Salt Spas - Halotherapy and its Benefits

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    Questions answered in this article include:

    • What is a salt lounge?
    • Are salt rooms good for you?
    • Can salt therapy be harmful?
    • Is a salt spa the same as halotherapy?

    Your body needs sodium. Sodium helps regulate fluids in the body, contracts and relaxes muscles, and helps in the transmission of nerve signals.

    Halotherapy is the latest twist in ancient wellness routines based around the medical qualities of salt (sodium chloride). Halotherapy involves relaxing in a salt lounge, where you breathe salt-rich air, with the aim of feeling more energised, having better skin, and possibly alleviating some respiratory conditions.

    In this article we’ll trace Halotherapy’s roots from antiquity to a surprising discovery in Eastern Europe, right through to the ultra-modern salt spas that are spreading all over America. We’ll describe the difference between ‘wet’ and ‘dry’ methods and investigate health claims made by its proponents.

    The Origins Of Salt Spas

    6000 BC

    Prehistory

    Salt has always been an essential part of medicine. It has been used as a remedy, a support treatment, and a preventive measure. It has been taken internally or applied topically in a wide variety of its forms.

    6000 BC

    1600 BC

    Ancient Egypt

    In Egypt, the Ebers papyrus listed salt recipes for laxatives and anti-infectives dispensed in liquid, suppository, or ointment form. Salt-based remedies were also prescribed for bleeding, wounds, and to accelerate childbirth.

    1600 BC

    129-200 AD

    Ancient Greece

    In Greece, Galenus of Pergamon (129-200AD) created a healthcare system that made use of salt in recipes against a variety of diseases like skin problems, infectious wounds, and digestive troubles. A physician to Marcus Aurelius and to gladiators, Galenus is considered one of the most accomplished medical researchers in history.

    129-200 AD

    1839

    Poland

    Felix Boczowski, a physician, notices the excellent health of local salt miners and creates the first salt cave spa. More on him below.

    1839

    1949

    Karl-Hermann Spannagel Invents Speleotherapy

    A similar story to the Polish case with the first clinical studies. Read more below.

    1949

    1976

    The First Halotherapy Machine

    The first halotherapy machine was invented in 1976 by Russian scientists and doctors. Called a halogenerator, this machine attempts to recreate the beneficial microclimate conditions of salt mines by grinding pure salt into micro-sized particles and releasing the aerosol via a fan.

    1976

    Felix Boczowski and the Salt Mines at Wieliczka

    Wieliczka is a town in Poland near Krakow. It’s famous for its salt mines – they’ve been in use since 1250.

    While “mining” calls to mind images of dark tunnels and dank underground, the Wieliczka is so much more.

    Chapels have been built out of salt caverns with the Chapel of St Kinga (Kaplica Św Kingi) being the most exceptional. In close vicinity to the chapel is the Erazm Barącz Chamber where you will find a beautiful underground salt lake. Its salty waters are said to be even denser than that of the Dead Sea’s.

    From Mine to Health Center

    In the nineteenth century, physician Felix Boczowski noticed that the men working in the Wieliczka salt mines had shockingly healthy respiratory systems.

    While coal miners had a history of relentless and deadly respiratory ailments, these ​salt miners had better respiratory health than even average people.

    Being a shrewd businessman and health resorts being in fashion in Europe at the time, Boczowski set up the first underground health facility in the Wieliczka salt mine in 1839. Starting out with 12 well-furnished patient rooms, the facility offered bath-house services that included brine baths, steam inhalations, and baths in salt mud and sulphuric waters from Swoszowice. There was also a park where its visitors could stay and listen to the miners’ orchestra.

    But Dr. Boczowski did not stop there. After years of research and observation, Boczowski concluded that the prevailing underground microclimate (an aerosol of salt and other minerals and constant temperature) had a positive effect on the body’s respiratory system. He published his findings in About The Breathing of Salt Dust. Later, he would be credited for the first Polish scientific dissertation in the field of saline treatment: About Wieliczka in terms of natural history, history and bathing (Bochnia, 1843).

    A century later, Professor Mieczyslaw Skulimowski took over the Wieliczka Salt Mine and developed a new field of medicine – subterraneotherapy. This kind of treatment exposes patients to pre-determined elements of the microclimate of salt excavations.

