Is smoking shisha bad for you?

Does smoking tobacco in shisha pipes reduce the risk?


Shisha pipes have been used for centuries and they originate in The Middle East or India in the sixteenth century.

Shisha, technically speaking, is the name for the flavoured tobacco which is smoked in what is actually known as a hookah, water pipes or shisha pipes.

The equipment known as shisha pipes consists of a water pipe, a chamber for smoke, a bowl, a pipe and a hose. Charcoal is burned in the pipe which heats the tobacco mixture, this, in turn, produces smoke that is filtered through the water. The smoke is then inhaled.

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Many users believe that smoking tobacco in this way is less harmful, however, shisha smoking carries many of the same health risks associated with cigarette smoking.

Even if tobacco free shisha is smoked the user will be at risk from the carbon monoxide and any toxins in the coal or charcoal used to burn the shisha.

We are going to assess whether, if you are addicted to nicotine, it is a less risky option to smoke tobacco through a hookah.

Smoking shisha carries the following risks:


People who smoke shisha tend, on average, to absorb more toxic smoke than cigarette smokers. The way that shisha smoking is practiced means that the pipe is ‘puffed’ on more frequently and the smoke is inhaled more deeply than a cigarette. This alongside the fact that a typical shisha ‘session’ lasts an hour means that a shisha smoker can inhale as much as 200 times the volume of smoke inhaled from a cigarette.

Whilst the water acts as a filter to the smoke it does not effectively remove high levels of toxins such as carbon monoxide, heavy metals and carcinogenic substances that are present in tobacco smoke.

Heart disease

When shisha smoke is inhaled, toxins from tobacco enter the smoker’s bloodstream and these toxins contribute to atherosclerosis, also known as hardening of the arteries, which in turn results in blood vessels being less flexible than they should be. The blood vessels become damaged as a result of smoking which causes fatty deposits which in turn cause narrowing of the arteries.

These tobacco related changes can lead to angina, congestive heart failure and heart attacks.

Vascular disease

Peripheral arterial disease is a condition where a buildup of fatty deposits in the arteries restricts the blood supply to the legs; it is also known as peripheral vascular disease.

Some people will be unaware of having the condition without having any symptoms but some people will feel aching in their legs when they walk. Other symptoms can include:

  • Numbness and weakness of the legs
  • Hair loss on the legs and feet
  • Brittle toenails that are slow to grow
  • Open sores on the feet and legs that are slow to heal
  • Skin colour changes on the feet and legs which may be pale or blue 
  • Shiny skin
  • Muscle shrinkage on the legs

The peripheral arterial disease can also cause erectile dysfunction as it can disrupt the blood supply to the genital area.

These symptoms are likely to develop over a period of time but if the symptoms appear or become much worse quickly it is important to seek urgent medical treatment.

Cerebrovascular disease

Reduced blood supply to the brain can cause a stroke which is a serious, life threatening condition when the blood supply to part of the brain is cut off.

The two main causes of stroke are:

  • Ischaemic whereby the blood supply is stopped when a blood clot blocks a blood vessel. This accounts for 85% of cases
  • Hemorrhagic whereby a weakened blood vessel in the brain bursts and so the blood supply to the area stops

There is also a related condition which is called a transient ischaemic attack (TIA) and is otherwise known as a mini stroke. The blood supply to the brain is temporarily interrupted and can last from a few minutes up to 24 hours.

Respiratory diseases

Respiratory diseases associated with tobacco smoking include:

Other conditions which may become worse of prolonged as a result of smoking include:

  • Pneumonia
  • Asthma
  • Chest infection
  • The common cold

Infectious diseases

Some risks of smoking shisha are related to the way it is practiced. Shisha tends to be smoked socially in groups. The mouthpiece is shared and so may not be hygienically cleaned between smokers. This leads to the transmission of infectious diseases and can include diseases such as tuberculosis, aspergillus (lung infection), helicobacter (responsible for stomach ulcers), viral herpes and hepatitis.

Problems in pregnancy

Smokers, in general, can have problems becoming pregnant as smoking affects the fertility levels of both men and women. If smokers are fortunate enough to become pregnant then there are a number of other issues related to smoking:

  • Increased risk of miscarriage
  • Increased risk of having an ectopic pregnancy. This problem occurs when a foetus implants outside the uterus, either in the abdominal cavity or the fallopian tubes. As the foetus is unable to develop in either place then a procedure must be carried out to terminate the pregnancy.  
  • Increased risk of having a baby prematurely
  • Increased risk of stillbirth or death of the infant shortly after being born. One third of these cases are believed to be caused by smoking
  • Increased risk of having a child born with abnormalities such as cleft lip and palate defects as well as heart defects
  • Increased risk of having an underweight child
  • The growth and health of your baby is more likely to be affected if you are a smoker
  • Placental abruption is more common in smokers. This involves the placenta breaking away from the wall of the uterus before the baby reaches full term

The risks do not stop there, children of mothers who smoke while pregnant run a greater risk of:

  • Sudden infant death syndrome (SIDS). This can happen to newborns as well as infants over 12 months old. If you or your partner continue to smoke after the child is born, the risk is greater
  • Suffering from asthma, ear infections and other respiratory diseases
  • Behavioural issues can also be attributed to smoking in pregnancy. Such disorders can include ADHD (attention deficit hyperactivity disorder)
  • Poor learning performance

Quitting shisha

Now that you are better informed about the risks associated with smoking shisha, you may well want to quit the habit. Addiction to nicotine is not an easy addiction to break but despite the difficulties involved, it is the most valuable thing you can do for your own health and for the health of your children.

A good place to start is to speak with your GP who will be able to put you in touch with a support group, many GP practices have their own stop smoking programmes. If required, this sort of group can advise on the different types of treatment that are available to help you stop. They include:

  • Medication
  • NRT (nicotine replacement therapy)
  • Counselling
  • Other therapies such as hypnotherapy and cognitive behaviour therapy (CBT)

In the case of addiction to smoking shisha, it is important to remember that for most people who practice the habit, it is a social event where they meet their friends. The social issue can be approached by arranging other times to meet your friends, go for a cup of coffee. Better still, go for a walk or to the gym, this will help to reverse some of the effects of smoking tobacco.

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