Shisha Smoking: Unraveling the Myths and Realities of Hookah Use

Shisha Smoking: Unraveling the Myths and Realities of Hookah Use

In the Orient, smoking a shisha (shisha) is a tradition and an essential part of Arabic culture. In recent years, smoking the water pipe, shisha has also established itself in Germany. Especially in cities, there is a wide range of shisha bars and restaurants where the water pipe can be consumed publicly. Shisha smoking is often seen as a much more harmless alternative to cigarettes. But experts warn that smoking a water pipe can also pose a health risk.

Smoking Shisha: Popular with youngsters

Shisha is particularly popular with teenagers and young adults. Friends meet up in a convivial atmosphere and smoke the hookah together. Hookahs have their origins in the Orient.

A water pipe consists of a glass container filled with water and a column of smoke. The so-called tobacco head is filled with special tobacco. The tobacco is then inhaled through a mouthpiece through a long tube. The tobacco in the shisha is added with fruity flavours that make the tobacco far tastier than usual. This is exactly where experts and doctors see the problem.


Water pipes and cigarettes, in comparison

Precisely because the tobacco inhaled from a shisha does not taste bitter, a water pipe can serve as a so-called gateway drug. In addition, the tobacco smoke from a shisha smells pleasantly sweet in contrast to the smoke from a cigarette. The health risks of shisha are underestimated mainly due to its taste and smell.

Many parents do not know that hookahs can be harmful. But just like cigarettes, shisha tobacco can also contain harmful substances such as nicotine, carbon monoxide, tar, lead or nickel.

If you want to compare how many cigarettes are equivalent to smoking a water pipe, two methods can be used: one measures the smoke volume, and the other measures the amount of cotinine in the urine. Nicotine is metabolized in the body, producing cotinine. This is then excreted in the urine.

Comparison of smoke volumes

Smoking a hookah with friends takes about an hour. According to the federal government’s drug and addiction report, each participant draws on the shisha around 100 times in these 60 minutes. Around 500 millilitres of smoke are inhaled per puff. So compared to smoking a cigarette, which you smoke in about 12 puffs of 50 millilitres each in a few minutes, this corresponds to the smoke volume of 100 cigarettes.

However, this does not mean that smoking shisha for one hour is as harmful as 100 cigarettes. According to the Federal Institute for Risk Assessment, meaningful comparisons can only be made based on the nicotine consumed.


Comparison of cotinine levels

If you smoke one water pipe a day, the level of cotinine in your urine is equivalent to smoking ten cigarettes a day. If you smoke shisha only occasionally, about every four days, this can be compared to consuming two cigarettes a day. 

Poor hygiene and tobacco as risk factors

In addition, it is a misconception that the water in the pipe filters and cleans the tobacco. Even if the smoke from a shisha is not inhaled directly like with a cigarette, an increased amount of nicotine gets into the blood. Remember that inhaling shisha is often more profound and intense than puffing on a cigarette.

The content of 0 per cent tar on the particular shisha tobacco varieties is misleading. But tar is always formed when the tobacco is heated, which is the case with the shisha. Incidentally, it is not only tobacco with its harmful substances that poses a possible health risk. Poor hygiene can also lead to infections such as hepatitis or herpes. If several people share a mouthpiece when smoking shisha, saliva residues can transmit diseases.

The danger of addiction from smoking the water pipe

Smoking and addiction are closely related. Nicotine is the trigger for smoking addiction. And this is also present with a water pipe. Whether the risk of becoming addicted to cigarettes is significantly higher than smoking shisha or vice versa has not yet been sufficiently proven. What is certain, however, is that smoking shisha is in no way conducive to health. Arguments from shisha smokers that consuming a water pipe leads to relaxation of the mind and body are countered by medical experts who argue that an absolute reduction in stress in the body through shisha cannot be proven.

Intensive research is currently being carried out on the subject of shisha. Nevertheless, there are already currently binding facts:

  • with flavoured tobacco, shisha is often referred to as a “tasty” gateway drug
  • Significantly higher nicotine concentration in the blood than after smoking a cigarette
  • Cardiovascular patients should refrain from smoking shisha altogether
  • Smoking hookah during pregnancy can have adverse effects on the health of the unborn baby
  • Increased risk of infections such as herpes
  • Nicotine can be addictive, regardless of how it is consumed


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