    These microclimate elements include:

    • stability of conditions that do not depend on the prevailing seasons above-ground
    • absence of the usual allergens like pollen and dust
    • low presence of microorganisms in the air
    • self-purification of the surrounding air

    Karl-Hermann Spannagel and Speleotherapy

    In neighboring Germany, Karl-Hermann Spannagel was making his own discoveries underground. Because of WWII and the resulting bombing raids, the locals in the area sought shelter in the Klutert cave. This cave was one of the largest natural caves in Germany, and it happened to also be one of the few natural salt caves in the country.

    Patients with respiratory problems noticed that the Klutert cave had a healing effect on them. This spurred Dr. Spannagel to initiate the research for what was to become known as speleotherapy. The Greek word speleon means cave (hence ‘spelunking’). It is a type of treatment that uses properties specific and unique to karst (land made of limestone), caves, and salt mines in order to treat breathing and skin problems.

    Dr. Spannagel conducted clinical studies – commissioned by the German government – on the treatment of childhood asthma and bronchitis in the Klutert cave.

    Dr. Spannagel with a clipboard (left), study participants in the subterranean chambers (middle), a round of table tennis (right)

    The Kluterhöhle, as it is known in Germany, became the first German underground therapy station and the first speleotherapeutic medical establishment.

    Spannagel’s therapeutic approach did not spread in Germany due in part to the small number of natural salt caves in the area but it gave rise to the formation of speleotherapy clinics in Eastern Europe.

    The first speleotherapy department and allergological hospitals opened in Solotvno in the Ukraine, followed by Chon-Tuz in Kyrgystan, Nakhichevan in Azerbaijan, Berezniki in Russia, Salihorsk in Belarus, and Brystianska in Slovakia.

    Karl Hermann Spannagel receiving a plaque of recognition. Photo Credit: Westfälische Rundschau

    Active Speleotherapy And Halochamber Clinics

    Maintaining speleotherapy clinics throughout history has been challenging at best. The Wieliczka salt mine was sometimes closed owing to revolts and political unrest. In the Ukraine, the salt mine at Solotvyno flooded in 2010. The speleotherapy establishment in Soledar operated for 9 years before it was closed after the Russian annexation of Crimea.

    Despite the odds, speleotherapy clinics in Europe are still active and operational today. Here are a few of the more interesting ones.

    Belarus' National Speleotherapy Clinic

    This is a speleotherapy clinic located within a salt mine near the town of Soligorsk. Operated by the state since 1990, it is one of the leading speleotherapy facility in the CIS (Commonwealth of Independent States). It provides medical treatment to more than 7,000 people suffering from respiratory diseases that visit every year.

    Located 420 meters underground between layers of potassium and stone salts, it used to operate as an ore mine.

    A mine in the Starobin potash salts deposit: rare combination of sylvinite and halite

    As per the Belarus government, patients receive care in these labyrinthian salt caves that have a unique microclimate of sodium, magnesium, and potassium ions. A constant temperature of 16 degrees above zero is carefully maintained, alongside humidity, gas optimization, and air ionization – all contributing to a microclimate purified of microbes, allergens, and impurities. The New York Times favorably described the air as “tangy”.

    The clinic offers medical treatment for:

    • bronchial asthma
    • chronic obstructive pulmonary disease
    • chronic bronchitis
    • nasal asthma
    • allergic rhinitis and other allergic diseases

    Treatment lasts for 19 days and include 17 procedures. The State observes that 70% of cases lead to remission that lasts from 6 months to as much as 2 and a half years. When repeated, the remission period can extend up to 3 years.

    In these salt caves, patients enjoy ball games, a gym, and lounges where they can spend time reading. There is no television, internet, and mobile phones so as to minimize electromagnetic radiation.

    Pavel Levchenko, one of the surgeons of the clinic emphasizes though that the facility is NOT a spa or a tourist attraction. He says, “People who come here have to be motivated. They have to be sick. We don’t want healthy people.”

    Belarus' Halochambers

    Not all of the institution’s patients are able to go below ground. Because of this, Belarus also offered artificial speleotherapy chambers.

