Hookah, or shisha, is a method of smoking flavored tobacco or a non-tobacco herbal mixture through a water pipe. The smoke is cooled as it passes through the water before being inhaled. However, the answer to whether hookah can make you vomit is unequivocally yes. This severe physical reaction is not uncommon and is typically the result of two distinct physiological issues: excessive nicotine absorption and exposure to an odorless gas.
Nicotine Overload and the Gut Reaction
Most flavored hookah tobacco contains nicotine, and the consumption method leads to a high overall intake. A typical hookah session lasts between 45 and 90 minutes, significantly longer than a single cigarette. This extended timeframe results in a cumulative dose equivalent to smoking a pack of cigarettes.
The body’s reaction to this high dose is acute nicotine toxicity. Nicotine acts as a potent stimulant, causing the adrenal glands to release adrenaline and triggering a systemic stress response. This sudden jolt to the central nervous system can cause lightheadedness and nausea. Nicotine also directly stimulates the smooth muscle tissues of the gastrointestinal tract, leading to stomach upset and intense vomiting. These effects are felt most rapidly if the individual has not eaten recently or is dehydrated.
Carbon Monoxide Poisoning as a Factor
A separate cause of sickness is the carbon monoxide (CO) generated by the heat source. The charcoal briquettes used to heat the tobacco do not burn cleanly, releasing a significant amount of the odorless, colorless gas into the smoke. This compound is then inhaled directly into the lungs.
Carbon monoxide poisoning occurs because the gas binds to the hemoglobin in red blood cells with an affinity hundreds of times greater than oxygen. This displaces oxygen, creating carboxyhemoglobin and leading to oxygen deprivation in body tissues, especially the brain and heart. Hookah users can be exposed to up to ten times the amount of carbon monoxide from a single session compared to a single cigarette. Initial symptoms of this oxygen starvation include headaches, dizziness, and weakness, which quickly progress to severe nausea and vomiting. This risk is present even when using tobacco-free shisha, as the CO is produced entirely by the burning charcoal.
Reducing Risk and Responding to Symptoms
To mitigate the risk of feeling unwell, simple steps can be taken to control exposure to both nicotine and carbon monoxide.
Prevention Strategies
Maintaining a slow pace and limiting the total duration of the session helps reduce the overall nicotine dose absorbed by the body. Users should also ensure they are adequately hydrated and have eaten a light meal before starting, as an empty stomach increases sensitivity to nicotine. Reducing carbon monoxide exposure requires focusing on the heat source and environment. Always ensure the area is well-ventilated, such as smoking outdoors or near an open window, to prevent the gas from building up. Some users opt for electric heating devices, like e-bowls or e-HMDs, which eliminate the need for charcoal entirely, thus removing the CO risk.
Responding to Symptoms
If symptoms like persistent headache, dizziness, or nausea begin, the immediate action is to stop smoking and move to fresh air. If the symptoms are severe, involving confusion, loss of consciousness, or unrelenting vomiting, seek emergency medical care right away. These are signs of dangerous carbon monoxide levels.