Carbon monoxide in hookah smoke

The charcoal used to heat the tobacco in a hookah gives off potentially toxic amounts of carbon monoxide. Carbon monoxide (CO) is an invisible, odorless gas that can poison you if you breathe it in. CO is in fumes produced when you burn fuel like charcoal. While many believe smoking hookah—a water pipe used to smoke flavored tobacco called “shisha”—is safer than smoking other forms of tobacco, hookah smoke actually contains many of the same harmful chemicals found in cigarettes, including carcinogens, nicotine, metals, and carbon monoxide gas.


Hookahs are becoming increasingly popular in the U.S., especially among young people. In recent years, hookah smoking roughly doubled for middle and high school students in the US. Over 1 in 10 12th graders in King County report smoking hookah in the past 30 days.


What is CO (carbon monoxide) and why is it inhaled when smoking hookah?

In the typical one-hour hookah session, the user inhales 100 to 200 times as much smoke as they would from a single cigarette. This often leads to significant increases in the concentration of CO in the body.  High concentrations of CO can result in CO poisoning.

What are the symptoms of CO poisoning?

When CO builds up in your bloodstream, red blood cells, which usually transport oxygen throughout your body, pick up CO instead.  This deprives your body of oxygen, which can lead to serious tissue damage, or even death.

Initial symptoms of CO poisoning are similar to the flu, but without a fever. If you’ve been smoking hookah and you experience these symptoms, it’s likely CO:

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  • Fatigue
  • Dizziness
  • Shortness of breath
  • Nausea or vomiting
  • Confusion
  • Blurred vision
  • Loss of consciousness

Research also suggests that survivors of severe CO poisoning may experience long-term neurological effects, including impairments in memory, concentration, speech, and depression.

What should I do if I suspect I may be experiencing CO poisoning?

If you suspect you may be experiencing CO poisoning, get fresh air and seek medical attention immediately.

How do I avoid CO exposure when smoking hookah?

The only way to avoid CO exposure from smoking is to quit smoking. Even smoking nontobacco hookah products exposes the smoker to potentially toxic levels of carbon monoxide and other toxins that are known to increase risk for cancers, heart disease, and lung disease.

It’s also best to avoid being around hookah smoke. Secondhand smoke from hookahs poses a health risk to nonsmokers. Secondhand hookah smoke contains smoke from the tobacco and charcoal, putting secondhand smokers at risk for the same adverse effects as hookah smokers, including CO poisoning.

In summary, play it safe and keep oxygen flowing through your body by avoiding inhalation of hookah smoke.

Spread the word! Download this infographic about hookah.

Want to quit but need help? Check out these resources to find the support you need.

Originally posted on January 27, 2017