Harmfulness of hookah. What is it really like?

Harmfulness of hookah. What is it really like?

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We are in modern times, when the trend is for a healthy lifestyle. This is, in principle, a good development and we can only be grateful for such a progress in society.

Of course, many media and influencers are also adapting to this trend and riding its wave to fight for anything that may seem even slightly unhealthy to this modern society.

One of the current trends is the battle with hookahs. This is slowly becoming a modern-day witch hunt - in the full sense of the term.

What's the idea? Because he crowd-shaming everything to do with smoking and always finding his own arguments without being willing to discuss anything openly. Thus, to write somewhere that hookah smoking is fundamentally different from cigarette smoking is now practically tantamount to public suicide.

The trend is clear - smoking is bad and this applies to all smoking methods! And in truth, it's no wonder. For cigarettes have been fighting the industry for a really long time and had to rely on a lot of studies and, most importantly, real evidence before they started to convince the masses in the new generation.

After fighting hard against the windmills, society has managed the impossible and the general perception has turned against smokers. In the context of partial successes, it was only a matter of time before a virtually fanatical society took up the hookah as the next frontier in its struggle.

And hookahs are just at the height of the battle with the smoking industry, and so with blinders on, article after article is now coming out to denigrate the industry. Who would dare to go against the trend these days and really try to think about the whole subject from start to finish?

It really amounts to the aforementioned social suicide...

So I decided to commit social suicide and take on the windmills. I stand by the fact that hookah is not as harmful as people claim.

Why do I think that? Because the current trend is for key studies and articles to use quotes out of context, reference unrelated data and, in the best cases, rather point to the misuse of shisha and its effects. These inaccuracies triggered an unstoppable avalanche of articles condemning hookah use.

You could say that this whole hookah hunt started with a study by the US American University of Beirut, where, using a developed standardized robotic smoking device, they took basic measurements [1]. Let's simply break it down.

Access to the measurement itself is a relatively good basis for initial orientation. The problem with hookah, however, is the different approaches to its preparation, handling, use of the different products and, last but not least, the smoking itself.

With a cigarette, the measurement is thus relatively stable and the simulated drag (for measurement set by machine to 35ml of smoke once per minute for about 6 minutes) approximately corresponds to reality./strong>

But setting the parameters for hookah smoking doesn't reflect reality as much - 530ml coating of smoke (approx 3s) every 17s for 60 minutes. That may not be an exaggerated impression, but it falls far short of the normal behaviour of a pipe smoker when smoking a hookah and we will explain why.

The frequency itself does not reflect reality. Imagine that you are sitting in a tea room with a pipe, discussing an interesting topic with someone. You may take turns smoking your pipe, occasionally need a drink, need to go to the bathroom or get involved in a discussion. In addition, you will usually have several changes of embers throughout the ritual. And these are just some of the factors.

Another thing is the equipment itself. With a cigarette, it is relatively easy to do an exemplary test. A cigarette is just a cigarette and you only test individual brands. The simulation is quite simple.

With a hookah, however, many other factors will affect the outcome. From the tobacco used, the way it is loaded, the chosen crown to the heat management used (HMS, foil...) or charcoal.

For our case under discussion, non-natural charcoal was used, which lay on the crown with the foil in direct contact with the tobacco throughout the test.

The test result itself focuses mainly on the volume of smoke inhaled and this is logically framed as higher (according to the source study used, the headlines use multiples such as 100-500 times higher smoke inhalation volume in a hookah than in a cigarette).

In principle, then, this statement is not completely false (with respect to the input parameters, which we have also already refuted) and cannot be contradicted. The problem is that most of the media take this figure out of context and automatically assume that a person smoking a hookah will logically absorb 100-500 times more pollutants. But what about the smoke?

The most important factor, which is generally overlooked, is the content of the smoke itself, especially the much-maligned tar contained in it. Cigarette smoke has been shown to be harmful by numerous tests and, over time, scientists have analysed up to around 4,700 chemicals contained in [1].

A lesser known fact is that only 142 of these compounds have been identified in shisha smoke [1].

Temperature is also crucial. The temperature of a cigarette is around 800-900°C, compared to the 100-200°C of hookah tobacco. The hookah heats the tobacco indirectly and thus only vaporises it. The smoke itself is largely made up of water and glycerine, which are biologically inactive.

From this simple basic comparison it must be clear even to the layman that we are talking about significantly different issues.

An oft-repeated claim by hookah opponents is that by virtue of the higher volume of smoke, you also ingest a higher dose of nicotine and thus run a high risk of addiction (smoke contains 6 times more nicotine National Institutes of Health [2]).

To confirm this, one study compared the intake of substances from 3 hookahs per day versus 11 cigarettes (13 people participated in both smoking methods for comparison). Despite the somewhat modern hookah equipment and preparation procedure (classic tinfoil, non-natural charcoal), the measured values are surprising.

Even when 3 hookahs were smoked consecutively, total nicotine intake was significantly lower than from 11 cigarettes [3]. The development of nicotine dependence in association with hookah has not yet been demonstrated in any of the studies that have focused on this topic [1].

Another scare factor discussed is the concentration of carbon monoxide (CO) when smoking a hookah. This claim is backed up by many measurements and is in fact true [1, 3]. However, it is important to understand how the process works and where the gas is produced.

