What’s the Right Amount of Salt to Use With Neti?

Salt is added to the irrigation water to make its passage more comfortable.  Our bodies are made of salt water at a concentration generally agreed to be approximately 0.9 percent, or 9 grams of NaCl (common table salt) per liter. Matching that physiological, or normal, concentration makes the solution more comfortable than either plain water or water with a greater amount of salt.  A “physiological” solution is made by placing ½ teaspoon of table salt into 250 ml (or approximately 1 measuring cup) of water.  In scientific jargon, this concentration of salt water is also called “isotonic saline.”

Adding salt may do more than just provide comfort.  A research protocol using fresh water without any NaCl for their placebo had to be stopped when several of the control subjects developed middle ear infections.

Isotonic saline works to clear mucus and relieve sinus congestion and runny noses.  It’s been shown to remove inflammation inducing chemicals like histamine and leukotrienes that the body secretes with allergy. Mucociliary clearance rate, the measure of the speed of removal of mucus, was noted to be increased in allergy patients using 4 ml of isotonic saline twice daily to flush their nasal cavities.

Hypertonic saline, defined as solutions with more than 9 grams per liter of salt, also works. In some studies, a higher salt concentration works better than an isotonic one.  Shoseyov and his colleagues used 3.5 percent NaCl, similar to sea water, and achieved better symptom relief in children than when they used a physiological concentration.

While isotonic solutions are thought to work primarily by their mechanical cleaning effect, hypertonic solutions may additionally decrease swelling.  Extracellular fluid in the nasal mucosa would theoretically be drawn out towards the area of higher salt concentration by osmosis.  There’s conflicting data showing that hypertonic saline may also increase the frequency at which cilia beat, thereby clearing mucus out of the nasal and sinus passageways more rapidly.

Hypertonic solutions might have a downside.  Greiff and his colleagues looked at pieces of nasal mucosa in petri dishes and found that increasing concentrations of saline caused the tissue to secrete more mucus and to react more severely to histamine and another stimulating chemical.  As this study was done in dissected tissue and not live people, the results should be interpreted with caution.

Investigators in another published report did look at the effects of hypertonic solutions in people.  They found that increasing concentrations of saline induced dose-dependent increases in the sensations of pain, blockage, and drippy nose.

In hospitals, hypertonic saline is often used to induce sputum production from the lungs in order to test it for specific bacteria when patients have pneumonia.  It has precipitated asthma attacks in some asthmatics and in those with hyper-reactive airways. Adults and children with asthma need to be careful to avoid aspirating hypertonic saline nasal irrigation fluid into their lungs.

The bottom line is that physiological saline has been found to work, and it’s the least likely salt concentration to cause problems.  If you’re comfortable using a slightly higher concentration of salt, it may give a better response.  The higher the concentration goes beyond what is natural to the body, the more likely there are to be side effects.  Don’t go any higher than 3.5 percent, the concentration of sea water.  Dr. Rabago, a family physician who studies neti, prefers 2 percent. That would be roughly equivalent to 1 teaspoon per 250 ml or 1 measuring cup of water.  He advises patients to adjust the concentrations of salt to their own personal preferences.


How to Quit Smoking: Comprehensive Strategy

Planning in advance and setting a quit date

Here are three things that you need to do before you even try to quit smoking. I would strongly recommend that you do all 3 of these things if you are serious about this. I promise this will work for you if you follow it as planned, because it contains excellent preventative measures for nearly every pitfall that a smoker can run into when they try to quit. Believe me I have done this enough times, and when I finally pulled it off and quit smoking for good 4 years ago, I knew that I had uncovered a truly wicked formula for kicking the habit.

So here are the 3 things:

1) Pick a quit date. Most will need to make this at least 2 to 3 months in advance, due to the other 2 requirements.

2) Start exercising every single day, if you do not already do so. This must be a minimum of 30 minutes per day. No excuses! Do it.

3) Take time off work for the quit. Preferably 2 weeks. Dont say you cant. Just move the quit date further ahead and save more money. No more excuses. Do it if you want to quit.

