Hookah: Health, Harm, and Safety


What is put in hookah tobacco? Is hookah more harmful than cigarettes? Are nicotine-free mixtures safe?

Let’s find the truth together!

How Does a Hookah Work? 

The bottom line is that the smoke passes through the water. And only then it gets into our lungs.

How does this happen?

Put hookah tobacco in the bowl, cover it with foil. Put hot coal on top. This way, we heat the tobacco to ~ 130-170 ° C.

Taking a puff, we let the air be sucked in through the tobacco heated by the coals. The resulting aerosol vigorously passes through the main tube into the water (or what you poured into the bowl: milk, wine, juice).

In water, it cools down and comes to us. We give off puffs of smoke like a dragon.

What Are We Smoking?


Hookah tobacco looks like a thick herb jam. And this is not far from the truth. Here is the typical composition of hookah tobacco:

  • Tobacco leaf. Burley, Virginia, and Oriental tobacco are the main blends;
  • Humectants: glycerin and propylene glycol. These are E420 and E1520. They are needed to moisturize the tobacco mixture so that it does not dry out, and the tobacco does not deteriorate. And also for the formation of fragrant clouds of smoke – what we value hookah for. Regular cigarettes are also impregnated with a sauce made of propylene glycol and glycerin;
  • Invert syrup. It’s just sweet sugar syrup. It consists of glucose, fructose, and a small amount of sucrose. It is obtained by heating an aqueous solution of sugar and acid. (By the way, honey is also the invert syrup). The syrup in hookah tobacco is responsible for the sweetness and taste. It also affects the softness of the smoke and even its quantity. Previously, hookah tobacco was impregnated with honey and molasses. And you can still find such mixtures;
  • Flavors. Apple, cherry, mint, and a million other flavors;
  • Sometimes dyes are added—for example, sugar color E150.

Is Hookah Harmful?

hookah place

Of course, yes. Any tobacco piece you smoke is not about a healthy lifestyle.

The smoke contains carcinogens and other substances that are poisonous to us. Why? Because pyrolysis occurs – that is combustion. Organic matter is burned. The water through which the steam is filtered will not retain all harmful substances even if it is water with activated carbon. Interestingly, has someone smoked a hookah on activated charcoal?

What Are These Poisons?

Nitrosamines, formaldehyde, benzene, polycyclic aromatic hydrocarbons (abbreviated as PAH) [1].

This is the case when a chemical name sounds bad and means terrible.

Many PAHs have carcinogenic, mutagenic, and teratogenic (that is, they affect the fetus in the womb and its development) effects.

Benzapiren is one of these.

Heavy metals are also found in smoke [1].

It sounds scary, but cigarettes have everything the same. And from this follows two opposite myths:

Hookah Myths

is hookah safe

Rumor #1

“Hookah is more harmful than cigarettes! For one hour of smoking, you get a dose of poisonous substances like from 100-200 cigarettes at once!”

Not certainly in that way. Yes, in one smoking session (an hour and a half), you will inhale more smoke in total. And with it, there is more nicotine, PAHs, and other beautiful compounds.


Smoke from cigarettes differs in composition from hookah smoke. There are tens of times fewer components in hookah smoke.

This does not mean that it is ten times less harmful.

What difference does it make whether you get poisoned with one poisonous substance or ten if the total is the same?

However, chemically speaking, smoke from a hundred cigarettes and smoke from a hundred puffs of a hookah is not the same thing. As a minimum, cigarette smoke contains more tar combustion products. And in the hookah, there are more distillation products. Therefore, it is not entirely correct to compare.

Plus, the time and intensity of smoking are essential. Everyone smokes differently—someone like a steam locomotive, someone once every half hour.

Not everyone smokes hookah every day. For some, this is a weekly need. For others – a prank once every six months. All this is worth considering.

What you get with a hookah more than with cigarettes is carbon monoxide CO. There are numbers from 8 to 15 times larger. [2] [3]

Carbon monoxide grabs the hemoglobin in the blood and prevents it from working: supplying us with oxygen. Because of this, there is nausea and headache when smoking a hookah.

Rumor #2


“Hookah is completely harmless! Water filters everything harmful.”

Well, come on! Do you know what is entirely safe? – No smoking.

Like any other tobacco smoking, Hookah harms health on all fronts: from heart and blood vessels to lungs and cancer [1].

Think for yourself: these are carcinogenic and toxic products of tobacco pyrolysis with additives.

Of course, tobacco is heated to lower temperatures of 130-170 ° C than in a cigarette (600-900 ° C).

Well, you get less tar but more carbon monoxide and benzopyrene.

What’s the catch?

Nicotine-Free and Tobacco-Free Mixtures

Let’s not be confused. Nicotine-free blends are not made from tobacco leaf but from any other herb: Ivan tea leaves, raspberries, regular green tea, etc.

There’s really nowhere to get nicotine.

Plus, tobacco blends from which nicotine was entirely removed are rarely found.

How is it done?

Complete drying and cooling of tobacco sheets almost completely remove nicotine.

Also, there are tobacco-free mixtures. That is, the composition is still not tobacco. A conditionally plantain. But it is soaked in liquid nicotine. It turns out the blend is tobacco-free but nicotine-full.

Is it More Secure?

smoking pipe

No, not likely. Nicotine is not the most harmful thing in tobacco. Yes, it forms addiction and makes you smoke. But it is slightly toxic, quickly degrades, and is eliminated.

Combustion products are much more harmful. If something burns, and we inhale this smoke, it is no longer super healthy. And it is not so important, whether it is burned out raspberry or Ivan tea leaves.

Check out exciting research here [4].

The smoke of tobacco-free mixtures will still contain tar, PAHs, carbon monoxide.

If there is no difference, why pay more?

Hookah can be addictive, just like any other tobacco product. Secondhand smoke will have the same health effects.

It’s no worse or better than a cigarette, pipe, or vape. Just another type of tobacco that a person can smoke.



  1. Fact sheet: waterpipe tobacco smoking & health
  2. Ultrafine particle emissions from waterpipes
  3. Change in carbon monoxide exposure among waterpipe bar patrons
  4. Does switching to a tobacco-free waterpipe product reduce toxicant intake? A crossover study comparing CO, NO, PAH, volatile aldehydes, tar, and nicotine yields

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