The problem is the coal itself. Burning coal produces most of the CO and all the other harmful substances measured. (up to 90% [1]). The measured values and the style of intake of this gas can then be very well compared to grilling on conventional charcoal [1], which can also be used as a basis for recommendations to prevent the health impacts of this gas:

  • Always use high quality natural coal (purity)
  • The coals must always be well heated on all sides
  • The whole room (especially the area where the coal is heated) must be well ventilated

With regard to coal, as the source of 90% of the pollutants in total, it is desirable to separate it as far as possible from tobacco. The Kaloud Lotus Heat Management System and its imitations appear to be the most beneficial in this respect, as they separate the char from the tobacco itself to a greater extent and thus help to significantly reduce the penetration of char particles into the tobacco. However, despite the significant assistance of this system, Kaloud Lotus does not completely prevent the passage of components that evaporate from the char and are then coated through the tobacco.

A study published in 2008 attempted to determine the real impact of long-term regular hookah smoking [2]. This focused on the presence of Carcino Embryonic Antigen (CEA) in the body of a smoker. This substance is taken as one of the indicators of cancer risk and its presence affects, for example, smoking.

The study was conducted on 59 hookah smokers aged 20 to 80 years who had been regular hookah smokers for 8 to 65 years. Thirty-six non-smokers were used to compare the final differences.

These 59 people were divided into 3 groups according to the frequency of hookah smoking:

The overall mean CEA of hookah smokers was virtually no different from that of non-smokers, and was thus several times different from the CEA measured in smokers (3.58 ng/ml versus 9.19 ng/ml). However, it should be noted that the group of the heaviest hookah smokers already had elevated values on average (5.11 ng/ml).

What is important to note, considering the age of the smokers and the location of the study (on smokers from Pakistan), one pipe there contains a full 60-120g (1-2 chattak) of tobacco and is smoked on obsolete equipment (chilam crown) with falling ash. Most older smokers also smoked pipes without molasses, which is evaporated by default - for example, Tombak.

With this in mind, the conclusions are very surprising and can serve to give an idea of ​​the possible impacts of the modern style of hookah smoking, which is very different (typically approx. 15-20 grams of modern refined tobacco and natural tested charcoal in a modern Heat management system for regulation heat).

A few statements

Statement of the State Health Institute [4]:

An average of 70 liters of smoke is created during one sitting with a hookah.

During an average one-hour session with a hookah, the smoker inhales approximately 100-200x more smoke than when smoking one cigarette

  • With regard to the parameters used to measure the volume of smoke, this statement is true but it is based on an unrealistic scenario (see, chapter 1 pipe as 100 (up to 500) cigarettes )

In connection with the used method of heating the tobacco and the size of burning carbon, 30-100x more tar, 17-50x more carbon monoxide is produced and the smoke contains 6x more nicotine p>

  • The claim is taken out of context and does not take into account the actual volume of harmful substances ingested, which is almost 40 times higher in cigarettes. Also surprising is the very low intake of nicotine, several times lower than that of cigarettes

The water in the hookah vase mainly cools the smoke. Even after passing through water, smoke contains high doses of toxic components including carbon monoxide, heavy metals and a number of cancer-causing substances

  • Water filters individual components with an efficiency from 4.2 to 78.6% with an overall average efficiency of 38% [2]. What is surprising is the significant reduction of nicotine and its low presence in the measurement [3]. It was then identified in the hookah smoke only 142 harmful ingredients compared to more than 4,700 for a cigarette [1].

Commonly used heat sources (embers) applied to tobacco are likely to increase health risks because their combustion releases toxic substances, including heavy metals and CO, into the smoke.

  • TRUTH. One of the few true statements. According to relevant studies, up to 90% of the pollutants measured come from carbon combustion. The result is comparable to charcoal grilling.

Sharing a mouthpiece while smoking a hookah poses a risk of transmitting infectious diseases including tuberculosis and infectious hepatitis

  • TRUTH. But it's similar to sharing anything. To avoid direct transmission, we recommend disposable mouthpieces and ideally a single pipe for each smoker at the table - one person per pipe.

Second-hand smoke from a mixture of tobacco and shisha smoke is risky even for non-smokers

  • Hookah smoke contains significant amounts of harmless glycerin and water. The content of harmful components is many times lower than that of cigarette smoke. Ventilation is then advisable to reduce the risk of CO.

Regular hookah smoking can lead to nicotine addiction

  • The nicotine content of shisha smoke is significantly lower than that of cigarettes and has not been shown to cause addiction in any of the many studies.

Thus, no study has shown that passing smoke through water reduces the amount of toxic substances and thus the danger of this smoking. On the contrary, the passage of aerosol through water cools the mixture and the smoker is able to inhale more smoke and deeper into the lungs, which may increase the absorption of hazardous substances into the body (Hrubá, 2015).

  • LIE. Water filters individual components with efficiencies ranging from 4.2 to 78.6% with an overall average efficiency of 38% [1]. What is surprising is the significant reduction of nicotine and its low presence in the measurement [3].


  1. Public health intervention for narghile (hookah,shisha) use requires a radical critique of the related standardised smoking machine – Chaouachi, K. (2009)
  2. Hookah smoking and cancer: carcinoembryonic antigen (CEA) levels in exclusive/ever hookah smokers – Harm Reduct J. (2008)
  3. Comparison of nicotine and carcinogen exposure with water pipe and cigarette smoking – Peyton J. (2013)
  4. Poster warning against smoking hookah. - State Health Institute (2007)

Source: hookahweek.com

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