So these are your preparation steps. You need to start exercising every single day, without fail. This cannot be missed. If you do this it will make it so much easier to stay off of cigarettes forever. You need two weeks off work in order to really make this work right and you also need lots of extra money. Save it up. Dont say you cant. That just means you want to keep smoking and die of lung cancer. Make a decision that you are going to do this for yourself, it will be awesome and you are going to have fun doing it.

Getting through withdrawal with a sledgehammer

OK so here is what you need to do. You are rapidly approaching your quit date and you have some time off work too. On your quit date, smoke your last cigarette and then throw everything away. Throw out your lighters, ashtrays, have a cleaning party. Try to get rid of all the negative, lingering effects of your smoking habit. If you try to hang on to any cigarettes at this point then just forget it and go back to smoking, you are not ready yet. You MUST throw out any remaining cigarettes. Soak them in water and throw them in the garbage. If you dont do this then you have already failed.

Go to the store and buy 3 big containers of cranberry juice. Also buy some chewing gum, chewing toothpicks, and bic pens that have clickers on the ends of them. You might use the gum, the chewing toothpicks, and possibly candy in order to keep your mouth busy over the next week. You might also use the pens and the clickers on the end of them to keep your hand busy while you are walking around in nicotine withdrawal. It helps a little.

So here is how you dominate your nicotine withdrawal in a big way:

Smoke your last cigarette and start drinking the cranberry juice. Do not go to sleep for 36 hours straight.

Review that last sentence again as it is extremely important: Do not go to sleep for the next 36 hours. You are going to stay awake on purpose in order to cut your withdrawal time in half. This actually works, I have done it. It worked perfectly.

Stay up for 36 hours and keep drinking the cranberry juice while you do this. You dont want to over do it of course, but you want to be drinking the stuff steadily over the next 36 hours. Keep sipping it. You will get sick of it. Keep sipping it anyway. It will obviously make you urinate quite a bit. Drink as much as you comfortably can. Keep it reasonable. But keep sipping it.

What you are doing is flushing the nicotine out of your system much faster than usual. This is going to make your withdrawal much faster and much more intense and much worse. However, you are going to sleep through it! That is the beauty of this system. Stay up for the full 36 hours and keep slamming the juice, then crash out at the 36 hour mark and go to sleep.

When you wake up, your withdrawal will be very close to being over. Completely.

This is a beautiful system and if you do it perfectly then you will only be in withdrawal for about 24 hours instead of for 7 days straight. It will be a little bit crazy when you stay up for the 36 hours and slam your juice, but you can have a party and celebrate your new smoke free life while doing this. Or you can just hang out or whatever. It doesnt matter. Make it through this portion of it and you are home free, at least as far as acute withdrawal is concerned.

Massive distraction for the win

The next part of your quit smoking strategy is to make it through day 4 through 14. You already made it past the acute withdrawal stage in days 1 through 3 by sleeping through most of it. Now you are almost out of the woods but you are still on shaky ground. You need a distraction to get you through to the 2 week mark.

This is why I recommend a vacation from work. If you are stuck back at work and you are comfortable smoking there, then that will be a huge trigger. Not a good distraction. What you need is a family vacation. If your family all smokes then take a personal vacation. Whatever. It doesnt matter. But I would plan to go somewhere as both a celebration of your quitting smoking and as a distraction to help you to stay quit in the early stages.

You want a vacation planned where you actually do stuff. Sitting around on the beach all day is probably not the best thing for you. Think more along the lines of amusement park, running around with kids all day until youre exhausted. Yes this might have some stress associated with it, but it is better than sitting idle and ending up relapsing because of it.

Take off work and plan a vacation. The trip will help you to transition into a life of non smoking. And it doubles as a nice reward strategy.

If you say you cant afford it, then you are not planning properly. Save your money and push your quit date further ahead. Are you going to do this or not? No excuses.


How Does Neti Work

Nasal irrigation with neti works by:

  • · Mechanically flushing out bacteria, viruses, dust, and allergens
  • · Thinning remaining mucus so that sinuses and ostia don’t clog
  • · Decreasing swelling of the nasal mucosa
  • · Removing histamine, leukotrienes, and other inflammatory substances
  • · Increasing frequency that cilia beat to remove mucus, crusts and debris

Is There Clinical Proof That Neti Works?

