Heavy Metals in Waterpipe Smoke and the Related Health Risks - A Review

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Excessive intake of heavy metals has harmful effects on health and waterpipe smoking could be one of the intake routes. Regarding the growing trend of waterpipe smoking in the world, in this study the heavy metal exposure related to waterpipe smoke and the health risks were surveyed in the published literature. Science Direct, Google Scholar and PubMed databases were searched using the keywords of heavy metals, hookah, shisheh and waterpipe. The results showed high concentrations of heavy metals in waterpipe smoke, tobacco, and charcoal. Also, high levels of heavy metals are reported in blood and toenails of the waterpipe cafes’ employees and for the smokers. The expected cancer risk for Cd, Cr, Ni, and as was higher than 1×10-6, and non-cancer risk for Cr was greater than 1. Burning of tobacco and charcoal is source of heavy metals in waterpipe smoke