Up in Smoke: The Myth of the Healthy Hookah

by Michael Grisafe on October 19, 2012

“Narghile.” “Hubble-bubble.” “Shisha.” All names for what is commonly known in the United States as “Hookah.” A hookah is a type of water pipe in which users inhale flavored tobacco smoke through a long, hose-like stem after it passes through a basin of water. Hookah smoking has been around in the Middle East for over 400 years; however it’s seen a surge in popularity among college age adults in the United States over the past ten years.1

If you don’t know what hookah is, I guarantee that you’ve seen a pipe advertised in a shop window or a new “hookah lounge” opening up in your hometown.

I first heard about hookah when my little sister called me from college one day: “It’s awesome! They have these little water pipes you smoke with fruity flavors.”

“Wait, you smoke now?” I asked.

This surprised me because my sister never drank, let alone smoked, and was a pretty solid vegetarian.

“Oh yeah, well, it’s ‘smoke’ but not really  ‘smoke.’ Not like a cigarette. The water filters out all of the bad stuff.”

Molecules

Image courtesy of jscreationzs / FreeDigitalPhotos.net

This reminded me of an explanation I’d heard years before of another “water-assisted-smoking-filtration-device” given to me by an undergraduate engineer. “You see,” he said after eating his fourth bag of Doritos, second bag of M&M’s, and third Twinkie, “the smoke passes through the water and takes out all the bad stuff. The bad stuff in the smoke is made of ‘polarized molecules,’ and the water has ‘polar molecules.’ You dig? So it sucks out all the bad stuff. Kinda like a magnet. Ohhhh yeahhh.” The veracity of this claim was then verified by a solid belch, a belly pat, and a complacent look of satisfaction.

So, with all of this outstanding empirical evidence behind me from “trusted experts,” why wouldn’t I try hookah when I came across it in restaurants across the Lower East Side in New York? For a couple bucks you could smoke a pipe, talk to your friends, and enjoy the evening while lounging on pillows. It seemed like a great way to unwind, and I was entranced by the allure of what seemed like an exotic and esoteric practice (please remember, I came from a small town in which “Indian food” was sometimes seen as a daring culinary adventure).

Thus, it wasn’t long before I became a hookah regular. It just never seemed like a health risk. I mean, the “real organic tobacco” was flavored by “real organic” apples, watermelon, or pears. And “organic” stuff is always healthy. After all, it’s from “nature.”

Around this “hookah-experimental-phase,” I also started to develop my super-sensitive-public-health-reflexive-interviewing-strategies which I deftly used on my smoker friends anytime they stepped out to light-up: “You schmucks know you’re going to get cancer, right? You cool with that?”

“You are too,” they’d shoot back (and here I might be omitting a playfully procreative moniker). “You smoke hookah like two hours every weekend.”

“Yeah, but that’s ‘pure’ stuff,” I’d tell them. “The tobacco smoke is cleaned by water.”

Which was true, right? Because smoking a hookah isn’t anything like smoking cigarettes? Right?

Right…?

Well, it turns out that hookah smoke contains many of the same dangerous chemicals in cigarettes- sometimes in even higher concentrations.

A Pack in 30 Minutes2

One of the first things that got my attention when researching hookah smoking was the rapid exposure that users get to many hazardous chemicals. Several studies have found that an average 30-60 minute hookah session is about equivalent to smoking a whole pack of cigarettes.3 This really made me think, because most of the people I know that smoke hookah (myself included) sat around smoking for at least an hour. That means that we were smoking the equivalent of 1-2 packs of cigarettes each time we went out. Not good.

Carbon Monoxide Poisoning

Smoke

Image courtesy of dan / FreeDigitalPhotos.net

One risk of hookah use is the high levels of carbon monoxide that a person is exposed to when smoking (even higher than cigarette smokers).4 High levels of carbon monoxide in your body prevent oxygen from being effectively delivered to your cells. This results in a condition known as “hypoxia,” which means inadequate oxygen supply. When a person is hypoxic from having too much carbon monoxide in their body, they get headaches, feel dizzy, and may be slightly short of breath. These effects gradually diminish as a person is exposed to normal, clean air, but in the mean time they can feel a bit sick. Think of it as a “hookah hangover.”

Trust me. I’ve been there, it’s no fun.

Driving Under the Influence….of Smoking?

Because of the carbon monoxide effects described above, a person’s motor skills can be affected enough to impair their driving. This was shown in a controlled study in which individuals who smoked hookah fared significantly worse on a driving simulator than those that didn’t smoke (measured by participants’ inability to avoid crossing over a center line while driving).5

Hooked on Hookah

Nicotine is one of the major addictive substances in cigarettes. Research indicates that hookah smoke contains about as much nicotine as cigarette smoke, meaning that hookah is potentially as addictive as cigarettes.6

At Least as Toxic as a Cigarette

Smoking

Image courtesy of graur codrin / FreeDigitalPhotos.net

The Centers for Disease Control and Prevention (CDC) warns that hookah use is at least as toxic as cigarette smoke.7 Researchers state that hookah users are exposed to carbon monoxide, heavy metals, nicotine, and a variety of cancer-causing chemicals. So much for being “all-natural.”

