Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

A hookah is a water pipe used to smoke tobacco. It’s also called a shisha (or sheesha), hubble-bubble, narghile, and goza. The word “hookah” refers to the pipe, not the contents of the pipe. The hookah was invented hundreds of years ago in the Middle East. Today, hookah smoking is also popular around the world.
According to the Centers for Disease Control and Prevention (CDC), up to 17 percent of high school senior boys and 15 percent of high school senior girls in the United States have used a hookah. The CDC notes that hookah smoking is slightly higher among college students, with about 22 percent to 40 percent having tried it. This might be because it’s typically a group event, and is done in special cafes, tea houses, or lounges.
A hookah is made up of a rubber hose, pipe, bowl, and smoke chamber. Tobacco is heated on coals or charcoal, and it may have flavours added to it, like apple, mint, liquorice, or chocolate. A common myth is that hookah smoking is safer than cigarette smoking. This isn’t true. Hookah smoking won’t get people high, but it does have other health risks, and can be addictive.
A hookah isn’t designed for marijuana or other types of drugs. Hookah smoking won’t get you high. However, the tobacco in it can give a buzz. Persons may feel lightheaded, relaxed, dizzy, or wobbly. Hookah smoking can also make people feel sick to their stomach. This is more common if users smoke too much or smoke on an empty stomach.
The coals used to light a hookah might make some people feel nauseous. Fumes from the coals can cause other side effects, including a slight headache.

Hookah tobacco is the same tobacco found in cigarettes. This means that when persons smoke a hookah, they are breathing in nicotine, tar, and heavy metals, including lead and arsenic. Smoking from one hookah for 45 to 60 minutes is about the same as smoking a pack of cigarettes.
Nicotine is the chemical that causes addiction when you smoke or chew tobacco. According to the National Institutes of Health (NIH), nicotine is as addictive as heroin and cocaine. When hookah smoking, the body absorbs nicotine. It reaches one’s brain in about 8 seconds. The blood carries nicotine to the adrenal glands, where it triggers the production of adrenaline, the “fight-or-flight hormone.”
Adrenaline raises the heart rate, blood pressure, and breathing rate. It also makes people feel more awake and less hungry. This is why nicotine makes smokers feel good for a little while.
Over time, nicotine can confuse the brain, causing people to feel sick and anxious if it is missed. As a result, smoking cigarettes or other tobacco products with nicotine may make people feel better. This is known as nicotine addiction.
Hookah smoking is often done in social situations. A 2013 survey of 32 people who smoke hookah found that they believed they had a “social addiction” to it. They didn’t believe they were addicted to nicotine.

With hookah smoking, persons inhale nicotine and other chemicals from tobacco, as well as chemicals from the fruit flavourings. Tobacco use is linked to almost 5 million deaths around the world every year. Hookah smoking also burns coal. This gives off other fumes and chemicals. An “herbal” hookah may still contain tobacco. It’s important to know that even if people are not smoking tobacco, they are still inhaling chemicals from coal and other substances.
In a hookah, the smoke passes through water before it reaches the hose and mouthpiece. A common myth is that the water filters out harmful substances. This isn’t true.

*Lung effects
Researchers in New York City compared respiratory
(breathing) health in hookah smokers to non-smokers. They found that young people who smoked only from a hookah sometimes had several lung changes, including more coughing and sputum, and signs of inflammation and fluid build-up in the lungs.
In other words, even occasional hookah smoking can cause health effects. Like cigarettes, hookahs also give off harmful second-hand smoke.

*Heart risks
The same study mentioned above tested the urine of hookah smokers and found that they had some of the same chemicals as cigarette smokers. Researchers also found other harmful chemicals, like carbon monoxide. These chemicals likely come from the coal that’s used to burn the tobacco.
A 2014 study tested 61 people, including 49 men and 12 women, immediately after hookah smoking in London cafes. Researchers found that hookah smokers had levels of carbon monoxide that were about three times higher than those of cigarette smokers.
Carbon monoxide can lower how much oxygen the body absorbs. This is because it can bond to red blood cells 230 times stronger than oxygen. Breathing in too much carbon monoxide is harmful, and it might raise your risk of heart disease and other illnesses.
The researchers also found that study participants had higher blood pressure after hookah smoking. The average blood pressure rose from 129/81 mmHg to 144/90 mmHg.
Over time, hookah smoking may cause chronic high blood pressure, which can also increase the risk of heart disease and stroke.

*Infection risk
Hookah smokers typically share one hookah in a group. Smoking from the same mouthpiece can cause infections to spread from person to person. Additionally, some bacteria or viruses may stay in a hookah if it isn’t cleaned properly.

Infections that can spread from sharing a hookah include:
* Cold and flu
* Cold sores (HSV)
* Cytomegalovirus
* Syphilis
* Hepatitis A
* Tuberculosis

*Cancer risk
A 2013 review notes that hookah smoking may also be linked to some cancers. Tobacco smoke has more than 4,800 different chemicals, and more than 69 of these are known to be cancer-causing chemicals. Additionally, hookah smoking may lower the body’s ability to fight some cancers.

That 2013 review also highlights research in Saudi Arabia that found that hookah smokers had lower levels of antioxidants and vitamin C than non-smokers. These healthy nutrients may help prevent cancer. Several other studies mentioned in the review link tobacco use to mouth, throat, pancreas, bladder, and prostate cancers.

*Other risks
Hookah smoking causes other health effects, including:
* Low birth weight of babies whose mothers smoked during pregnancy
* Higher blood sugar levels, which can increase one’s diabetes risk
* Larynx (voice box) swelling or damage
* Changes in blood clotting
* Stained teeth
* Gum disease
* Loss of taste and smell

Hookah smoking doesn’t make people high. However, it does have many serious risks and is addictive, much like cigarette smoking. Hookah smoking isn’t safer than cigarette smoking. If persons are considering hookah smoking socially, don’t share mouthpieces. Ask for a separate mouthpiece for each person. This may help prevent the spread of infection.