In what is dubbed the largest ever study to explore the adverse effects of smoking shisha – a tobacco that’s sometimes mixed with fruit or molasses sugar and inhaled through a hose or tube – researchers from Brighton and Sussex Medical School found that people are more likely to gain weight and develop type 2 diabetes after inhaling “hookah” fumes, when compared to non-smokers.
The participants, from Iran, took a questionnaire which investigated their smoking history, cardiovascular risk factors and anxiety and depression.
This was then measured against their biochemical results, analysed by taking blood tests.
Out of the 9,840 participants involved, 6,742 were non-smokers, 976 were ex-smokers, 864 were cigarette smokers, 1,067 were hookah smokers and 41 were both cigarette and hookah smokers.
The results revealed that "obesity, metabolic syndrome, diabetes and dyslipidemia were positively associated with hookah smoking while negatively associated with cigarette smoking," the authors wrote.
The findings have cast doubt on the belief that smoking shisha is typically less toxic than smoking cigarettes. In fact, the researchers have even gone as far as to say it could be more detrimental to a person’s health.
“A single session of hookah smoking may be equivalent to more than a packet of cigarettes, and the inhaled toxic compounds may be even greater,” Professor Gordon Ferns from Brighton and Sussex Medical School told The Telegraph.
”It is unclear why hookah smoking is associated with obesity and diabetes. It is possible that the toxins in the smoke stimulate an inflammatory response that causes tissues to become resistant to the effects of the hormone insulin, that regulates glucose in the blood.
“However, it is also possible that hookah smoking is associated with other social behaviours that lead to weight gain.”
Following concerns regarding the long term health effects of hookah smoking, the researchers are calling for more to be done to reduce its appeal to younger generations. According to 2018 analysis by the University of Pittsburgh School of Medicine, hookah smoking accounted for over half of the tobacco smoke volume consumed by young smokers in the US.
“There is now good evidence that hookah smoking is not harmless. The risks of hookah smoking with respect to some types of cancer is well established, and the evidence for an association with cardiovascular disease is growing,” Ferns added.
”From a health policy perspective, it would be important for the public to recognise the risks of hookah smoking.
“The use of flavoured tobaccos may be particularly attractive to young people. Hookah smoking should be treated no differently from cigarette smoking.”
The results are supported by the British Heart Foundation (BHF) which claims that while it’s difficult to say exactly how much toxic substances a person is exposed to in a typical shisha session, that you can potentially “inhale the same amount of smoke as from more than 100 cigarettes”.
“Traditionally shisha tobacco contains cigarette tobacco, so like cigarettes it contains nicotine, tar, carbon monoxide and heavy metals, such as arsenic and lead,” the BHF states.
“As a result, shisha smokers are at risk of the same kinds of diseases as cigarette smokers, such as heart disease, cancer, respiratory disease and problems during pregnancy.”
For information on how to quit smoking you can call the NHS Smoking Helpline on 0300 123 1044, or find your local NHS Stop Smoking Service here.
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