In addition, studies have shown that hookah use can impair cardiac function8, and lead to cancers of the esophagus9, mouth, lung10, stomach, and decreased fertility.11 So basically all of the “pleasant things” we have come to associate with cigarette smoking are at least as prevalent for hookah smokers.

Filtering Through a Water Pipe Doesn’t Decrease Toxins

As you’ve probably guessed from all of the writing up until now, smoking tobacco through a water filter really doesn’t do anything to decrease the type of toxins that would be normally delivered by smoking cigarettes.12 I’m sad to say that my engineering friend was wrong (he’s now working in the biomedical field, so let’s hope his knowledge has improved!).

Switching to Coffee

I have to admit, I’m new to the field of public health, and I was hoping a little bit that hookah smoking wasn’t quite a bad as I thought it was. Visiting hookah lounges was always a way to socialize with my friends in a way that wasn’t as debaucherous as drinking or as socially passive as watching TV; kinda like a coffee shop with cushions on the floor.

coffee

Image courtesy of healingdream / FreeDigitalPhotos.net

I think deep down I knew it wasn’t the best health-wise, but I just wanted to believe it was little bit better than smoking cigarettes.

So I can understand how people like my sister would reject cigarettes but embrace hookah. Until you have the facts, it doesn’t seem so bad. Cigarette smoking is widely known to cause cancer and other detrimental health effects while hookah is relatively new and unknown to many people in the West. Because of this, it’s no surprise to see that cigarette smoking often decreases during college years, while hookah use is showing a rapid increase.13

Hookah just seems “hip” and “trendy,” and the popular media often touts it as being somehow “more pure and natural” than cigarette smoking. Which is true in a way: hookah does use “all-natural” tobacco and flavors.

The only problem is that cancer is “all-natural” too.

What do you think? How hazardous to your health is smoking hookah?

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After reading this article, did your views on hookah smoking change?

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References

1Ashurst, J. V., Urquhart, M., & Cook, M. D. (2012). Carbon monoxide poisoning secondary to hookah smoking. The Journal of the American Osteopathic Association, 112(10), 686–8.
2Serota, J. A. (2007). A Pack in 30 Minutes. Journal of Pediatric Health Care, 21(3), 209–210.
3Cobb, C. O., Sahmarani, K., Eissenberg, T., & Shihadeh, A. (2012). Acute toxicant exposure and cardiac autonomic dysfunction from smoking a single narghile waterpipe with tobacco and with a “healthy” tobacco-free alternative. Toxicology letters, 1–6. doi:10.1016/j.toxlet.2012.09.026
4Ashurst, J. V., Urquhart, M., & Cook, M. D. (2012). Carbon monoxide poisoning secondary to hookah smoking. The Journal of the American Osteopathic Association, 112(10), 686–8.
5Elias, W., Assy, N., Elias, I., Toledo, T., Yassin, M., Armaly, Z., & Bowirrat, A. (2012). The detrimental danger of water-pipe (Hookah) transcends the hazardous consequences of general health to the driving behavior. Journal of translational medicine, 10(1), 126.
6Dale, L.  (n.d.). Is hookah smoking safer than smoking cigarettes? Retrieved from http://www.mayoclinic.com/health/hookah/AN01265
7Centers for Disease Control and Prevention.  (2011, August 22).  Smoking and Tobacco Use:  Hookahs. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/
8Cobb, C. O., Sahmarani, K., Eissenberg, T., & Shihadeh, A. (2012). Acute toxicant exposure and cardiac autonomic dysfunction from smoking a single narghile waterpipe with tobacco and with a “healthy” tobacco-free alternative. Toxicology letters, 1–6.
9Dar, N.A., Bhat, G.A., Shah, I.A., et al. (2012). Hookah smoking, nass chewing, and oesophageal squamous cell carcinoma in Kashmir, India. British Journal of Cancer. doi: 10.1038/bjc.2012.449
10Koul, P. a, Hajni, M. R., Sheikh, M. a, Khan, U. H., Shah, A., Khan, Y., Ahangar, a G., et al. (2011). Hookah smoking and lung cancer in the Kashmir valley of the Indian subcontinent. Asian Pacific journal of cancer prevention : APJCP, 12(2), 519–24.
11Centers for Disease Control and Prevention. (2011, August 22).  Smoking and Tobacco Use:  Hookahs.  Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/
12Shihadeh, A., Salman, R., Jaroudi, E., Saliba, N., Sepetdjian, E., Blank, M. D., Cobb, C. O., et al. (2012). Does switching to a tobacco-free waterpipe product reduce toxicant intake? A crossover study comparing CO, NO, PAH, volatile aldehydes, “tar” and nicotine yields. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association, 50(5), 1494–8.
13Nuzzo, E., Shensa, A., Kim, K. H., Fine, M. J., Barnett, T. E., Cook, R., & Primack, B. a. (2012). Associations between hookah tobacco smoking knowledge and hookah smoking behavior among US college students. Health education research, 1–9. doi:10.1093/her/cys095

[10/19/2012 Article Update:  A big thanks to Margaret and "number1monkeyfan" for pointing out that my last section title, "Switching to Tea," didn't really go with the ending of the article- due to the fact that I cut an alternate ending that mentioned "tea."  I forgot to update the title to "coffee," which still only marginally ties in...Sigh...  I'll try to keep my edits and section titles straight next time!]

