Water Pipes: Just As Bad As Cigarettes?

by admin on September 9, 2011

DrSamGirgis.com has the pleasure of hosting the following post by guest blogger, Dr. Richard Andraws MD, who is a Board Certified Cardiologist


Oh! hookah of the magic bowl,

Thou dost bring me greatest pleasure,

Who likes not thee, hath not a soul,

And can know of joy no measure.

Thy fragrance brings me visions bright–

Dispels the shadows of the night.

Epigram from Over the Hookah:  The Tales of a Talkative Doctor, by George Frank Lydston, M.D., 1896

Water pipes, also known as hookahs or shishas (among other appellations), have been used in the Near East for centuries to smoke sweetened tobacco. The smoke, created by heating the tobacco with charcoal, is drawn through a water bath that cools it before it is inhaled. Water-pipes have seen a resurgence as trendy “hookah bars” offer patrons an array of flavored tobaccos to puff on, ranging from “pomegranate” to “mint chocolate” to “prickly pear.” The perception is that the cooled, mild smoke is more benign than that of cigarettes with none of the more serious health risks. And the communal fun of sharing the pipe makes the experience even more attractive.

Cardiovascular disease is the leading cause of death and disability in the United States and is the leading cause of death in smokers. Cigarette smoke is laden with a hazardous stew of some 4000 inflammatory chemicals that are not only potentially carcinogenic but also cause blood vessels to malfunction and become rapidly diseased.  This commonly leads to heart attacks, strokes and poor circulation. It’s so toxic, in fact, that it takes roughly ten years for a former smoker’s risk of vascular disease to return to the levels of a nonsmoker.

Thus, the recent study published by Hakim and colleagues in Chest, is particularly important as the use of water pipes burgeons. The investigators studied the physiologic and biochemical effects of a single 30 minute pipe smoking session on a group of 45 volunteers. The average age of the volunteers was 32 years; thirty were male; the majority smoked water pipes two or three times every week. Volunteers were instructed to smoke the way they normally would. The same tobacco and charcoal was in all pipes. Subjects with chronic lung disease, pregnant or lactating women, recent illness, and those smoking or exposed to smoke within 24 hours were excluded.

After the session, the volunteers’ blood pressures and heart rates had significantly increased over baseline. Blood pressure and heart rate are strongly linked to cardiovascular disease. Measures of lung function showed significant deterioration. The amount of carbon monoxide in the subjects’ bloodstreams increased; interestingly, female smokers had higher levels than their male counterparts. The amount of exhaled nitric oxide modestly decreased (nitric oxide is essential to the health and normal functioning of blood vessels). Finally, there was a decrease in certain white blood cells in some subjects, possibly due to the smoke inducing cell death. As an interesting aside, the investigators also found that the volunteers rated themselves as less happy on a scale of 1 to 10 after smoking, despite saying they felt good.

Granted, this was a very small, uncontrolled study, and some findings (e.g. a decrease in one inflammatory maker) were unexpected. The small size limits the statistical strength of the observations, and clinical conclusions cannot be drawn. The authors call for larger, more powerful studies. However, this study is an important addition to the growing evidence base against water pipes, which appear to have many of the same cardiovascular effects as cigarettes and may be putting their users at just as much risk.


Hakim F, Hellou E,  Goldbart A, et al.  The acute effects of water-pipe smoking on the cardiorespiratory system. Chest 2011; 139:775-781.




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