Carbon Monoxide in Hookah: Why Charcoal Creates CO (and What Charcoal-Free Electric Hookahs Change)

The hookah CO mainly come from burni

ng charcoal. As avid hookah users, we searched for alternatives in eliminating the Carbon Monoxide from Hookah to decrease the impact on our health. According the multiple studies, up to 90% of CO from smoking hookah comes from the charcoal so we thought of innovative ways to decrease the intake of CO. The advantage of an electric hookah vs regular hookah is that it doesn’t use charcoal, thus eliminating up to 90% of carbon monoxide in hookah.

Before anything else, this article is written for adults in the US, and it’s informational only. I’m not saying any kind of smoking or inhalation is “safe.” I’m only explaining the part that most people ignore when they talk about hookah and health: the charcoal itself is not just a heater, it’s a major toxicant source.

How does hookah produce Carbon Monoxide?

Carbon monoxide is a gas created by incomplete combustion. In normal life you hear about it from car exhaust or heaters, but with hookah it’s the same basic idea: when you burn something carbon-based, you can create CO as part of the burn.

In a regular hookah session, the thing that is actually burning is the charcoal. The bowl content, especially the modern molasses-style mixtures that most people use, is usually being heated and cooked rather than burning like a cigarette. That detail matters, because it explains the “mystery” a lot of people notice: why can hookah produce a lot of carbon monoxide even though the bowl doesn’t look like it’s burning hard? The answer is that the charcoal is burning the whole time, and you’re pulling airflow directly across that combustion source for the entire session.

This is why the phrase “hookah charcoal carbon monoxide” is not some scare tactic keyword. It’s literally describing the main source.

The study that made it obvious: charcoal vs electric heating

What finally convinced me this wasn’t just speculation is that researchers have tested the same hookah session two different ways: once with charcoal on top of the bowl, and once using an electrical heating element designed to mimic charcoal’s heat pattern over time and across the bowl. That design choice is important, because it removes the common argument of “yeah but electric heat is different.” In this setup, the point was to keep the heat similar and only change the combustion source.

In that machine-smoking study, the researchers used a standardized regimen that looks a lot like what a long session feels like in real life, just controlled. They ran 105 puffs at 530 mL each, spaced 17 seconds apart. With a popular ma’assel mixture, they found that approximately 90% of the carbon monoxide in the mainstream smoke originated in the charcoal. They even published the CO yields: about 57.2 mg of CO with charcoal heating versus about 5.7 mg with electric heating. That difference is not small. It’s basically the whole story in numbers.

So when people ask, “does hookah produce carbon monoxide,” the honest answer is yes, but the bigger answer is: in a traditional setup, most of the CO isn’t coming from the bowl the way people imagine it, it’s coming from the coals.

This is also why people get dizzy from hookah

This part is personal, because almost every hookah user I know has either felt it themselves or seen it happen to someone else. That moment where you’re mid-session and you suddenly feel lightheaded, like the room spins a little, or you have to sit back because you feel “off.” A lot of people shrug it off as “nicotine” or “I didn’t eat,” and sure, those can play a role. But carbon monoxide is a known cause of dizziness, and charcoal is a major CO source in a regular hookah setup, so it’s not a coincidence that the dizziness often shows up in charcoal sessions.

CO is also scary because you can’t reliably smell it or taste it. You can be in a room that feels fine and still be building up exposure. CO interferes with how efficiently your blood carries oxygen, and when your brain doesn’t get the oxygen it wants, dizziness and headaches are some of the first symptoms people notice. It can feel like a “hookah buzz,” but it’s not the kind of buzz anybody should be chasing.

If anyone feels dizzy during a charcoal session, we treat it as a real warning sign. The move is simple: stop the session and get into fresh air right away. If you’re still feeling bad, don’t try to power through it. In the US, Poison Control can be reached at 1-800-222-1222 for guidance, and if someone is confused, fainting, having chest pain, or hard to wake up, that’s a 911 situation. I’m not trying to be dramatic here, it’s just how carbon monoxide is treated in general, because it can turn serious fast.

This is one of the biggest reasons we started caring about the electric hookah route in the first place. The dizziness issue is what made it feel real, not just theoretical.

Herbal shisha doesn’t automatically fix carbon monoxide

A lot of people in the US are moving toward herbal shisha, meaning tobacco-free, often nicotine-free mixes. And I get it. Some people don’t want nicotine at all, some people want a smoother session, and some people just like the flavors and ritual without tobacco.

