Herbal Cigarettes: Are They Really Any Healthier?

Herbal cigarettes: They carry a certain "coolness factor" and sound like they might be a healthier alternative to tobacco, but are they really safer to smoke?

Not really, experts say.

“Even herbal cigarettes with no tobacco give off tar, particulates and carbon monoxide, and are dangerous to your health,” according to the American Cancer Society (ACS).

The ACS outlines the dangers of a few of these herbal alternatives — from clove cigarettes known as kreteks to flavored cigarettes known as bidis and water pipes called hookahs.

“Hookah is not a safe alternative to smoking cigarettes,” Dr. Ellen Rome from Cleveland Clinic in Ohio said in a post about the dangers of sharing these pipes that heat tobacco with charcoal and filter it through cool water.

“A typical one-hour session involves inhaling 100 to 200 times the volume of smoke inhaled from a single cigarette,” Rome noted.

Plus, because hookah is often a social event with people sharing the hookah device between them to smoke, there is also an increased risk of transmitting or acquiring an infectious disease, according to a 2019 American Journal of Health Behavior study.

The U.S. National Cancer Institute (NCI) defines herbal cigarettes as containing a mixture of flowers, herbs and other natural ingredients. What is not in herbal cigarettes? No tobacco or nicotine.

Despite these natural ingredients, they still emit many of the same harmful chemicals that cigarettes have, such as tar and carbon monoxide, according to the NCI.

While certain herbal cigarettes are well known, others are more obscure.

So, exactly how many types of herbal cigarettes are out there for the smoking? Several.

Bidis are tobacco rolled in native Asian plant leaves called tendu or temburni or in an unprocessed tobacco leaf, according to the ACS.

They are lower in tobacco but higher in nicotine, about three to five times as much as in traditional cigarettes, according to the ACS. Bidis may also be flavored, with fruit flavors or chocolate, according to the U.S. Centers for Disease Control and Prevention. They’re small, thin and unfiltered.

Meanwhile, Indonesian kreteks contain tobacco, ground cloves, clove oil and other additives, according to the ACS. They’re a “trainer cigarette” favored by young people. Their cancer-causing chemicals and nicotine make them harmful and addictive, according to the NCI.

Hookahs aren’t cigarettes, but pipes that first came into use centuries ago in India and Persia, according to the CDC. They use charcoal to heat flavored tobacco. Some use herbal “shisha” instead of tobacco, but those come with their own risks.

Bidis are at least as dangerous to human health as cigarettes sold in the United States, according to the ACS, which notes their higher concentration of dangerous chemicals.

Risks of regularly smoking bidis include heart attack, lung diseases such as emphysema and chronic bronchitis, and oral, lung and stomach cancers, according to the ACS and CDC.

Heart attack and coronary heart disease risk are threefold higher for those who smoke bidis, the CDC said, citing studies done in India because little research on long-term effects has been done in America.

A study published in The Lancet Global Health found that “bidis are at least as harmful as cigarettes on cardiorespiratory health” and death. Study authors included Dr. MyLinh Duong, from McMaster University and Hamilton Health Sciences in Ontario, Canada.

Kreteks are also linked to lung issues, including up to a 20 times greater risk of abnormal lung function, such as blocked airways, according to the ACS. They’re also linked to lower oxygen levels, inflammation and fluid in the lungs.

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