A hookah, or shisha, is a water pipe used to smoke specially prepared, often flavored tobacco. The process involves passing charcoal-heated air over the tobacco mixture, drawing the resulting smoke through a water-filled chamber, and inhaling it through a hose and mouthpiece. Hookah smoking is typically a social activity, with sessions often lasting an hour or more, which extends the period of smoke exposure.
The Sensory Experience
The initial physical sensation of drawing smoke from a hookah is distinct from a conventional cigarette, primarily because the water in the pipe’s base cools the smoke. This cooling makes the draw feel much smoother and less harsh on the throat. The inhalation technique requires a slow, deep pull to draw the large volume of cooled, dense smoke.
The most notable sensory aspect is the intense flavor and aroma delivered by the shisha, the flavored tobacco mixture. The smoke is rich with sweeteners and flavorings, often described as fruity, spicy, or dessert-like. This dense, aromatic vapor contributes to a gentle, pleasant texture, contrasting sharply with the dry, hot smoke of a traditional cigarette.
Immediate Physiological Effects
The feeling commonly associated with smoking hookah is a combination of lightheadedness, mild relaxation, and a subtle euphoria, often described as a “buzz.” This bodily reaction is primarily driven by the absorption of nicotine and a significant amount of carbon monoxide (CO). Nicotine acts as a central nervous system stimulant, which can cause an initial rush of energy followed by a sensation of calm.
The lightheaded sensation is largely attributable to the massive volume of smoke inhaled and the subsequent uptake of carbon monoxide. During a typical hour-long session, a user can inhale 100 to 200 times the volume of smoke compared to a single cigarette. Carbon monoxide binds to hemoglobin in red blood cells, displacing oxygen and causing a mild, temporary state of oxygen deprivation, or hypoxia. This mild hypoxia manifests as the dizziness or lightheadedness that users often seek.
The body also reacts with physical indicators of stress, including an acute increase in both heart rate and blood pressure. Studies show that even a brief 30-minute session can cause a rapid increase in plasma nicotine levels and a sharp spike in expired carbon monoxide. This physiological response suggests a temporary adrenergic overactivity, similar to the body’s reaction to a low-dose stressor. For new users, or those inhaling deeply, this acute exposure may also cause throat irritation or a cough, signaling the body’s reaction to the inhaled toxicants.
Acute Health Risks and Misconceptions
The smooth, cool sensation leads many users to believe the water chamber filters out toxic substances, but this is a misconception. Research indicates the water does not filter out a large proportion of harmful components; the smoke still contains high levels of toxicants, including nicotine, tar, and heavy metals. The cooling effect simply allows the user to inhale more deeply and hold the smoke longer, paradoxically increasing toxic exposure.
The most significant acute danger is carbon monoxide (CO) poisoning, which stems from the burning charcoal used to heat the shisha. Charcoal combustion produces high levels of colorless and odorless CO gas, which is inhaled along with the tobacco smoke. In a single session, a user can be exposed to nearly nine times more CO than from a single cigarette.
Symptoms of mild CO poisoning—such as headache, sleepiness, confusion, and irritability—can easily be mistaken for the lightheaded “buzz” or fatigue from the session itself. At higher levels, acute CO exposure can cause severe symptoms like nausea, vomiting, fainting, irregular heartbeat, and even transient loss of consciousness. Because the risk is tied to the charcoal, poorly ventilated spaces, such as indoor hookah lounges, significantly increase the danger of reaching toxic CO levels.