Hookah: Is It Safer Than Cigarette Smoking?

Well, whatever you take in in (through your mouth) eventually has an impact on you. Be it chocolate, green-tea, paper, shoe-laces, your own flesh; they have the tendency to penetrate through the circuits of your body and mess with them.

And then there’s Hookah, the magnificent “mouth -inhaler” from Asia, there’s nothing that could go wrong if you blow the pipe? Right? Scottish do this all the time and make weird noises but they all are fine, right? So why should one bother being health conscious about the magnificient Hookah?
Well, one should definitely be bothered! Why? Read through this article, you’ll find out.

Carbon Monoxide Intoxication Cause By Hookah

A recent prospective study conducted by researchers from Kecioren Training and Research Hospital, Turkey investigated scientific evidence to study the effects of hookah smoking on health. According to the researchers, hookah smoking can cause severe carbon monoxide intoxication which can eventually lead to premature, erratic or both increased and decreased heart rates at different time intervals in a person’s life.

The researchers recruited 33 healthy volunteers from a hookah café for the trials and measured their vital signs, carboxyhemoglobin levels and heart beat using ECG before and after a 30-minute hookah smoking session.

Elevated Carboxyhaemoglobin Levels 

The results showed that carboxyhemoglobin levels, the chemical formed when red blood cells bond with carbon monoxide in blood, had increased from 1.3% to a minimum of 23% and in some extreme cases, carboxyhemoglobin levels were as high as 44% which is equivalent to severe acute CO intoxication. moreover, the participants’ blood pressure had also reached abnormal levels.

The charcoal or wood that is used to heat the hookah can cause carbon monoxide poisoning and exposes to metals and other cancerous toxins. Hookah smoke is exposing you to

Exposure to cancerous toxins
Even though the smoke passes through water, it can still contain a lot of toxins and cancer agents. Most of these substances cause lung, bladder and oral cancers. Since most hookah smokers have the tendency to hold most of the smoke in their mouth, even after several puffs, in order to exhale a large cloud of smoke, it significantly increases the risk of developing mouth cancer.

Toxic Metals Top The List Of Toxins

  • Chromium
  • Arsenic
  • Cadmium

The latest kind of hookah known as steam stones contains a variety of different toxic chemicals that are significantly dangerous to a person’s health. An analysis led by Amberlie Clutterbuck, a doctoral student in the UC Department of Chemistry, found residues of toxic metals that included chromium, arsenic, and cadmium following several simulated hookah/steam stones smoking scenarios.

Clutterbuck also tested different charcoal that is ordered by hookah users to heat the steam stones. She tested several 30-minute simulated smoking scenarios involving the different brands of steam stones and charcoal.

Clutterbuck’s analyses also found that the toxic metals from the steam stones did not consistently travel through the hookah to the mouthpiece, so the study suggests that the majority of toxic metals that turned up in the mouthpiece likely came from the charcoal used to heat the apparatus. Those metals included varying amounts of chromium (Cr), nickel (Ni), copper (Cu), arsenic (As), cadmium (Cd) and lead (Pb) that were found on the filters.

Clutterbuck used an advanced tool called the Agilent 8800 triple quadrupole ICPMS (ICP-QQQ) – an instrument used in atomic spectroscopy – to measure the levels of toxic metals that could result from a 30-minute smoking session using the steam stones.

The analysis found that out of the different smoking scenarios involving the steam stones, there were statistically significant and similar amounts of chromium and arsenic inhaled, regardless of the brands of steam stones or charcoal that were used. Both of those chemical elements are human carcinogens if present in certain forms.

Exchange Of Diseases

 Since hookahs are famously smoked in large groups, where each individual shares the same pipe used to inhale the smoke, a person is likely to share saliva of others, which can cause other viral and bacterial infections, which can be transmitted due to the presence of the pathogenic strains, such as tuberculosis and hepatitis. Periodontitis can also occur because of a bacterial infection in the oral cavity, along with many other streptococcal diseases.

Lung Abnormalities In Light Use Smokers

Not only is hookah smoke bad due to the cancerous effects and potential for causing heart disease, it is also been found that hookah smoke can cause permanent lung abnormalities.

A 2016 study found that hookah smoke can cause permanent changing in the lung cell lining. Ronald Crystal, MD, professor and chairman of the Department of Genetic Medicine at Weill Cornell Medicine, and his team came to the conclusion of the study be measuring the effects of hookah smoking on study participants using clinical and biological parameters.

The clinical data showed that, compared to non-smokers, waterpipe smokers coughed more frequently and produced more sputum. Biological changes were observed in “marked changes in the cells lining the airways” of waterpipe smokers. In addition, the researchers noted an increase in the circulation of small particles shed by endothelial cells in the lungs.

“This is indicative of ongoing damage to the capillaries,” said Dr. Crystal, who is also the Bruce Webster Professor of Internal Medicine at Weill Cornell Medicine. Together, the clinical and biological changes associated with light-waterpipe use are signs of early lung damage.

