With proven benefits shown for hypertonic saline in restoring airway surface liquid, one might make the assumption that being in a room filled with salt would be beneficial for people with cystic fibrosis. Indeed, CF is often mentioned specifically among the respiratory disorders Salt Spas (also called salt caves, salt grottos, or halotherapy chambers) claim to ameliorate. That doesn’t happen often, if I’m honest. Usually the closest we can get to being marketed to is asthma or bronchitis. So it almost makes it feel sort of special, that salt caves would be popping up around the country, as if they were made to cater just to us.
Of course, that is not true by any stretch. The salt rooms and spas that offer halotherapy generally assert that they’re specially designed with a very specific distinction of salt rocks which can treat everything from migraines to high blood pressure, chronic fatigue to, of course, breathing difficulty. For any layperson who wants to critically examine such an idea, this should be the first red flag. In all actuality, salt room businesses didn’t open with us in mind, it just so happens that they used legitimate research done concerning cystic fibrosis as a platform to advertise as a medically supported therapy.
Annoying as that is, it is smart business. Securing a loan, insurance, acquiring real estate for an actual brick and mortar location, furnishing it with high quality halite imported from the Himalayas and Eastern Europe…it all gets pretty expensive. It would be a very poor profit plan if your wellness center could only accommodate a relatively tiny demographic, as opposed to nearly everybody who has considered themselves ill at one point or another. The problem comes when these businesses, who sell themselves on scientifically sound principles, step off into pseudoscientific territory, making illogical and dubious claims as extensions of proven therapy.
When a person or entity makes a claim, it is incumbent on them to provide evidence to back it up. As it stands, very little examination of salt spas has been done, and most certainly not with the vigorous scientific standards which would be required to be accepted in peer review. So when confronted, people with a personal stake in a salt cave business may grasp at research that could be cherry picked, or misapplied for a broader meaning. That’s what they do when they use cystic fibrosis research (among others) into salt therapy to rationalize the parameters of their claims. (In fact, some halotherapy companies have been reprimanded for advertising they can treat specific diseases such as CF and psoriasis).
Another thing they do, is supply testimonials, and appeals to antiquity and cultural wisdom as support. Salt cave supporters resort to stories of the thousands of people who’ve found relief in salt caves world wide, many times, as witnessed by their own eyes. But these are just anecdotes, most likely of the placebo variety. In fact, the entire set up is aimed at psychosomatic relief. Salt rooms use masterful lighting schemes, intimate spacial design and soft, squishy recliners to manipulate the anxiety levels of the user. Really, it’s a pleasant way to while away an hour. Though, for the price being charged, one would hope it’s providing more than a relaxing atmosphere to doze away one’s worries.
So let’s look at the claims of the average salt room, and see if there’s anything more that could be leaving the user feeling refreshed, and breathing better. First, there’s the micronutrients that are allegedly being absorbed during your time in the salt room. Business owners assert that the average person is deficient in the minerals like bromide, iodine, and potassium, but appropriate levels can be gotten through their salt. In reality, potassium-iodide related deficiencies have been significantly curbed in first world countries thanks to fortifiers in salt, and most people manage to get the necessary amounts of these through their food. In any case, one doesn’t go to a salt cave to eat the salt, so instead, they suggest that simply being in the room with the stuff is enough to right any imbalances you’ve been experiencing.
Next is the unsurprising declaration of ionization to heal the daily stresses from modern life. Aside from the fact that there’s not much credible evidence to accept that our bodies are effected by charged particles of any kind, negative ion output from salt is, as I have explained in this post, pretty much a marketing myth. There’s also no way to support the claim that salt cave air is any cleaner than normal air, certainly nothing that could quantifiably be stated as a fact.
With halotherapy, as is common in pseudoscientific alternatives, there’s a lack of prior plausibility. That is, the likelihood that a remedy could work the way it claims to work based on what we know about the laws of nature. When the plausibility is low, it raises the stakes for the burden of proof. In other words, extraordinary claims require extraordinary evidence.
Studies supporting these claims are scant, mostly published in Russian or Polish journals, and have been criticized for being vague, biased, and of low quality. Many salt spas use dry aerosol “salt generators” which grind up salt into tiny breathable particles and blow them into the air. One such generator has been clinically studied in Russia, the Halomed device, and was shown clinically effective for respiratory and skin conditions, however, the study’s prime author, Alina Chervinskaya, is a minority owner of Halomed.
A few prominent pulmonologists have warned against salt rooms and salt generators for the treatment of asthma. Salt being a known irritant, it can cause airways to contract, which may trigger an asthma attack. However, overall, the risks associated with going to a salt cave are low, the real “danger” being that of a thinning bank account. In general more salt isn’t a bad thing for CF patients, and one CF specialist in Florida has noted that while FEV1 remained unchanged, a small number of patients who he has referred to a salt spa for multiple treatments have reported less congestion and sinus pressure. Still, the benefits of going to a spa for halotherapy are unproven to be better than a placebo, and are likely short lived.