But here’s the part that surprises people: switching from tobacco shisha to herbal shisha does not automatically remove carbon monoxide if you keep charcoal. If the dominant CO source is the charcoal, then keeping charcoal keeps the CO problem. Herbal might change nicotine exposure, but it doesn’t magically change what burning coals do.

This is exactly why “tobacco-free hookah” and “carbon monoxide in hookah” are not the same conversation. You can have tobacco-free and still get hammered by charcoal-generated CO if you are using coals the same way.

What electric hookah changes, and why the difference is so clean

Electric hookah vs regular hookah comes down to one core difference: a regular hookah uses a combustion heat source, and an electric hookah uses electricity instead. That’s it. That’s the pivot point.

When you remove charcoal from the equation, you remove the combustion source that creates most of the CO in a traditional session. I’m being careful with wording here because I don’t want to make unrealistic claims. I’m not saying “electric hookah means zero risk” or “electric hookah is safe.” But I am saying something very specific and defensible: a charcoal-free electric hookah eliminates charcoal-generated carbon monoxide because there is no charcoal being burned.

If you think about it like a system, it’s actually obvious. No burning coal means no coal smoke, no ash, no coal fumes, and no constant CO generation sitting a few centimeters from the airflow you’re pulling through.

This is why the “up to 90%” line matters so much. If that study’s estimate is roughly right for typical conditions, then charcoal-free heating removes the bulk of CO exposure that comes from the charcoal. Even if there is a smaller remainder from other processes in the bowl, it’s not comparable to having a burning coal sitting on top for an hour.

It’s not only CO: charcoal also drives PAHs

The same charcoal-vs-electric study didn’t only look at CO. It also looked at polyaromatic hydrocarbons, usually called PAHs. PAHs are combustion-related compounds that show up when organic material is burned, and they matter because certain PAHs are well known in toxicology discussions. In that study, the researchers found that about 75–92% of the measured 4- and 5-ring PAHs originated in the charcoal, and more than 95% of benzo(a)pyrene was attributable to charcoal.

I’m including this because it reinforces the main theme: charcoal is not a neutral heater. It is an active source of combustion-generated toxicants in the mainstream smoke. Even if the bowl isn’t burning like a cigarette, you’re still inhaling products from the thing that is burning, and in a regular hookah session that thing is the charcoal.

Why hookah CO gets worse indoors (and why people underestimate it)

One reason CO becomes such a real issue in hookah culture is that sessions are often social and indoor. The longer the session goes, the more time the charcoal has to generate CO. The more coals you use, the more combustion you have. The less ventilation you have, the more you can trap it in the room.

That’s also why lounges have to take CO seriously, even when everything “looks normal.” CO doesn’t need to be visible to be a problem, and it doesn’t need to smell bad to be building up.

This is another reason the charcoal-free direction made sense to us. It’s not only about what you inhale directly, it’s also about what you’re putting into the air around you during a session.

So what’s the point of an electric hookah for herbal users in the US?

If you’re a US user who prefers herbal shisha, the goal is usually something like this: keep the ritual, keep the flavor, keep the vibe, but reduce the unnecessary downside. For a lot of people, charcoal is the biggest downside because it’s the main reason carbon monoxide shows up in hookah sessions.

A charcoal-free electric hookah is basically the cleanest way to remove that variable. Instead of lighting coals and managing combustion, you’re moving to controlled heat without ash and without a constant combustion gas stream sitting on top of the bowl. You still need to be an adult and use common sense, but it’s a fundamentally different heat source and that changes everything about the CO conversation.

This is the whole reason products in this space exist, including electric systems like the ones associated with LUKAH Hookah and the charcoal-free electric hookah options we focus on at Etherna. The point is not to pretend there’s no downside to inhaling anything. The point is that the traditional hookah setup has an avoidable CO driver, and the avoidable driver is charcoal.

Final thoughts

If you take one thing from this article, let it be this: carbon monoxide in hookah is mainly a charcoal issue. If you keep charcoal, you keep most of the CO. If you remove charcoal, you remove the dominant source of CO that researchers have measured in controlled comparisons. That doesn’t make anything “healthy,” but it does mean you’re not ignoring the biggest driver just because “hookah is hookah.”

And if you’ve ever felt dizzy during a charcoal session, don’t treat that as a normal part of the experience. Treat it like what it might be: your body reacting to a combustion gas that you don’t want in your session in the first place.

If you want the hookah ritual without burning coals, then charcoal-free electric hookah is the most direct answer I’ve seen. It’s the one change that targets the main source instead of trying to justify it.