Margaret October 19, 2012 at 1:33 pm

Michael,
Again, incredibly well researched. This seemed like a very personal article for you. I will have to admit to being a little naive to hookah until recently. When I heard about them I did the research, because as a science person, I could not believe that water would filter out all the bad stuff.

As I sit here reading this article and showing the results to my roommate, who does not believe your results or the articles behind them. I wonder at how much scientific evidence is needed to prove to people that something is bad for them when they believe it is good.

Does smoking through a hookah decrease any of the bad chemicals just caused by the additives in cigarettes or tar?

In “Switching to Tea”, I don’t think that you mentioned tea
Thanks, Very well researched. Great research. A little personal, Are you okay with that?

Thanks,
Margaret

Michael Grisafe October 19, 2012 at 5:06 pm

Hi Margaret,

For some reason I bought in to the whole “water-filters-out-all-the-bad-stuff” argument for a long time as well. One of the biggest problems with hookah in particular is there hasn’t been as much published research on the subject in the West. This coupled with a limited awareness of the practice in general often leads to misinformation (I know that I was misinformed by many blogs before I had access to the articles I referenced).

Thanks for catching the title error! I had a different ending that mentioned tea that I changed at the last minute. I changed it now. While “switching to coffee” is a band-aid fix, it sorta, kinda, not really ties in with a line in the closing. Bottom line: I screwed up! Doah!

number1monkeyfan October 19, 2012 at 2:49 pm

My favorite so far. I completely enjoyed it. I didn’t understand the last paragraph though. You mentioned tea and then didn’t say anything about it…

Looking forward to next week’s article.

Michael Grisafe October 19, 2012 at 5:07 pm

Thanks! I changed the ending title per your suggestion.

Lindsay Miller October 19, 2012 at 4:37 pm

Michael,
Another entertaining, informative blog! I loved the survey at the end, too.

Michael Grisafe October 19, 2012 at 5:08 pm

Thanks! I appreciate it! If you want to insert a survey via the plug in I can show you. It’s super easy.

Pertti (Bert) Hakkinen October 19, 2012 at 8:08 pm

FYI, we at the (U.S.) National Library of Medicine have a rather new “EnviroHealth Links – Tobacco, Smoking, and Health” Web page. Its “Smokeless and Other Non-Cigarette Tobacco Products” section contains links to selected resources about hookahs. You have noted one of the three resources that we selected (it’s the one you note as both #7 and #11 in your References). Your readers might also be interested in the “Smokeless and Other Non-Cigarette Tobacco Products” PubMed searches that we offer via this Web page.

Michael Grisafe October 20, 2012 at 12:03 pm

Thanks, Bert! For anyone interested in checking out the material Bert references, go to: http://sis.nlm.nih.gov/enviro/tobacco.html#a7

Erik Cox October 20, 2012 at 7:06 am

Great article – well written and researched. Look forward to the Vaporiser follow up…

Michael Grisafe October 20, 2012 at 12:05 pm

Ah, yes. The lovely vaporizer….I take it you got the reference to “the munchies” at the articles beginning. ;-) I’ll have to think about doing a vaporizer follow-up…

Quintus October 20, 2012 at 10:56 pm

Smoking is just bad for you and others, if the smoke passed through water or not. The quote from the media display their ignorance “more pure and natural” than cigarette smoking. Which is true in a way: hookah does use “all-natural” tobacco and flavours.” I don’t agree with. Cigarette smoke and hookah smoke, there is no difference. The tobacco is the same, all natural. The implication is that natural chemicals are healthier than “unnatural ones”. If they were unnatural chemicals they would not exist.
All you are doing with a hookah is giving your nicotine receptors a bigger hit and faster than that which they would obtain from a cigarette.

Angela October 22, 2012 at 10:03 am

Thank you for the post! It was very enjoyable and informative to read. I have never tried hookah, but I didn’t even know that it had tobacco in it. Judging by the smell I always thought that it was just water vapour with some essential oils or something, and wondered why people were into it. Seems like an interesting history: first used to smoke hash & opium (which apparently have cancer-fighting properties, but put you out of service in other ways), then shift to tobacco, which is milder, but has different downside. Wondered if anyone had ever tried to create genetically modify tobacco plants or create synthetic forms of tobacco with lower carcinogen levels and found this: http://www.pbs.org/wgbh/nova/body/safer-cigarettes-history.html

G. Armour Van Horn October 22, 2012 at 1:55 pm

The water filters out *something*, otherwise you’d never have to refresh the “bong water”. I remember one pipe that had three water chambers in series, followed by one filled with cherry liquor. It was easy to see the first water chamber collect contaminants.

Of course I’m pretty sure nobody ever put any tobacco in it.

