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Taken with a grain

As I lie back on a lounger in a slightly weird but very comfortable salt-lined grotto, a magazine perched on my lap and soothing nature documentaries on the giant television in front of me, it strikes me that this is the least unpleasant medical treatment I've ever had. The experience is marred only by the deeply unattractive blue plastic shoe-covering booties on my feet, to protect the salt that covers the floor.

The slight tang of salt in the air gives away what the treatment is: salt therapy. Also known as halotherapy and speleotherapy, it involves breathing in the tiny particles of salt that are being pumped into the air around me. There are various supposed benefits, most of them lung related.

The therapy has its roots in naturally occurring salt caves in eastern Europe. But I'm a bit nearer home, in Central, at the newly opened Inhalo, which houses Hong Kong's first so-called salt caves.

The simplicity of the treatment - there really is nothing to it except lying back in a room and breathing - along with a shortage of credible clinical studies, can make it hard to swallow (or indeed, to inhale) some of the claims. Like most people, I'm accustomed to thinking of salt as essentially bad for me, but according to the halotherapists, it's the method of ingestion that counts.

If salt is inhaled rather than eaten, proponents of the therapy claim that it is effective against a range of conditions. These include asthma, cystic fibrosis, emphysema, psoriasis, ear infections, allergies, bronchitis, colds and even snoring.

Salt therapy emerged in the 19th century when doctors in Poland noticed that salt miners didn't seem to suffer from respiratory conditions. But it took off in the past decade, with spas like Inhalo that recreate salt cave conditions mushrooming around the world.

It has spread, in particular, to western Europe, North America, Australia and, thanks to the many people with eastern European heritage there, Israel. It was there that Inhalo CEO Omri Shamir, an asthmatic, became convinced of its benefits. 'After a few sessions, I felt better. Not completely better - you never get completely better with asthma - but I only had to use my inhaler occasionally, when I'd been using it every day before.'

He and his wife, marketing director Caroline Goldsmith-Shamir, gave up their jobs in academia and marketing and moved to Hong Kong to set up the spa. 'We think Hong Kong is perfect for this,' explains Caroline, saying that because of the city's wealth, there is an openness to alternative therapies. There are also a host of respiratory problems, most caused by cramped living conditions and air pollution.

Sessions at Inhalo last for 50 minutes - 30 minutes for children - and a minimum of 10 to 15 sessions are recommended, two to three times a week. That can add up to more than HK$7,000 - and, unlike a lot of medical treatments, the raw materials aren't exactly expensive.

About four to five tablespoons of medical salt imported from Europe are used in an adult session, with about five milligrams of it actually absorbed by the body.

The only moving part is the generator that grinds up the salt to microscopic quantities and distributes it into the air. The rock salt decorating the floor and walls of the salt caves is purely cosmetic. It took a couple of months to dry out properly between the couple taking over the premises and being able to declare Inhalo open.

It's also possible to undergo a form of salt therapy that doesn't involve sitting in Santa's grotto. This is courtesy of a salt pipe, which is a specially designed pipe filled with salt crystals.

Inevitably, having only sat through a single session, I didn't notice any improvement in my respiratory functions.

But it was at the very least a nice experience. Potential side effects are mild - my own seemed to be fairly typical, including a faint prickly sensation on my arms and around my eyes that persisted until washed away with a shower, and a vague taste of salt in the back of my throat that persisted until washed away with a beer. Of course, what goes in must come out, so expect a certain amount of mucus.

The big problem for salt therapy, as with so many alternative treatments, is a lack of robust scientific evidence. There are certainly plenty of people convinced of its benefits. But the medical profession is still largely sceptical. 'Some doctors are receptive,' says Caroline, optimistically.

But, clearly, many are not. 'This is definitely non-evidence-based, and not approved by any sensible, normal person,' says Professor Kenneth Tsang of the department of medicine's division of respiratory and critical care at the University of Hong Kong. Most of the existing papers on the subject, he adds, 'are obscure or unreferenced sources. Superficially, there seem to be some European Respiratory Journal papers which are good scientifically if you look at the standing.

'But if you look at the actual papers, they were not fully published projects but rather abstracts in meetings, which carry next to nothing in terms of standing.

'Overall, I am afraid there is not enough evidence to justify any use of salt therapy treatment in a straight scientific sense.'

There are, for example, Russian studies from 2004 and 2006 that claim a reduction in a range of symptoms, including coughing, and an improvement in lung flow/volume among people at risk of chronic obstructive pulmonary disease, and smokers, who used a salt-based inhaler.

But cast around for medical evidence of salt therapy's effectiveness and you'll find plenty of quotes from the author of those studies, Dr Alina Chervinskaya of the Federal Medical and Biological Agency in St Petersburg, who herself had a hand in the development of salt-based aerosols.

Dr Amos Lo, a specialist in otorhinolaryngology at Matilda International Hospital, adds that the therapy may be helpful in the treatment of asthma and cystic fibrosis. But he says that the evidence isn't there. 'There haven't been any good-quality studies to show that it works,' he says. 'There are some studies that show a slight benefit, and lots of claims.

'There was a paper written in 2006 in Allergy which found out that halotherapy would decrease bronchial hypersensitivity in asthmatics,' he says, but adds that there was no evidence that the treatment increased airflow to the lungs. 'At most we can only say that halotherapy may possibly be an add-on therapy in asthmatics, but the usual inhaled steroid should be continued as definitive treatment.'

Salt therapy's claimed benefits in the treatment of skin conditions such as psoriasis, acne, dermatitis and eczema, are likewise unproven, says Dr Tinny Ho of dermatology clinic Skincentral.

'I have never heard of halotherapy as a proven treatment option for skin problems,' she says. 'I also don't believe in the proposed mechanisms of 'normalising pH', and 'improvement of local microcirculation'. The only part that I agree on is that it may give positive psycho-emotional and antidepressant effects. So it's basically a placebo effect.

'A placebo is fine as long as the treatment doesn't over-claim its beneficial effects or market itself as a proven medical treatment option,' adds Ho. 'That can delay people from getting proper medical attention. A placebo must also not be harmful.'

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