    Found in regular locations above ground, these are rooms made from salt blocks equipped with a halogenerator that releases a special salt aerosol.

    Wieliczka Underground Health Resort

    Wieliczka has continued its tradition of providing services as a health resort using subterraneotherapy. As per their website, they aim to provide prevention, therapy, and treatment of respiratory illnesses as patients stay more than 400 feet below ground.

    Their Underground Treatment services range from daytime visits to overnight stays in the salt mines. The temperature is kept around 13°C (55 F).

    The rehabilitation program relies on physiotherapy activities like respiratory gymnastics and the salt mine’s specially developed curative microclimate (free from allergens, bacteria, fungi and electromagnetic radiation).

    Wieliczka underground lodgings

    Those staying overnight are housed in the Eastern Mountains’ Stable Chamber, which (as the name suggests) housed the mine’s horses in the early 20th century.

    Today, the health resort calls this section a “natural inhaler” with a reading room, sleeping pods, and brine graduation towers.

    Because the facility is state-approved and supported, the services of the underground hospital is available to patients with a Polish National Health Fund referral. The health resort employs medical professionals specialized in pulmonology, layrongology, and allergology to name a few.

    Halotherapy In the US

    Halotherapy and Halochambers

    While speleotherapy was becoming more well regarded in Europe, it was still limited to people able to travel to salt caves. There was demand for some kind of above-ground solution. That demand was met in 1976 when Russian scientists and doctors created a halogenerator. A halogenerator attempts to recreate the beneficial microclimate conditions of salt mines.

    The creation of this new device was a big step – instead of going deep underground to experience speleotherapy, one could achieve the same results in any suitable room equipped with a halogenerator (so the theory goes). This is how dry salt therapy, or halotherapy, found its way to US shores.

    Salt Spas And Lounges

    Although not yet as accepted by US medical practitioners as a serious healthcare treatment as it is in Europe, it has nevertheless found a new home in the wellness niche. Today, there are over 1,000 salt therapy facilities in different states.

    Salt Spa FAQ

    What Is a Salt Lounge?

    A salt lounge is a room that simulates natural salt caves. Designed to be relaxing to the senses, visitors lie back in comfortable recliners and inhale salt-laden air sprayed by a halogenerator.

    Temperature, humidity, and air ionization are carefully controlled to mimic the salt cavern microclimate that is said to be so beneficial in its subterranean counterpart.

    How Does It Work? What Is a Halogenerator?

    Salt spas are equipped with halogenerators. Dry pure salt crystals that are contaminants-free are placed into the machine which then cuts, crushes, and grinds them into microscopic particles.

    A blower apparatus pumps the particles into the room so that visitors can breathe in this salt-laden air.

    what is a halogenerator

    When you can control the particle size and the concentration of how much salt is being inhaled; that’s where the efficacy comes from.

    The Salt Therapy Association

    How Long Is One Session?

    While salt aerosol inhalation depends on salt concentration in the air, a session in a salt spa can last anywhere from 30 to 45 minutes.

    How Often Should You Go to a Salt Spa to See Results?

    People with seasonal allergies usually go 3 to 4 times a week. Others with chronic illnesses who find relief in salt lounges go 6 to 8 times a week.

    Casual visitors who simply go to relax and unwind book sessions as often as they like.

    Photo Credit: Kilkenny Salt Therapy

    How Much Is One Salt Spa Session?

    Depending on how luxurious your destination spa is, prices can range from $40 for an hour, $25 for 10 minutes in a salt booth, to $75 for a day pass.

    The Benefits of Halotherapy

    Salt therapies like speleotherapy and halotherapy are accepted non-pharmalocological therapies in Eastern and Central Europe. In the words of this study on speleotherapy and halotherapy:

    There are a number of publications on this issue in [many European medical journals] ... and in some EU countries, some types of rehabilitation and spa treatment for certain groups of patients are partly provided by the healthcare system.

    O.I. Lemko, I.S. Lemko

    Keeping in mind that facilities like Wieliczka and Belarus’ National Speleotherapy Clinic are state-owned and managed, and that patients availing of services are often covered by health insurance, it is safe to say that these practices are accepted as non-pharmacological therapies by the medical community in the EU.

