were washed with hot soapy water after each use were found to be contaminated by a large spectrum of bacteria, including Pseudomonas aeruginosa, Serratia marcescens, Proteus mirabilis, and Staphylococcus aureus. Similar findings were reported by other authors and, because in many cases contaminating bacteria were the same as those that could cause acute rhinosinusitis, it was suggested that the main source of device colonization was the sinonasal cavities. The risk of contamination seems independent of the type of device. Additionally, the use of a one-way valve irrigation bottle, theoretically capable of reducing the risk of reflux of contaminated solution in the device, was found to be practically ineffective. In contrast, contamination seems to be influenced by the composition of the solution. It was shown that acidic, isotonic saline solutions were more frequently associated with bacterial contamination probably because some of the most common contaminants grow optimally in similar environmental conditions. Finally, contamination was found more frequently with longer durations of NI use. With some exceptions, studies have reported that both bottles and bulb syringes were contaminated after one to two weeks of use in approximately 25% of the cases and in 45% after four weeks.

–– Nicola Principi & Susanna Esposito: "Nasal Irrigation: An Imprecisely Defined Medical Procedure", Int J Environ Res Public Health. 2017 May; 14(5): 516. doi: 10.3390/ijerph14050516 PMCID: PMC5451967 PMID: 28492494

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    Good Lord, don't recommend tap water for nasal irrigation. Potable water safe for drinking and hand washing still contains contaminates that can cause serious problems if forced up the nasal passages – De Novo Nov 28 '19 at 9:31
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    Actually @LangLangC it's not paranoia, medical professionals recommend to use boiled/cooled water OR distilled water. Besides high levels of chlorine and other contaminants that are processed differently via GI tract than if absorbed directly into nasal vasculature, there have been (albeit only a few, but rather serious) cases of brain infections by local municipal water parasites and fungi. The venous drainage of the nasal and sinus passageways is in the "danger triangle" en.wikipedia.org/wiki/Danger_triangle_of_the_face – DoctorWhom Nov 28 '19 at 15:26
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    At least one of those cases was in the USA, btw, so it's not just a "third world" problem. Yes lots of people use tap water, but we can't say it's safe. – DoctorWhom Nov 28 '19 at 15:30
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    @LangLangC Sorry if that came across negatively, I didn't read it that you were recommending anything unsafe. I was just clarifying that it's not a "paranoia" but actual medical recommendations based on exceedingly rare but serious complications that have occurred. I've worked with 7 different ENT or allergist specialists and have read the data on those super-rare events. – DoctorWhom Dec 4 '19 at 1:40

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