Hookah smokers breathe in higher quantities of heavy metals than believed

According to a new study, when smoking hookah, only a minimal amount of heavy metals are removed in the "filtration" process, suggesting that shisha pipes are not as toxin-free as previously believed.

Research of the German Jordanian University and the Royal Scientific Society Amman-Jordan showed that on average, 3 percent of heavy metals present in tobacco are removed and this would not be enough to protect users from exposure to these toxins.

Shisha is often thought to be less severe than cigarette smoking due to 'filtering' by bubbling through water. Yet, we know that a typical shisha smoking session, which can last up to an hour, can expose someone to 100-200 times the volume of smoke in a single cigarette.

Lead researcher, Akeel Al-Kazwini, said that since the trend of smoking waterpipe has increased markedly among the young in the last decade, not only in the Middle East but worldwide, their research adds to the evidence about its potential health hazards and it is also important to highlight the fact that water is mainly cooling the smoke, and not filtering it as is commonly believed.

The levels of heavy metals in three of the four brands of tobacco were found to be the same. The amount of heavy metals in the water container was relatively low for all four brands - an average of 3 percent of total heavy metals present. This is compared to 57 percent in the smoke and 40 percent in ash residue.

The most abundant metal present in smoke was uranium, which was present on average in 800 parts per billion across 4 samples.

Al-Kazwini added that at present, the waterpipe tobacco industry operates without regulation and the impact of health warning labels on waterpipe use has not been extensively investigated. It is therefore essential that regulators and policymakers prioritize the correct labelling of waterpipe tobacco products in order to ensure users are informed of the dangers.

The study is published in the open access journal BMC Public Health.