Cigarettes vs. Hookahs

If you run any Google search on Cigarettes vs Hookah, or Waterpipe Tobacco Smoking (WTS), you will immediately find that there is an avalanche of sites professing that Hookahs are as harmful, or more harmful than cigarettes. While smoking of any kind—cigarettes, cigars, pipes, vapes, and Hookahs—will never be healthy or harmless, Kaloud has performed more than a decade of research and development aimed at significantly reducing the harm caused by smoking Hookah or WTS. This article demonstrates that Kaloud has succeeded in significantly reducing the harm caused by smoking Hookah (WTS), and it dispels the mountain of outdated information that seeks to paint Hookah smoking as being as harmful as other forms of smoking.

Hookah History

Prior to European colonization of the “New World”, Tobacco was a plant that was used in ceremonies by indigenous populations in North and South America. In many cases, the Tobacco Plant was associated with powerful Nature Deities, and so it was sacred. Early European explorers were exposed to Tobacco and found the experience of using it pleasant. It wasn’t long before European traders began bringing tobacco, cacao, sugar, and other commodities to Europe where all of them quickly found popularity among the aristocracy and were distributed throughout Europe and Asia by means of merchants traveling the Silk Road.

There is some debate, but it is generally agreed that the use of Hookahs, or Waterpipe Tobacco Smoking (WTS), began sometime in the 16th Century in the Court of the Moghul King, Akbar Khan, where it was used as a digestive after meals. Akbar Khan’s physician, a Persian, saw that his king would cough during and after smoking tobacco from a pipe (the common method of smoking tobacco at the time), and so he invented the world’s first Hookah: a Waterpipe that that used a clay bowl, mounted onto a coconut shell filled with water and with a bamboo straw to draw in the smoke. While Akbar Khan’s physician incorrectly thought that he was filtering impurities from the smoke, his invention did cool the smoke, and so Akbar Khan’s coughing fits subsided and the Hookah pipe was born.

Over the course of time various cultures including Indian, Persian, Arab, and others adopted and innovated on the Hookah pipe. These innovations included things like metal downstems, the addition of flavors and glycerine to shisha tobacco, the use of aluminum foil to prevent the direct contact of charcoal to shisha tobacco, and, with the invention of the world’s first Heat Management Device (HMD), the Kaloud Lotus, in 2012, the ability to cook instead of burn, shisha tobacco.

The Studies

Since the first study of its kind in 2003 by Alan Shihadeh, there have been more than 500 studies, and references to studies, of Waterpipe Tobacco Smoking. In general, the goal of these studies is to study the composition and volume of gasses in Hookah tobacco smoke versus cigarette tobacco smoke. The outcome of these studies can be boiled down to five basic conclusions:

First, that “there is more gas produced in one Hookah session than in one cigarette, ‘Whereas one WTS session was associated with 74.1 liters of smoke inhalation […] one cigarette was associated with 0.6 liters of smoke [...]. One WTS session was also associated with higher levels of nicotine, tar, and CO.’” [Source: University of Pittsburgh School of Medicine]

Second, that the increased volume of gas in Hookah smoke which contains greater nicotine, tar, and carbon monoxide (CO), is more harmful than the compounds present in the gas produced by one cigarette;

Third, that the naturally occurring nicotine in Hookah Tobacco smoke is addictive;

Fourth, that nicotine as a compound is harmful; and

Fifth, that Hookah smokers use Hookah (WTS) in the same way that cigarette smokers use cigarettes.

The Flaws in the Studies

It may be helpful now to point out certain logical fallacies inherent in each of the conclusions above since in nearly every study to date, the focus has been to prove all, or some combination, of the conclusions listed above.

Conclusion One, that there is more gas volume in one Hookah session than one cigarette:

While it is undeniably true that one cigarette will produce significantly less smoke volume (gas) than a typical Hookah smoking session, it is also undeniably true that the chemical compounds present in cigarette smoke are vastly different than those present in Hookah smoke. Additionally, the typical cigarette smoker doesn’t just smoke one cigarette, and, “[f]or example, a frequent cigarette smoker may consume 15–25 cigarettes per day[.]” [Source: University of Pittsburgh School of Medicine]

To date, there is only one study that actually discusses the breakdown of the gas in Hookah Tobacco smoke, and that is the 2021 Study conducted by Kaloud at an ISO Certified Laboratory in Germany.

In the Kaloud study, it was shown that using charcoal with the Kaloud Lotus, Ayara Carbon Filter, and Krysalis Eltheria resulted in an average reduction of 98.1% of Carbonyl Compounds, 97.5% of Polycyclic Aromatic Hydrocarbons (PAHs), 84.5% of Volatile Organic Compounds (VOCs) and 34.9% of Carbon Monoxide (CO).

Please note that:

Carbonyl Compounds are harmful, but not toxic.

PAHs are known carcinogens.

VOCs are toxic and, depending on the VOC, carcinogenic.

CO is toxic, but not a known carcinogen, and is produced by the charcoal used to heat Hookah tobacco. [Source: University of Pittsburgh School of Medicine] Kaloud and other companies are working hard to develop a viable clean alternative to charcoal.

It may be that the reason that no other known study looks at the actual composition of Hookah Tobacco smoke may be because the composition of Hookah smoke is very different to the composition of cigarette smoke.

