Reducing Exposure to Nontuberculous Mycobacteria (NTM)

Thank you. It sounds like you’ve worked out a system. It wasn’t Dr .Falkinhamm’s info about distilled water that concerned me, though it’s helpful info. I read reviews on a couple on Amazon and was concerned about the filters and comments about the smell one of them got. I’d love to be able to compare a couple in person.
Does your entire inside distiller get tohigh temps as it distills?

I should add that I’d be using it for sinus rinses.

Thank you!

Thank you so much for sharing. This was very, very helpful. Will surely change to spring water. I set my hot water heater to 140° but now I realize the sediment may be harmful in that hot water heater. So appreciative.

I thought purified was better?

Municipal and well water (drinking water) are tested, and required to meet specific levels of purity. Mycobacteria is not one of the pathogens tested for because it is everywhere in water, soil and air, and most people are not adversely affected by it.

That leaves those vulnerable to infection to figure out how to best get the pure water they want. So here is a little tutorial on these terms:
Drinking water
Purified water
Filtered water
Distilled water
Sterile water
Spring water

There is no standard for "purified" or "filtered" water in the US. Most purified or filtered water comes from municipal water supplies and is bottled in plants that are only concerned about safety (as in no e. coli) and clarity, so clean techniques are used, but not necessarily sterile. To be free of mycobacteria filtered water must pass through .2 micron filters - I'm not aware of any bottling plant that does this.

Distilled water is processed into steam and then returned to it's liquid state. It is sterile after the process, but if it is not bottled under sterile conditions, may become contaminated as well.

Sterile water, such as the liter bottles used for cleaning wounds, is sterilized by boiling or distillation, then immediately bottled under sterile conditions. Once opened, it is used on a single patient and discarded after 24 hours.

Spring water comes naturally to the surface from underground, and is required to be bottled in such a way as it does not become contaminated. Dr Joe Falkinham and his students have tested many brands of spring water and found them to be free of mycobacteria.

Tap water may be treated at home to make it free of mycobacteria. It may be boiled for 10 minutes plus 1 minute for each 1000 feet above sea level or it may be passed through a .2 micron filter. In either case, it must then be stored in sanitized containers.

Tap, filtered, purified and spring water may still contain dissolved solids (generally minerals) which do not mean it is unsafe.

Do you know if Mountain Valley Spring water and Mountain Valley Sparkling water have been tested by Dr Joe Falkinham?
Have a great healthy day!

Are there any water pitchers with the 0.2 micron filters

Hi lilianna. Yes, the LifeStraw pitchers have a pore size microfilter of 0.2 micron. I have one that I use for cleaning my nebulizer and Aerobika parts and am pleased with it.

I don't have a list at hand. Dr Joe's point was that the amount of mycobacteria, if any, in bottled spring was so low it did not pose a risk. Even at NJH, it is what is offered to patients and visitors.

I am going to repeat something here that I have said before on Connect. I am not trying to offend anyone, but rather try to bring another point of view.

Mycobacteria is EVERYWHERE, and you cannot avoid it entirely. The point is to try to REDUCE EXPOSURE to a safer level for those of us with Bronchiectasis and MAC.
What does that mean in practical terms?
I'm only going to talk about water here.

For that stuff we stick directly into our lungs, we get as close to zero as possible. That means being diligent with all of our devices - diligence to some means cleaning and disinfecting after each use, to others it means cleaning after each use and disinfecting once a day, and for still other it means cleaning daily and disinfecting after X number of uses. All of these can be OK depending on the fragility of the patient. But NTM is not going to grow on your device within 8 or 12 or 24 hours if you wash it. Also, testing shows that nebulizers lose at least 20% of their effectiveness after 60 cycles in a sterilizer.

When you clean or sterilize devices, no need to use sterile water - it becomes sterile along with everything in it when heated. Whether to use tap, filtered or distilled water is up to you and the instructions for what you are cleaning.

For stuff we are exposed to every day that produces mist, like showers, we heat our water above 135F, sanitize the shower heads monthly, use showerhead with big holes to reduce, turn on the exhaust fan and take a short shower. Did you know one of the best thing you can do is keep your toilet seat lid closed, especially when flushing?

For things like washing clothes & dishes, don't stand over the a sinkful of steaming water. Fill the sink full of dishes with HOT soapy water, leave the room and come back when it has cooled (less vapor) to finish - and your dishes have mostly soaked clean. If you have one, load the dishwasher, run it, open it when done to airdry and leave the room. Keep your sink clean - it can harbor a lot of nasty bugs besides NTM. Close the washing machine and leave the room while it is running and emptying to avoid the most exposure.

Stay out of obvious, known sources of exposure - hot tubs (indoors and out), indoor swimming pools (and the rooms that contain them) and outdoor misters. Enjoy a dip in an outdoor pool, the ocean or the gulf. Some brave souls also swim in lakes and rivers - I am one, but take care to keep my head out of the water.

Drinking water - remember we are MINIMIZING exposure - if you have or possibly have GERD, or a swallowing problem, this is more important because you have the risk of aspirating water into your lungs. For the rest, swallowed NTM will pass through your body and out - it will not colonize in your stomach or intestines or migrate to your lungs.

Refrigerator water filters and Carbon filters (including reverse osmosis) can harbor and grow NTM - avoid them. But, is it OK to have ice in a beverage occasionally when eating out? That depends on your risk tolerance - it is OK for me, but you might decide otherwise.

Filter or Boil? Doing both is not necessary, as long as you use a .2 micron filter & change it according to directions.
Note: There are .2 micron filter Lifestraw pitchers for countertop use and household or single-source filters for faucets. I am not planning to get into a discussion of .2 micron filters, brands and installation - there are a wide variety available online from water purification experts. Mine is installed in-line between a carbon filter that takes out the "big stuff" and a separate filtered water faucet at the kitchen sink. There are other choices out there

CAUTION: All precautions are for nothing if you don't clean and sanitize your water pitchers and bottles, caps and straws regularly soak in Dawn & water, scrub with a brush, sanitize in VERY hot water or in the dishwasher on the sanitize or hot-dry cycle.

Bottled Water - I drink bottled spring water, because per Dr Falkinham the NTM counts are so low as to be safe. He has dedicated his lifework to studying NTM in water, so I trust him and his opinions. I do not open bottles and leave them sit around for a few days, because I assume once I put my mouth on them I am introducing germs, and not just NTM.

Thanks for reading what has turned out to be a long post - the whole point of it is that there is NOT one and only one best answer. I have chosen a path, for the past six years, that was first recommended by my ID doc "Take reasonable precautions, then go out and live your life. You are going to live with this for the rest of you life. Don't let it consume you."