Van

Jim June 4, 2013 at 6:26 am

Van,

Just because residue is left in the water doesn’t mean a thing. When you smoke, residue is left in the filter, your lungs and the windshield of your car. At any point, does the residue diminish the contaminants that you have inhaled?

Laura Milsom November 1, 2012 at 6:22 am

Well written and informative post. I came across this while looking into shisha smoking for a lesson plan for high school students in the UK. I think they would really respond to your writing and learn a lot from your post. Would you mind if I used it in part? Fully signposted of course.
Keep up the good work.
Laura Milsom

Michael Grisafe November 1, 2012 at 12:13 pm

Hi Laura,

By all means, use it! The intent is to influence healthy behavior, so I would be flattered to see this used for your class (I still can’t believe it’s reached across the pond!). Thanks for reading, and I hope your lesson goes well.

-Mike

PS Let me know how your students respond (or just have them comment).

Justin December 26, 2012 at 12:18 am

While I agree the article is well written I am tempted to challenge the validity of studies referenced and the generalizations being made about limited I formation from resources. I am curious to know how much empire me data was available and used. What are the limitations of all the data. I understand this is just an article but there are no numbers. Nothing is presented in a true measurable way. I do not disagree that smoking is smoking but this article fails to back up any claims with true data. Is this ad hoc theory based on your opinion and speculation of spotty sources? I believe articles like these, while having a proper aim, falsely proclaim unreasonable assumptions. Again, I am purely saying not that you are wrong, but that I have a hard time accepting this article as science and doubt the validity of all that was presented. I can fact check and research the sources, of course… But what non-scholar, lay-man is going to do that? I guess I’m asking for more responsible reporting. In any case, at least I can say on a positive that you are a gifted writer.

Michael Grisafe December 26, 2012 at 2:52 am

Hiya Justin,

Thanks for your feedback! I really appreciate it because it’s often difficult to decipher just how much information is too much or too little. In the case of my hookah article, the target audience is a layperson with a passing familiarity with science. In this context, I was a bit wary of throwing out too many statistics and making the article too technical. I also wanted to cover a lot of ground to outline the risks on hookah smoking. There are plenty of articles supporting the risks and hazards of hookah smoking, and I picked out some of the most salient to highlight. However, that being said, I definitely see your point that a few well-placed statistics from these studies would have helped to support my case. Thanks for the feedback, and I will work to support my articles with more deftly placed facts in the future.

Shay January 9, 2013 at 7:06 am

I’m a little weary of this information/studies because I cannot seem to find any numbers related to how these tests were done. I’m not doubting the water-filtration myth, however this information seems weary at best to me.

From what i’ve found, there is typically 0.8g-1.0 tobbaco per cigarette. From personal use of hookah, a 20-45 minutes session has about 25g of Shisha. I recently contacted a shisha company asking how much tobbaco is in that weight, they told me 18%. So on average, 4.5g tobbaco for hookah, 1g for 1 cigarette.

Cigarettes are burnt, which is (AFAIK) different then vaporizing shisha (Shisha is not burned). The main igredients in shisha are tobbaco, glycerin, flavoring and honey or molasses. Glycerin helps bind the flavor, honey stabilizes the heat so it does not burn.

Most of the smoke from hookah comes from the glycerin (See how much smoke you do not get, if you make your own shisha without it), so the smoke volume would be much higher then cigarettes based on this alone.

I’m very curious to see how these studies were done, and how they came to these conclusions. There are so many factors to take into account, it’s not as simple as comparing smoking a cigarette to a cigar.

Lastly, I see many places offer herbal shisha, for example using tea leafs in replacement of tobacco. I’m curious to see the results of this vs cigarettes and tobacco shisha. Is it really the tobacco thats doing the most damage, or is it just smoking anything in general? They even have “steam stones” available for hookah, which are small rocks injected with glycerin/flavoring – when they heat up they release “steam” flavoring producing smoke as well.

Duane G. Beitmen February 1, 2013 at 11:21 am

7) Life expectancy for Pipe Smokers:
Okay, sit down for this…. A US Surgeon General report “Smoking and Health” (No. 1103, page 112) noted,“Death rates for current pipe smokers were little if at all higher than for non-smokers, even with men smoking 10 pipefuls per day and with men who had smoked pipes for more than 30 years.” On page 92 the report also stated, “Pipe smokers who inhale live as long as nonsmokers and pipe smokers that don’t inhale live longer than non-smokers.
What? Life expectancy for pipe smokers is three years longer than… Non-Smokers! Just try to use that argument with an anti-smoking activist! Of course this is not to encourage people to smoke, but has more to do with the personality of a typical pipe smoker. Most are type “B” where most cigarette smokers are type “A”. So a pipe smoker, on average, is a more laid back person. Second, smoking a pipe is very relaxing. You just can’t be angry when you are smoking a pipe.
Cigars are also relaxing but it seems, not as much as pipes. Most cigarette smoking is not so much a relaxing experience as it is a need for nicotine.

http://www.seattlepipeclub.org/content.aspx?page_id=22&club_id=969877&module_id=17020

Michael Grisafe February 11, 2013 at 2:24 am

Hi Duane,

Yeah, confounding factors can indeed be just that- confounding! Thanks for bringing up the point of how many different factors can led to misinterpretations of data!

