Research at Rambam revealed that smoking a waterpipe – just once – can cause significant damage to the heart and lungs

Writer: Roberta Neiger, ProText

Rambam researchers have shown that even one waterpipe session significantly affected users’ lung function, and increased blood pressure and pulse. It boosted amounts of the toxin carboxyhemoglobin to levels that may require medical attention, oxygen administration or hyperbaric treatment. To achieve this toxic level, one must smoke between 10-100 cigarettes. Additionally, levels of exhaled NO, a molecule that helps protect the heart, lung and blood vessels greatly decreased. 

Research subjects smoking waterpipes                         Photo credit: RHCC.

In a project conducted recently at Rambam, Prof Lea Bentur, director of the hospital’s Pediatric Pulmonary Department, examined 45 male and female subjects. All were over the age of 18, the average being 32. Subjects were asked to smoke a waterpipe with an Egyptian-made brand of apple-flavored tobacco popular in Israel.

A half hour after smoking, the subjects underwent examinations of blood pressure, pulse, breathing, lung function and blood composition. Significant bodily damage was apparent. The level of carboxyhemoglobin, which prevents oxygen delivery to body tissue, jumped to up to 26%. This is a far greater increase than that caused by cigarettes. Levels above 25% require hospital admission and may adversely affect the heart and brain. Interestingly, females – who are more susceptible to cigarette-smoking damage – had higher carboxyhemoglobin levels.

Waterpipes, also known as hookahs, shishas or nargilas, are widespread in the Middle East, Turkey, India, and Pakistan. With globalization and immigration, waterpipe use has spread to Western countries, notably among youth. The ‘moasel’ tobacco used in water- pipes has the same amount of nicotine as 10 cigarettes, and as many toxins as 100 cigarettes.

According to Prof Bentur, the charcoal disks used in waterpipes are synthetic, and contain coal, as well as industrial and waste materials. There is no basis to the common belief that water filters the poisons in the smoke, she adds. Smoke is not filtered at all, and enters the body directly.

Prof Bentur explains that the waterpipe’s ‘innocent’ appearance is misleading. “The pipes are often beautiful objects made of colorful glass,” she says. “The tobacco has a fruity taste that seems natural, but it is still tobacco. It contains nictotine, tar, benzoapyrene, arsenic, chromium and lead, which can cause lung, bladder and other cancers. More than cigarette smoking, waterpipe smoking increases chance of chronic bronchitis, heart and vascular disease. Mouth-to mouth use may encourage the spread of mouth, lip and gum infections.”
Prof Bentur and her team are taking this research one step further. They will explore the connection between waterpipe smoking and endothelial dysfunction, a precursor to atherosclerosis. They will check its effect on airway cytokines, small proteins involved in cellular interactions and communications.
“I first got the idea for this research when I noticed that many young adolescents with mild asthma developed severe deterioration in a short period,” says Prof Bentur.  “When I asked them if they smoked, they answered, ‘yes, but only a waterpipe.’”

“I am convinced that parents must stop their children from waterpipe smoking, which can become chronic and dangerous,” says Prof Bentur, who supports increased education and regulation, at least for those under 18.