Conclusion two, that nicotine, tar, and carbon monoxide, are more harmful than the compounds found in cigarette smoke:

As stated in the beginning of this article, there is no healthy or harmless way to smoke. Vapes, cigars, pipes, Hookahs, and cigarettes, will all have some kind of harmful effects on human physiology over time, especially if consumed obsessively or excessively. With that being said, if taken on a direct one-to-one comparison by volume, there are almost certainly compounds in cigarette smoke (Carbonyls, PAHs, VOCs, and CO) that appear in significantly higher concentrations than in Hookah smoke. [Source: PMC]

A cigarette is designed to completely burn the tobacco, which produces smoke and leaves behind ash. A typical Hookah is not designed to burn tobacco, rather the tobacco is a substrate for glycerine, flavoring, and honey or molasses, with the smoke being produced by using charcoal to aerosolize glycerine and flavoring, not to burn and ash the tobacco. For this reason, the tobacco remaining after the typical Hookah session is crisp on the top and progressively less crisp with greater moisture towards the bottom of the Hookah tobacco bowl.

While CO and tar are undeniably harmful, the CO in Hookah smoke is from charcoal and not the burning of tobacco as in cigarettes [Source: University of Pittsburgh School of Medicine], and by gas volume, the tar levels are typically much lower than in cigarettes.

Conclusion three, that the naturally occurring nicotine in Hookah Tobacco smoke is addictive:

The fact is that most cigarette smokers are addicted to their habit, whereas the rituals associated with using a Hookah make it far less likely that the typical Hookah user is addicted to Hookah smoke, which means that they are not consuming the smoke at the same frequency as a cigarette smoker. [Source: University of Pittsburgh School of Medicine]. This will be discussed further under the discussion of “conclusion five” below.

Conclusion four, that nicotine as a compound is harmful:

While Nicotine in very high doses can be toxic and potentially deadly, in lower doses it is metabolized quickly by the body, with a half-life of around 2 hours, and there is significant research that indicates nicotine has “beneficial effects” in treating “ulcerative colitis, Alzheimer's disease, Parkinson's disease, Tourette syndrome, attention deficit hyperactivity disorder, and obesity.” [Source: xPharm: The Comprehensive Pharmacology Reference 2007, Pages 1-8, by Michael D.Meyer]. This is not to say that people should smoke to consume Nicotine for any potential positive effects it might have on their physiology, however, it is meant to say that the mere presence of Nicotine in smoke is a much more complicated issue than simply labeling it as an evil and addictive compound.

Conclusion five, that Hookah smokers use Hookah (WTS) in the same way that cigarette smokers use cigarettes:

As discussed briefly under the discussion of “conclusion three” above, the act of smoking a cigarette involves a very different set of steps compared to the rituals associated with smoking Hookah.

By way of example, Smoking a cigarette requires the following steps:

Take cigarette out of packaging;
Light the cigarette with a match, lighter, or other heat source;
Smoke the cigarette

The three steps above can typically be done within seconds anywhere so long as a person has a heat source to light the cigarette. The obvious benefit of this is that a cigarette is extraordinarily flexible in where and when it can be consumed, and so the typical cigarette smoker can, and often does, smoke throughout the day.

Alternatively, a Hookah requires the following steps:

Put charcoal on a stove or other heat source to heat up and wait 5-10 minutes;
While charcoal is heating prepare your hookah bowl by packing hookah tobacco;
Pour water into your Hookah base;
Place your Hookah downstem into your Hookah base making sure there are no air leaks;
Plug in your Hookah hose into your Hookah downstem and check for any air leaks;
Place your Hookah bowl onto your Hookah downstem;
Place your Kaloud Lotus or other Hookah Heat Management Device (HMD) onto your Hookah downstem;
Put the lit charcoal into your Kaloud Lotus or other Hookah Heat Management Device (HMD);
Wait 5-10 minutes for the Hookah tobacco to warm up and take your first puff;
Smoke for 30-90 minutes

Because of the nature of how the technology of a Hookah works, it cannot be used anywhere or anytime. In fact, as demonstrated above, it will take 10-20 minutes before the Hookah is even ready to use. It is not as convenient as stepping out for a cigarette break, or a quick smoke from a car to the door to a building. Hookah requires process, it requires ritual, and it requires time—a lot of it.

Because of this, the nicotine from a Hookah session is often broken down long before the next Hookah session, which is often the next day, and in many cases, days or weeks later. While there are Hookah users that smoke Hookah multiple times a day, these are outliers within the overall Hookah community, which are mostly casual Hookah smokers that smoke with friends at social gatherings. The social quality of smoking Hookah means that the pipe is often passed from person to person, and so the total consumed gas volume is divided between two-to-four individuals.

In Summary

Kaloud as a company respects and supports any competent scientific inquiry into the health effects of using Hookah. Kaloud does not believe that smoking will ever be healthy, but we do know that there are things a person can do to significantly reduce the harmful effects of smoking from a Hookah pipe, and we have done our best to communicate those to the public. Like any other vice, there are steps thoughtful adults engage in to mitigate the harm associated with the vices they engage in.

Based on the analysis above, the conclusions we hold to be true are that:

Hookah smoke and cigarette smoke are very different in their chemical composition and any study that attempts a one-to-one comparison is flawed from the outset;
Nicotine is not necessarily addictive, and depending on the dose, it is not harmful, and may be beneficial to human physiology;
The physical act of smoking a cigarette is very different from the rituals associated with smoking from a Hookah pipe; and
Because of the differences, addiction to Hookah smoke is far less likely than cigarettes

We invite the reader to perform their own critical analysis of the studies comparing cigarettes to Hookahs, and we further invite the reader to investigate the motivations of the people performing and funding those studies.

For our part, we invite any and all scientific inquiries into our products and our study. We will provide any of our products free of charge to any credible institution seeking to validate, challenge, or disprove our study or the logic of this article.