Justen February 6, 2013 at 4:10 pm

I have smoked cigarettes, and I have smoked hookah (even buying one of my own). I quit smoking cigarettes, and have since then bought into the fact that hookah is “safer” and in a way (I truly believe) it IS. True, tobacco is bad (lets just say that). Cigarettes have additives and many MANY more chemicals than shisha tobacco. So yes, shisha tobacco is almost just as bad as cigarettes, but that’s the key word “almost.” Coffee contains caffeine which is just as addictive if you have an addictive type personality. The water doesn’t filter anything and I knew that before coming into the hookah community, it cools down the smoke for a smoother inhale. You can purchase natural coals that don’t have those harsh chemicals. I read something (I don’t know if its true) that interested me and it went something like this: “for those who say smoking hookah is the same as smoking a pack of cigarettes, does that mean a liter of beer is the same as a liter of 100 proof alcohol?” The idea is yeah, the volume of smoke is equal to that of a pack of cigarettes, but is it really just as harmful? I challenge anyone to smoke a pack of cigarettes in a half hour while someone sits for half hour hookah session. You can also purchase tobacco-free products that are made of herbs. I believe some are even sugar-cane, or what is called “steam stones” (which are stones soaked in a flavored glycerine fluid,* I BELIEVE*) . Again, I’m no expert and I hear from both sides, so it’s hard to say what’s really true. I think it’s all about moderation. I smoke maybe twice a month. Think about all the pollution in the air if you live in the city.. That has to be just as bad for you as smoking the occasional hookah. Again, I have no proof to back up any of my theories, these are just my formulated opinions based on my experiences. Response?

ally February 9, 2013 at 4:25 pm

when you stopped smoking, was it hard?

Michael Grisafe February 11, 2013 at 2:21 am

Yeah. But I’ve replaced it with a solid coffee addiction (tough to say it is better with Starbucks’ prices!).

Thess February 10, 2013 at 8:07 pm

How can you possibly get a pack worth of smoking chemicals out of a hookah
when there is only 5 cigarettes of so of actual tobacco in the bowl.

Just because it “vapors” for 30 minutes doesnt mean it magically
has more tobacco then what you put into it….

nobody has any common sense any more.

5g (or 3 cigarettes go in) you will NOT
magically get a packs worth of tobacco smoke out of it. period.

The fact you thought you did discredits the whole article.

Michael Grisafe February 11, 2013 at 2:20 am

Hi Thess!

First of all, I want to thank you for reading and commenting on something that didn’t seem to make sense to you! That’s the great thing about science- it’s intended to fuel debate that centers around evidence and experimentally testable assumptions.

In this case, your assumption is that because the amount of tobacco burnt in a 30 minute session is less than a pack’s worth of cigarettes, an individual is actually receiving less than a pack’s worth of toxins.

For certain chemicals that are water soluble (meaning that they tend to stick in the water as they pass through), this may be the case. Unfortunately, tar is not water soluble and readily passes through the water and directly into a person’s lungs. This tar, in turn, is a known carcinogen.

This still doesn’t solve the problem of why smoking less tobacco would be equivalent a smaller amount of cigarettes. The answer to this conundrum lies in the quality of the tobacco and how a person smokes. The tobacco used for hookahs tends to be pure, shredded tobacco, as opposed to cigarette tobacco, which is often diluted with fillers. This means that a smaller amount will be more highly concentrated.

However, the main reason that smoking less hookah tobacco is physiologically equivalent to smoking a greater quantity of cigarettes is that hookah tobacco is also burnt at a lower temperature than cigarettes. Why does this matter? Because it allows individuals smoking hookah to comfortably inhale larger quantities of toxin-containing-smoke than a regular cigarette smoker would be able to so that it passes deeper into their respiratory system. This means that a larger amount of smoke per unit of tobacco enters a person’s lungs than a person smoking a cigarette. Because of this, a smaller quantity of tobacco can actually lead to more exposure in a person using hookah than a person smoking the equivalent amount in cigarettes.

Think of it like this, Thess: if you stuck your face in front of a fire hose and I turned it on for a minute, you probably wouldn’t get that much water in your mouth because you’d be knocked over. However, if you turned on a garden hose for about 15 seconds, you’d probably get much more water in your mouth because the stream of the water is more tolerable. Thus, if this water was tainted with toxins, you’d have a greater exposure from the garden hose than the fire hose even though you “received” more water from the fire hose (and probably got a terrible headache). Make sense?

Thanks for reading, Thess, and continue to challenge “Mind the Science Gap” articles that seem to make “magical” assumptions.

