The Health Effects of Shisha
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The Health Effects of Shisha

We dispel some of the myths and explore the health effects of smoking shisha.



There has been a recent global boom in the demand for shisha bars. With the heavy marketing campaigns and increased awareness of the dangers of cigarettes, people are seeking a social alternative and many have settled on shisha (a.k.a hookah, waterpipe, chillim, nargile or my personal favourite hubbly-bubbly.) Shisha smoking has become an attractive evening pastime for youths throughout the world who cannot yet go to a bar and have a drink and need to find a social alternative. However there is a large amount of misinformation circulating about shisha that has left people unaware of the danger it poses to your health. With the increase in demand for shisha places, we need to look at just what people are getting themselves into, and dispel some of the myths surrounding this up and coming social trend.

There is a common belief that shisha is a healthier alternative to cigarettes. Rumours have long existed that the water in a shisha pipe acts as a filter to take out the tobacco's chemicals, nicotine and toxins leaving you with a clean, smooth, cold and tasty smoke, compared with the harshness and dirtiness of cigarettes. Other beliefs claim that the longer the pipe you are smoking from, the more harmful elements are filtered out. Unfortunately, if my epistemological studies taught me anything it's that belief isn't knowledge, and the research shows that those that believe shisha is healthier than cigarettes are just plain wrong. The smell, taste and stigma of cigarettes may have been removed with shisha, but you are still smoking tobacco and recent studies suggest that shisha has detrimental health effects that far outweigh having a ciggie or two.

The health effects of shisha can be assessed in two ways; firstly we're going to look at the negative health effects derived from smoking the tobacco itself, and then the effects of sharing a shisha pipe within a group.

The nicotine in tobacco is not water soluble, neither are many of the other chemicals that can be found in shisha tobacco, nor more importantly is carbon monoxide (CO). Unsurprisingly, smoking shisha therefore imparts all these toxins into your lungs with extremely negative consequences to your health. The negative effects of tobacco are widely known, and include: cancer of the lungs, mouth and bladder; heart problems; respiratory diseases; gum disease; sexual impotence; reduced sex drive; infertility and miscarriages in women; and addiction to tobacco itself (which furthers the chance of catching the other maladies as you smoke more.)

These health problems are well known with regards to smoking cigarettes, but the truth is that they are far more pressing a danger when smoking shisha. This is because more smoke is inhaled per puff than with a cigarette, furthermore a shisha session frequently lasts an hour and some studies suggest equates to smoking 200 cigarettes whereas smoking a cigarette takes 2-5 minutes and -except for the heaviest of smokers – is not done for hours at a time. There are further problems with smoking shisha over cigarettes; commonly the smoke is inhaled much deeper, in fact people actively try to take deep pulls on a shisha pipe, filling more of their lungs with smoke and increasing the chance of respiratory problems. The way a shisha pipe burns the tobacco is by placing a coal or burning wood on top of the tobacco. This coal emits CO, some of which enters the pipe whilst smoking increasing the levels of CO in your lungs and blood.

A study by the World Health Organization (WHO) demonstrated the harmful levels of CO inhaled when smoking shisha. Before revealing these figures it must be stated that there is no standard facts that can be given for smoking shisha for x amount of time or with x amount of tobacco. Individual smokers will inhale varied quantities per drag and will smoke for different amounts of time or to varied depths. making it hard to study the effects of shisha smoke. The WHO study examined people's exhaled breath after smoking and analysed the quantity of CO in the breath in parts per million (ppm.) In non-smokers, an exhaled breath contains 3ppm of CO, a light smoker of cigarettes has 10-20 ppm in their breath, a heavy cigarette smoker has 30-40ppm and a shisha smoker has 40-70ppm of CO in their breath. From these results it should be obvious that shisha is dangerous to smoke, and that the rumours of water purifying the smoke are not true.

However there is still some dispute about the long term effects of smoking shisha and about the accuracy of this study. The arguments for shisha being healthier than cigarettes claim that the smoke is 30 times less concentrated with chemicals than in cigarettes, and that only 142 chemicals have been unearthed in shisha tobacco compared with 5000 in a cigarette. Even if this were to be true, it does not mean that shisha is not harmful. The damaging CO levels exist in both the smoke, the tobacco, and in the coals that should not be inhaled. Just as you wouldn't stand next to a bbq breathing in the coal fumes, (even if it did smell delicious) you should not inhale coals in shisha.

Shisha smoking is a social activity that people often go to bars specifically to partake in. The sharing of a shisha pipe has several potential health effects that may not be apparent to many people. Even if you have individual mouth pieces, this does not prevent the contraction of illnesses from sharing shisha pipes. Diseases can be contained in and spread through the hose of the pipe or in the bowl of the shisha pipe itself if not properly cleaned. Diseases left in the shisha pipe and passed on to others can include tuberculosis, hepatits, herpes, aspergillus and helicobacter. Most of these present themselves as flu-like symptoms and range in severity from causing breathing problems to death if left untreated. It is relatively unknown that these diseases can be contracted through shisha smoking, which may account for why it is considered so socially acceptable, but hopefully with a bit of education and research people can begin to change their attitudes to shisha and subsequently improve their health.

In the UAE, they have already taken measures to try and reduce the health effects of shisha smoking, and therefore the burden on healthcare. In 2009 the Dubai Department of Economic Development passed a law banning shisha bars from residential areas, and from locations near schools and mosques. This ban came into effect at the start of this year (2012), giving shisha bars affected some time to close or relocate. It shows that measures are being put in place in the UAE to reduce the risk from tobacco products and improve peoples health, and also marks an acknowledgement of the dangers posed by shisha smoking in a region with a long history and tradition of shisha smoking. The UAE has also issued a 'healthier' shisha tobacco that is not actually tobacco. The substitute contains no nicotine or tar and so is considerably safer. Other alternatives to tobacco have been developed as well. Shiazo is a company that make and sell 'SHIAZO shisha steam stones' which are rocks that you place in the top of your shisha pipe instead of tobacco and coal. These stones, when heated, release moisture from inside them as steam instead of smoke. The steam is much healthier for you, in fact Shiazo claim it has no adverse health effects at all. The stones are purported to give the same feel, flavour, and provide up to 20% more smoke than shisha without any of the negative health effects. Much as the e-cigarette is to cigarettes, or the volcano vaporizer to marijuana, this product is a healthier alternative to smoking that produces vapour that will not effect the lungs negatively as no particles are entering them. Vapour or steam is much safer to inhale, and the removal of coal from the process removes one of the significant contributors of CO. Be warned that while this allows you to enjoy shisha without the dangers of tobacco smoking, if you are still sharing your shisha pipe, the risk of catching contagious diseases remains.

Putting the alternatives methods aside, it is clear that smoking shisha tobacco is unequivocally bad for your health. This information needs to be more common knowledge so that those who think they can smoke shisha without damaging their health are better informed and can make accurate decisions. People should be free to decide whether or not to smoke shisha but doing so with the misinformation that seems prevalent is dangerous and will have adverse effects on their health and their country’s healthcare system. Further studies may need to be done to accurately discover the severity of smoking shisha on health, but we can definitely dispel the myths and say without doubt that it is not healthy.

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