The researchers also noted some interesting facts about an average hookah session. According to them compared to one cigarette, one waterpipe session exposes the smoker to:

  • 100 times more tar.
  • 3 times the amount of phenol.
  • 2 to 4 times the amount of nicotine
  • 7 to 11 times the amount of carbon monoxide
  • 17 times the amount of formaldehyde
  • 2 to 5 times the amount of high molecular weight carcinogenic polyaromatic hydrocarbons

Although the study is quite significant on its own but the researchers admit that it was quite small and more studies need to be conducted in the future.

Second Hand Smoke of Hookah – A Sweet-Smelling Poison

Secondhand smoke exposure is the third leading preventable cause of death in the United States. Secondhand smoke has been responsible for 3,000 lung cancer deaths and 35,000 heart disease deaths annually among Americans that have never smoked

Beyond health consequences, the new study identified airborne nicotine in the four hookah bars surveyed even though tobacco-based hookah is banned in these venues in New York City. Secondhand smoke is a big deal huge deal I would say because according to many individuals it is something that can be avoided altogether without any real issues, but cannot be implemented properly. There need to be better health reforms that deal with this issue directly and people especially young adolescents need to be educated about this growing issue.

According to the study’s researchers, many of the hookah lounges did not even have access to open windows or doors to properly exhaust the smoke, the research team found that indoor air pollutant concentrations differed, but the number of toxins was directly dependent on the number of people smoking and hookahs being used.

Essentially researchers had discovered that the average levels of exhaled carbon monoxide rose significantly after the workers’ shifts had ended, with readings from two of the 10 workers greater than 90 parts per million, which is in those amounts that are seen in heavy tobacco smokers.

Moreover, the blood levels of proteins that indicate inflammatory response (e.g. forms of interleukin, interferon, and tumor necrosis factor) were found to be substantially elevated in workers after their shifts. Such proteins are a natural reaction of an immune response, but can also indicate diseases such as arrhythmia and cancer when present in really high levels.

Babies Born To Hookah Smoking Mothers

Babies born to women who smoked hookahs daily during pregnancy weighed less at birth, approximately at least 3.5 ounces less than babies born to nonsmokers. Moreover, babies born to hookah smokers are also at a higher risk for developing many respiratory diseases.

Hookah Side Effects And Other Diseases

According to the CDC, “Hookah smoke is at least as toxic as cigarette smoke”. Contrary to popular belief, the water does not filter out toxic chemicals from hookah smoke. As there are numerous toxic and cancer-causing chemicals in cigarette smoke, similarly there are many toxic substances and carcinogens in hookah smoke.

A meta-analysis investigated several studies conducted between 1991 and 2014 discovered that 27 known or suspected carcinogens were found in hookah smoke. Some of these carcinogens include arsenic, chromium, cobalt, and lead all of which are toxic metallic compounds.

What is less well known is that the concentrations of toxins in hookah smoke and cigarette smoke can vary quite drastically; some carcinogens occur in higher concentrations while others occur in lower volumes in hookah smoke. Examples include carbon monoxide (which is present in higher levels in hookah smoke than cigarette smoke and can contribute to many cardiovascular diseases and heart problems) and benzene and high molecular weight polycyclic aromatic hydrocarbons (PAH’s) for which levels are higher in hookah smoke than cigarette smoke. While on the contrary, levels of tobacco-specific nitrosamines and low molecular weight PAH’s may be higher in cigarette smoke than in hookah smoke.

Smoking Hookah May Put You At The Risk Of Developing A Plethora Of Cancers

It’s still under scientific investigation the exact nature of the cancer risks linked to hookah smoking, but it’s clear that there is indeed a well-established association between the two.  One more thing that the scientific community is unaware of is how long after exposure to hookah do cancers develop. This is known as the latency period, the time elapsed between exposures to a carcinogen and the development of cancer.

As a point of reference, it’s known that the latency period between exposure to cigarette smoke and cancer can be several decades. It could also be that hookah smoke, due to varying levels of different carcinogens than cigarette smoke, will lead to types or subtypes of cancer which are rarely seen in cigarette smoking cases.


hookah side effects

Lung Cancer

most of the carcinogens that increase the risk of lung cancer found in cigarette smoke are also present in hookah smoke. Moreover, the charcoal that is used to light up the hookah is a great risk to health as it raises blood carbon monoxide volume, it contains metal than can lead to toxicity and poisoning and lead to cell mutations leading to cancer.


Benzene, a known carcinogen which contributes to leukemia and blood-related cancers especially acute myelogenous leukemia (AML), is found in hookah smoke.

Researchers analyzed 105 hookah smokers and 103 individuals who did not smoke hookah, who were exposed to hookah smoke. they measured the breakdown products of benzene before and after smoke exposure. Hookah smokers’ level of benzene byproducts were on average 4.2 times higher after smoking in a hookah bar and 1.9 times higher after being exposed to hookah smoke at home.  Disturbingly, levels also increased 2.6 times in non-smokers who had been exposed to hookah smoke.

Bladder Cancer

Epidemiological studies associate hookah smoking with bladder cancer.  This is not surprising since in the United States it’s felt that 50 percent of bladder cancers in men are caused by cigarette smoking.