Amanda March 19, 2013 at 12:36 pm

Hello,

Very well written and informative article. I also found this very personal and relatable to me. Since starting college, I even started smoking hookah occasionally with friends here and there. I at first didn’t know the true dangers of it and just started doing it. I then did research, got worried, but then just tried to tell myself that those things wouldn’t happen to me, or that it wouldn’t be as bad. I kept telling myself that. Now I’m even more worried. I’m glad my hookah use is very rare – I only go to a hookah bar maybe once when I’m home from college on a break, and only used to do it more often in the fall with my friends’ hookah that she owned. Now I barely ever do it. Hopefully I’ll be okay. I just can’t believe I was so blind to everything. I did my research, and google-searched hookah, and hookah effects and health risks, but then chose to ignore it. I swore I’d never smoke anything in my life. I mean, I at least have never and don’t plan on smoking cigarettes. I think the difference with hookah than cigarettes that comes across to people is that hookah doesn’t smell or taste disgusting. Of course, they add all of the lovely flavors you love to it. The social and “lounging” aspect is also very much enjoyable.

I have two questions.

One – when my mother found out I have at least tried hookah, she became very disappointed in me and told me it’s a good way for me to start smoking cigarettes. I don’t find this to be true, for me anyways. Do you think hookah is a pathway to cigarette smoking? I still am highly against cigarettes. I don’t even think I have been addicted to the nicotine in hookah considering I have only even smoked it once since 2013 hit.

Two – I suppose I am technically considered a smoker, or no? I’m not even a social or casual smoker, I think, because again I do not smoke hookah all too often; not even as often as you mentioned. (I did for about 2 weeks in the fall, beginning my freshman year of college, though) I ask this because I feel awkward now going into a doctors office and they ask are you a smoker? I say no. Do you use tobacco products? I say no. This is controversial in my own mind.

I am trying to stray away from it though, because I want to take good care of my lungs, heart, and my whole body. One thing I learned from your article was that it’s not safe to drive after hookah. I did not know that. I would always drive to and from the hookah bar with my friend, who doesn’t have his license, so I am the driver. I usually like to wait though, and I park a bit far away so I can go outside and walk and get fresh air. I usually feel fine though and my headache and lightheadedness disappears shortly after the session.

Thank you for your article.

Amanda March 19, 2013 at 12:41 pm

Actually one more thing.

Though the act of smoking or inhaling anything other than oxygen is harmful to you of course, can we at least say that the tobacco is at least not as bad? Now this just me trying to find one tiny bright side into all of this. My take on it is that yes, I’m inhaling carcinogens whether I like it or not between the smoke itself and even stuff coming from the coals, but at least the tobacco is more pure and has less of the chemicals right?

I try reading the ingredients of hookah tobacco and it doesn’t seem as bad as when you hear that a cigarette contains thousands of chemicals including household cleaners and such. Am I right, sort of? (I still know it is unhealthy.)

Thanks

Portable Hookah March 22, 2013 at 2:01 am

The courtyard is filled the sound of bubbling water from
the hookahs that patrons smoke while relaxing and enjoying the atmosphere.
Starring Mia Wasikowska, Johnny Depp, Helena Bonham
Carter, Anne Hathaway, and Crispin Glover. This flashlight with battery would kill every darkness anytime,
anywhere.

Michael Grisafe March 22, 2013 at 9:13 am

What??! Is there such a movie with Johnny Depp and these guys smoking hookah?!?! Waaaaaiiiiit… are you talking about the new “Alice in Wonderland”?

Constance March 31, 2013 at 11:20 pm

Do you have any information about either addition or health risks with organic non-tobacco hookah smoking?

beth April 5, 2013 at 11:03 am

Thanks for the article!

I appreciate the explanation in the comments about how since it’s cooler you take more in and deeper etc.

I read that a two hour session was the equivalent to about 100 cigarettes. :(

The other things I find interesting that you didn’t touch on…

When smoking hookah it’s fairly well documented that you often get oxygen starved/carbon monoxide influx which can’t be all that good for your brain long term. This does not happen so much so with normal cigarettes.

Also fairly well commented on is dehydration, which I honestly am not sure how or why. It’s just all over mentioning how it dehydrates. So would love to hear your comment on that.

I find it beautiful how one lady said “I don’t use tobacco products” to her doctor because she seldom does it. It’s tobacco, (or, maybe she’s doing the herb/rock?) Anyways, because it ‘smells’ prettier, and doesn’t stain the fingers it’s hip/cool/accepted where as cigarettes now make you the beaten red headed step child.

Makes me wonder how it is that the people who were all het up to ban smoking in all those public places across the states haven’t yet jumped on this band wagon. And, a little annoyed that no one sees how it’s still a horse, even though it has a different coat.

Yes, it’s smoking….. it’s smoking, with ‘more smoke’ even… and, it’s glorified and prettier so even those who don’t ‘like’ cigarettes think it’s fine/healthy/okay. All cause of the fruity flavors and the nice scent and lack of staining and lack of ashing.

And, as for the three chambered pipe comment and ‘filtering out something’. Well, it’s partially called ash that’s fallen into the water.

Anyways… thank you for an incredible article, for your explanations through the comments… sorry I vented slightly about the frustration of being a ‘dirty’ smoker when I see how they’ve repackaged it to make it hip and stealthy.

MoizVajihi April 7, 2013 at 9:52 pm

hi michael
Very Informative.Well researched.But i have been facing some questions about hookah i wud be glad if you cud help me out
Where is the tobacco kept in the hookah?
Does the smoke come from the burning coal or burning tobacco?
I have heard that some hookah brands do not put tobacco in hookah is it true?