    The US still has to catch up on speleotherapy and halotherapy practices, though. For now, they are relegated to the wellness community as health spa alternatives.

    For those who are wondering about the benefits of halotherapy in particular, here are some studies that have shown positive results in the following aspects:

    Depression and Relaxation

    Salt caves as simulation of natural environment and significance of halotherapy

    In a 2014 Polish study, 303 individuals aged 18-51 from Katowice, Kraków, and Rzeszów were surveyed on their knowledge and experiences of salt caves. The survey revealed that 57% of the women and 39% of men bought salt cave sessions for therapeutic reasons. A general finding was that those who attended felt better after the sessions they went to.

    Asthma

    Halotherapy as asthma treatment in children: A randomized, controlled, prospective pilot study

    In a 2016 randomized, double-blind study carried out in Israel, children between the ages of 5-13 years old with mild asthma were randomized to a salt room with or without a halogenerator. Initial results suggest that halotherapy may have positive effects in children with mild asthma.

    Optimal therapy of children with bronchial asthma at Pyatigorsk spa

    A study on children suffering from bronchial asthma in Pyatigorsk showed that a combined treatment of halotherapy and dry air-radon baths gave better results than the separate therapies.

    Other Respiratory Ailments

    Halotherapy in the combined treatment of chronic bronchitis patients

    Patients with chronic bronchitis were treated with halotherapy along with other modalities. Results indicated that halotherapy increased the efficacy of treatment in the sanatorium.

    Effects of halotherapy on free radical oxidation in patients with chronic bronchitis

    Forty-nine patients with chronic bronchitis were treated with a combination of modalities including halotherapy. The introduction of the latter advanced the improvement of the patients’ conditions.

    The scientific validation and outlook for the practical use of halo-aerosol therapy

    This is a paper discussing two methods: halotherapy and halo-inhalation. Features and contrasts of the two methodologies are analysed.

    Adenotonsillar hypertrophy (AHT)

    Double-blind placebo-controlled randomized clinical trial on the efficacy of Aerosal in the treatment of sub-obstructive adenotonsillar hypertrophy and related diseases.

    In a 2013 study in Italy, a total of 45 patients who had cases of adenotonsillar hypertrophy were given either aerosol halotherapy or a placebo treatment in a randomized fashion over the course of 10 treatment sessions. In their analysis of results, it was found that twice the amount of the patients given the placebo experienced positive effects.

    Sports Performance

    In a 2012 study in Romania, 12 teenage runner athletes underwent halotherapy treatment. After 21 days, an evaluation of their respiratory and cardiovascular health was performed. The results showed an increase in respiratory volumes for all the runners with some of the participants bumping up to “excellent” indices.

    Cautionary Notes

    Of course, not all studies showed positive results. Some were inconclusive and most recommended more precise studies with bigger trial groups.

    One oft-referenced example is Rashleigh et al’s attempt on a meta-analysis of existing articles and studies on halotherapy. The researchers reviewed 151 articles but only one study met the inclusion criteria set by the group. (It must be noted though that non-English studies were excluded from the database search.) The end result was that halotherapy could not be recommended as a viable COPD therapy and the group determined that more high quality studies need to be done.

    Placebo Effect

    While salt spa goers usually report positive experiences, there does exist the possibility of a placebo effect. This refers to how a drug or a treatment works mostly because of one’s belief in said drug or treatment.

    Dr. Niket Sonpal, an assistant professor at the Touro College of Medicine is skeptical of the efficacy of halotherapy and credits improvement of a patient’s depression and anxiety to the placebo effect.

    Dr. Norman Edelman, Senior Scientific Advisor to the American Lung Association, on the other hand, believes otherwise and explains how salt therapy offers relief from the distressing symptoms of COPD or asthma.

    Can Salt Therapy Be Harmful?

    Salt therapy — like gargling or nasal irrigation — has proven beneficial to one’s health across time. Halotherapy, on the other hand, is relatively new and studies on its safety are sparse. In the US especially, halotherapy is done in spas where there is no strict standardization of salt dosages administered.