Yes, there’s scientific evidence that flushing with salt water works to decrease the symptoms of rhinosinusitis, or inflammation of the mucosa of the nasal cavity and sinuses that occurs in response to viruses, allergens, bacteria and other irritants.

A study published in the Archives of Otolaryngology Head and Neck Surgery in 1997 asked participants a survey of questions known as the SNOT-20.  They were asked about 20 symptoms such as the need to blow the nose, sneezing, postnasal drainage, cough, runny nose, congestion, trouble sleeping, and more.  Compared to controls that were simply spraying saline into their noses, participants flushing with normal saline (0.9%) using Sinus Rinse irrigations had fewer symptoms, and they experienced those symptoms less often.  They achieved a clinically significant improvement in their quality of life as measured by the SNOT-20 while the spray group did not.

In 2002, Rabago and his group in Wisconsin irrigated the noses of study subjects with 150 ml of 2% buffered saline (1tsp heaping of canning salt, one-half teaspoon of baking soda, and 1 pint of fresh tap water) daily into each nostril for six months.  They found a statistically significant reduction of symptom severity and an improved quality of life.  Use of antibiotics and medical nasal sprays decreased.

Heatley et al also noted that patients reduced their use of medicines significantly due to improvement of symptoms with this natural method of healing.

A study published in Laryngoscope used store-bought dental Water-Pik devices with Grossan nasal adapters (Hydromed or Kenwood Therapeutics) to irrigate both nostrils of subjects with 250 ml of lukewarm tap water with a half teaspoon of table salt twice a day.  They reported improved symptoms of congestion, postnasal drainage, allergies and discharge in 23 out of 30 participants after six weeks of use.  92% of the study participants completed the six week program, signifying its practical ease of use.

A 2009 study looked at the common cold in children.  On average, kids get 6-8 per year, and the US Food and Drug Administration recently changed the label on all over-the-counter cold medicines to prohibit their use in kids younger than 6 years of age.  In this report, 69 children aged 3-12 years first saw a film on neti and witnessed a facilitator perform it.  They then demonstrated proficiency using disposable syringes filled with 15-20 ml of normal saline (0.9%) per nostril, and were instructed to perform the action 1-3 times per day. At the end of the study period, the children showed an overall improvement in nasal air flow, decreased symptoms indicating improved quality of life, and an improvement of pathology noted on sinus X-rays.

A small randomized controlled trial in children with lab confirmed pollen triggered symptoms found that saline irrigation in addition to antihistamine pills significantly reduced allergy symptoms and the amount of medicine taken.  In comparison, when only antihistamine treatment without nasal irrigation was used, kids were noted to obtain less symptom relief and required more medicine to be comfortable.

Adults with hay fever, have also reported improvement of allergy symptoms when using saline nasal irrigation in clinical trials.

Pregnancy inhibits many women from using cold and allergy medicine for symptom relief.  A recent study asked pregnant women with seasonal allergies to irrigate their sinuses with saline containing a higher than usual concentration of salt.  They irrigated 3 times daily for 6-weeks as opposed to a control group who used no local therapy.  Those irrigating noted a statistically significant improvement in symptoms from 2-weeks on throughout the remainder of the trial.  Rhinomanometry, a measure of nasal airway resistance, also improved, an objective measurement of decreased congestion and ease of breathing through the nose.

Woodworkers with chronic symptoms from wood dust demonstrated significantly improved mucociliary clearance and nasal air flow on expiration after a program of nasal saline irrigation.

Neti has also been show to be an effective method for preventing viral infections of the nasal cavity and sinuses.  A randomized, controlled study of 60 adults found that those performing daily nasal irrigations had fewer episodes.  When they did get infected, their symptoms lasted fewer days.

There’s also a preventative effect in kids.  In a randomized, controlled study of 390 children, those irrigating their sinuses with saline had fewer episodes of sinus congestion and runny noses.  Those using neti on a preventative basis were less likely to end up being treated with medication.

There are many more scientific studies showing positive and genuine results with neti, too many to write about them all.