Rin April 8, 2013 at 5:25 pm

How can smoking a pinch (about 1 cubic inch) of flavored tobacco in a hooka be the same as smoking the amount of tobacco found in 200 cigarettes??? Something does NOT make sense here!! I call BS!!! And I would like to see the empirical data showing the toxic compunds found in cigarette smoke compared to the toxic compounds found in hooka smoke! That would be the smoking gun (pun intended) of evidence for all to believe!

Dean watson April 9, 2013 at 7:24 am

Hello all,

My own thoughts and feelings on on hookah. I have been a frequent smoker for many years now and have looked into all the studies out there and the claims of how it’s is so much worse than cigarettes.
I am of the same opinion that the water provides no filtration and is on a medium to cool the smoke. The water does change colour but this is due to the flavouring running down the tube and carried with the smoke discolouring the water therefore providing a false representation of good effects. If you want to test this a vortex bowl can be used which prevents this to give a much more flavour full smoke, doing this the water will only change colour mildly from the heavy vapour carried.
As for the it contains as much smoke as 100 cigarettes I think this is correct, but the majority of that smoke is produced from the vaporisation of the mollases and glycerine. If you wash the tobacco then attempt to smoke the remaining as usual you not get the thick smoke and it will last significantly less time. Therefore the studies are flawed. Also the net weight of what has been consumed after the smoke is finished is approximately 50% of what was there before the session started, meaning all the tobacco and some flavouring remain. The actual nicotine content in the shesha is vaporised within the early stages of the smoke and then just leaves a full and flavoursome smoke to be enjoyed. The tobacco used is also washed of most nasties before being adapted for shesha.
These are just my opinons and personal findings. I think that a proper study is required, but will not happen or if the findings are that shesha is not as harmful as smoking ciggies will not be published as this gives a form of smoking the ok stamp which in this day and age is a big no no.
As for the tar content this is something that interests me greatly, as is it the most damaging effect of smoking. I do not how much a session produces but think that it cannot be a large amount as the tobacco is never burnt so therefore how can the tar be released? And most if not all the shesha tobaccos claim to be tar free.
If real genuine evidence came out I would give up tomorrow but until then double apple and shisha on the beach it is.

Theresa April 25, 2013 at 10:56 am

What about herbal shisha? The ones with no nicotine? I’ve used the hookah to help me quit cigarettes and then stopped using the nicotine shisha. I highly doubt this would be as addictive or as cancerous as cigarettes.

Shubham May 10, 2013 at 11:57 pm

1st of all, Thank you so much for the article !
I would like to ask you something Michael , My friend is a hookah smoker ( does 1-3 times in a week ) and according to me this has made him somewhat too skinny . Is my assumption wrong or true to some extent?

Shubham May 11, 2013 at 12:00 am

And sorry i forgot to mention he is just 15

Suren May 20, 2013 at 8:40 am

I am so much interested to visit hooka bar and see their culture. Is this different from Pub or not specially in united state. but i donot have so much many. any way let see…………………………………..

Robert May 21, 2013 at 5:31 am

First thing I want to say is how can shisha be as bad as cigarettes? people are out there smoking 10-40 cigarettes a day every day without fail and I myself don’t smoke cigarettes but go and smoke shisha on rare social occasions normally with a group of 5-10 friends so for a start I’m not smoking it myself for a whole hour therefore surely it’s nowhere near as bad for you.

Secondly if people are worried about catching diseases from others don’t be thats the exact reason they give you induvidually wrapped mouthpieces when you go and smoke

third for people worried about smoking tobacco there are herbal options and stones similar to the look of gravel available to smoke instead

Lastly cigarettes contain some of the most disgusting things I’ve ever heard of yet the government will never put a ban on selling them as quite frankly they do not care for anybody’s health only how their tax is looking once it’s in the countries finances last year the tobacco industry was supposedly worth £15.5 Billion imagine how much tax the government take from that

taking that into consideration does it really sound worst then cigs?

razazel May 24, 2013 at 9:52 pm

Just wanted to explain that hookah is actually safer than cigarettes but not because the water filters out anything, that is indeed a myth. It’s safer because it does not work under the same principle as a cigarette which is combustion, which produces carcinogen smoke. Hookah works by heating the wet organic vegetal matter just enough to get the molasses (honey and glycerin) evaporating: cooking. In a nutshell a hookah bowl is just like a grill but turned upside down, saying that you’ll get cancer from a hookah is like saying you’ll get cancer from smelling and breathing the fat evaporating from a piece of meat on a grill. Also, there’s no way smoking a bowl is the same as smoking a pack of cigarettes, people would just pass out at the end of the session and wake up feeling horrible, in terms of the amount of vapor inhaled it could be the same, but chemically smoke is not even close to be the same as vapour. And last, i haven’t found a single study where it’s shown and explained in detail how was the study conducted, with a cigarette, you light it and smoke it and that’s it, you can’t semi-smoke it or kinda smoke it, in a hookah there are many factors involved in setting up the bowl correctly that drastically affect the final quality of the session, because of this, a hookah can be used to almost literally smoke the tobacco as in a cigarette or to just smoothly and evenly cook it in order to extract the humidity in the form of much healthier vapor. So, basically, PROPER studies should be conducted along with hookah connosieurs that know what they are doing instead of just allowing scientist to guess how a hookah is setted up. And, hookah might not be 100% healthier, but definitely is not the same as cigarettes and is in no way worst than them. Happy “smoking” ;)

Chas June 5, 2013 at 8:44 pm

I have smoked one to two bowls of shisha for over 35 yrs. I do not accept the junk science funded by anti-tobacco interests.