    Also, there are usually no medical staff on hand to handle a medical emergency unlike in the EU where this type of therapy is part of medical establishments and clinics and even approved by their health insurance companies.

    Proponents of halotherapy, in the meantime, state:

    We understand more studies are needed to understand if there are any further contraindications, but we can confidently say that thousands of individuals have experienced salt therapy throughout the decades, and none have suggested the contraindications were present. We also encourage individuals to consult their local physician before beginning any regiment of dry salt therapy.

    The Salt Therapy Organization

    Citations and References

    Bar‐Yoseph, R., Kugelman, N., Livnat, G., Gur, M., Hakim, F., Nir, V., & Bentur, L. (2017). Halotherapy as asthma treatment in children: A randomized, controlled, prospective pilot study. Pediatric pulmonology, 52(5), 580-587.

    Chervinskaya, A. V. (2003). Halotherapy of respiratory diseases. Physiotherapy, balneology and rehabilitation, 6, 8-15.

    Chervinskaya, A. V. (2007). Halotherapy in controlled salt chamber microclimate for recovering medicine. Balneologia Polska, 2, 133-141.

    Chervinskaya, A. V., & Zilber, N. A. (1995). Halotherapy for treatment of respiratory diseases. Journal of Aerosol Medicine, 8(3), 221-232.

    Cătălina, S., Cătălin, S., & Ion, S. (2012). Impact assessment of saline aerosols on exercise capacity of athletes. Procedia-Social and Behavioral Sciences, 46, 4141-4145.

    Farkhutdinov, U. R., Abdrakhmanova, L. M., & Farkhutdinov, R. R. (2000). Effects of halotherapy on free radical oxidation in patients with chronic bronchitis. Klinicheskaia meditsina, 78(12), 37-40.

    Gallicchio, V. S. (2014). Use of Trace Elements and Halotherapy in the Treatment of Human Diseases. Pharmacology and Nutritional Intervention in the Treatment of Disease, 44-95.

    Gelardi, M., Iannuzzi, L., Miani, A. G., Cazzaniga, S., Naldi, L., De Luca, C., & Quaranta, N. (2013). Double-blind placebo-controlled randomized clinical trial on the efficacy of Aerosal® in the treatment of sub-obstructive adenotonsillar hypertrophy and related diseases. International journal of pediatric otorhinolaryngology, 77(11), 1818-1824.

    Hübelova, Dana & Kozumplikova, Alice & Caha, Jan & Überhuberová, Jarmila. (2019). Who Are Paediatric Speleo Therapy Patients?.

    Iu, S. (2013). Speleotherapy development in Romania on the world context and perspectives for use of some salt mines and carst caves for speleotherapeutic and balneoclimatic tourism purposes. Balneo Research Journal, p ISSN, 2069-7597.

    Josef Cáp; Pavel Slavik; Ladislav Pecen (2007), Stanovení endogenního kortizolu u dìtí (PDF) (in Czech), archived from the original (PDF) on 18 July 2011

    Lemko, O. I., & Lemko, I. S. (2017). Speleotherapy, halotherapy, haloaerosoltherapy: definitions, mechanisms of influence, perspectives of usage (part І). earth, 20(67), 68-74.

    Lăzărescu, H., Simionca, I., Hoteteu, M., & Mirescu, L. (2014). Speleotherapy–modern bio-medical perspectives. Journal of medicine and life, 7 (Spec Iss 2), 76.

    Maev, E. Z., & Vinogradov, N. V. (1999). Halotherapy in the combined treatment of chronic bronchitis patients. Voenno-meditsinskii zhurnal, 320(6), 34-7.

    Rashleigh, R., Smith, S. M., & Roberts, N. J. (2014). A review of halotherapy for chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease, 9, 239.

    Sokolova, M., Ivanova, N. A., & Shabalov, N. P. (2007). Optimal therapy of children with bronchial asthma at Pyatigorsk spa. Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury, (3), 8-12.

    Zajac, J., Bojar, I., Helbin, J., Kolarzyk, E., & Owoc, A. (2014). Salt caves as simulation of natural environment and significance of halotherapy. Annals of Agricultural and Environmental Medicine, 21(1).

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