Pancreatic Cancer

Studies have noted that hookah users have an increased risk of developing pancreatic cancer. We also know that hookah smoking increases the risk of gum disease (periodontal disease) and that gum disease is now known to be a significant risk factor for pancreatic cancer.

Oesophageal Cancer

Many investigations have found hookah smoking to be a risk factor for oesophageal cancer while carcinogens in cigarette smoke which lead to oesophageal cancer are also present in hookah smoke.

Oral Cancer

Tobacco irritates the tissues in the mouth and throat, and as seen with people who chew tobacco, causes inflammation which can lead to cancer.

Stomach Cancer (Gastric Cancer)

Recent studies have shown an association between hookah smoking and stomach cancer, as well as precancerous findings in the stomach of regular hookah users.

Infertility – A Consequence Of Hookah Smoke

Smoking, either its hookah smoking or, smoking cigarettes causes infertility, especially in women. it means it will take longer to conceive a child, prenatal health problems, and the ability to conceive becomes difficult. Due to the toxic chemicals and carcinogens contained in tobacco smoke, it affects fallopian tubes, including blockages which make it difficult to conceive since the egg and sperm don’t interact.

There is an increased risk of developing cervical cancer, as the cells lining the cervical wall start rapidly multiplying. The eggs that develop in ovaries get affected, which can lead to PCOS.

According to many studies that explore the association between smoking and fertility, 10 or more cigarettes per day can immensely affect one’s ability to conceive. This doesn’t mean fewer cigarettes smoked each day would not cause fertility problems, it’s just that more a person smoke the more likely is his fertility going to be adversely affected, as it has been shown that smoking 10 or more cigarettes each day significantly increases a person’s risk of developing fertility problems.

Other studies have shown that for each cigarette smoked per day, the longer it will take a woman to conceive a child. For instance, a woman who smokes 8 cigarettes each day will on estimate take longer to become pregnant than a woman who smokes just 4 cigarettes each day.

Hookah Side Effects: Consequences On Male Reproductive System

Smoking has also been known to lower sperm count as it destroys sperm and affects testosterone levels. Studies have shown that smokers have 23% lower sperm rate than nonsmokers, on average. Moreover, second-hand smoke is enough to cause fertility problems in both men and women. Therefore even if u don’t smoke hookah but are in a gathering where your friends are smoking hookah or in a café where others are smoking, your fertility is most likely going to get affected.

In April of 2016, European Urology published a meta-analysis on the effect of smoking on semen health. The analysis consisted of 20 studies and more than 5,000 men belonging to several European nations. The study found that smoking was associated with decreased sperm count, decreased sperm motility, which is how mobile the sperm cells are, and poor sperm morphology, the shape of the sperm, which meant that abnormally shaped sperm had poor mobility and showed difficulty in penetrating the egg. All these factors make it difficult to conceive and lead to improper fertilization.

All these factors are enough to make conceiving difficult especially if both partners are smokers, or smoke in front of their partner.  Even though smoking does affect fertility, but it’s not completely true that smoking causes complete infertility, at least in men, due to lack of evidence. But men who are close to becoming infertile a few sessions of hookah smoking are enough to cause infertility.

Emphysema – A Probable Outcome Of Hookah Smoking

Chronic Obstructive Pulmonary Disease (COPD) often commonly referred to as chronic bronchitis and emphysema, makes it difficult to breathe and is often characterized by a rough cough and sputum production. The condition typically becomes worse over time and presents itself as an obstructive lung disease with long-term poor airflow.

The disease has very high morbidity (disease) and mortality (death) rates. In the United States, more than 6.5 percent of adults of age twenty-five and above report a physician diagnosis of COPD including emphysema and chronic bronchitis.

Emphysema, however, involves the gradual destruction of alveoli sacs of lungs, which hinders breathing and restrict the flow of oxygen to the body cells as that is the main role of alveoli; exchange of gasses in lungs. The disease can over time destroy the alveoli and limit the elasticity of the pulmonary airways. This results in patients experiencing shortness of breath and trouble breathing.

Emphysema often occurs when a person smokes tobacco, while the tobacco damages the lung lining and alveoli sacs. Since hookah contains so much smoke and carcinogens, the risk of a person developing emphysema increases greatly.

Does Hookah Smoke Have Neuromodulatory Effects?

Since hookah contains nicotine it does affect the central nervous system negatively. Hookah smoke restricts most blood arteries and stimulates the central nervous system. Once a person inhales the smoke, the smoke passes through nose and mouth into the air passageways, eventually passing through the lungs. In the lungs, the nicotine gets absorbed by the surrounding blood vessels rapidly, where it reaches the brain in less than eight seconds.

Nicotine has a mixed effect on the person’s CNS depending on the person’s mood, dosage and both external and internal stimuli, it can act as a stimulant or a depressant. As nicotine fires off neurotransmitters in the brain, causing the release of dopamine, it can become quite addictive.

Depending on the extent to which dopamine is released in the brain, smokers start to enjoy the warm sensation they begin to feel, and the limbic system gets affected. Smokers especially long-term smokers can, therefore, become easily addicted.

Leave A Reply

Your email address will not be published.