Larhonda June 6, 2013 at 3:43 am

A fascinating discussion is worth comment. I do believe that you should publish more
on this subject matter, it may not be a taboo matter but generally people don’t speak about these subjects. To the next! Kind regards!!

www.apo-burg.de June 7, 2013 at 10:04 am

What’s up, just wanted to say, I loved this article. It was inspiring. Keep on posting!

Stephen June 8, 2013 at 2:28 pm

I’ve been reading articles like these more and more lately. I’m not going to argue that smoking hookah is safe. As a matter of fact, odds are that it is, at the very least, a little bad for you. That said, I would like to add a few points I feel like are often skimmed over by people writing articles citing research against the safety of smoking hookah.

First of all, if a hookah bowl is packed correctly, there is actually next to no combustion of the tobacco that occurs. This is quite different than cigarettes which get their smoke from combustion. I’ve read places that it is often this combustion which causes a reaction with chemicals in the tobacco and the air which create a portion of cigarettes nasty carcinogens.

Secondly, I haven’t seen any valid studies of the actual composition of hookah smoke as compared to cigarette smoke. It is my understanding that shisha actually consists of washed tobacco (boiling water is run through it continuously until the water runs clear), molasses, flavoring, and propylene glycol. Propylene glycol is the stuff in an electric cigarette that is vaporized to give the appearance of smoke. Therefore, it would seem that the thick appearance of the smoke could in fact be highly concentrated with water vapor (because of the condensation of cold water cooling hot smoke), vaporized propylene glycol, and tobacco which has been washed prior of a large portion of its tar, ammonia, etc.

Lastly, there have been no reported cases of people who smoke solely hookah who have succumb to lung cancer or other major health problems (that I have been able to find). Granted, this demographic is a small one that is hard to represent easily as most of the people only smoking hookah live in countries without proper means to medically examine and catalog each occurrence of medical abnormalities, and people who smoke hookah in the US generally aren’t opposed to smoking cigarettes either.

Just my 2 cents. I was on a 2 bowl a day habit when i was at college, and i never noticed any decline in my health until my room mate got me started on cigarettes. I wouldn’t even get winded after going on a run immediately following a long hookah session. That said though, the absence of evidence is not the evidence of absence, and, given what we know about tobacco products, it would stand to reason there are better things you can do for your body. I just can’t, having so much first hand experience with both, agree that hookah is nearly as detrimental as cigarettes are. I could be wrong though (It has been known to happen.)
Good article. :]

Katrina June 12, 2013 at 11:55 am

Mr. Michael Grisafe,
Where did you go? I love this article! There are many questions to be answered. I want to thank you for writing it, I would like to thank everyone for their comments and posts, information, proof, opinions, assumptions, thoughts, knowledge, feelings, beliefs, evidence, lack of evidence, and actual experimentally testable data. I would also like to say, I greatly appreciate the feedback from The Hookah Smoking community the most! Thank you for being honest and real with your comments.
I have so many questions……
Mr. Michael, could you please come back to answer many of the questions that have been posted and left un-answered. Not that your word is the Gospel, however, I hold great stock in your opinion. And if you wrote a Bible, I would read it. :)
The same question keeps popping up about organic, non-tobacco, tea leaf Shisha Hookah Smoking! What is the deal with this? Ok, no tobacco, no nicotine, organic tea leaves, wonderful taste and smell. Are we still lighting this on fire in one way or another? With heating rocks or a lighter or a torch or a forest fire? Is it still producing smoke in one way or another? With or without water or water filters or vapors? Bottom line, is it still smoke? Still fire? Still smoking? Could it be that some way carbon monoxide influx to the brain still exists and lack of Oxygen to the brain is still not a good idea? Please help me out with this one! Anyone? I really do need many answers!!

Alex June 19, 2013 at 9:23 pm

I am and avid hookah smoker and was trying to find replacement parts for my hookah and stumbled across this post. I agree that in a nutshell hookah is not really good for you. I grew up in a family with a dad and brother addicted to cigarettes and I have been very careful not to become addicted to nicotine. The one thing I wanted to mention was that smoking for half an hour is only equivalent to the volume of smoke you get from a whole pack of cigarettes. The actual nicotine levels that you get from smoking hookah is only slightly higher than a cigarette and is absorbed into the body over a longer amount of time. The tar levels of hookah smoke is higher than cigarette smoking but if you are careful and read the shisha containers you can buy tobacco without tar. Overall a very well constructed article but I just thought I would let you know how a hookah hobbyist sees it.

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