New study of Emiratis provides further evidence that smoking medwakh leads to heart disease

Medwakh and shisha have been linked to mouth bacteria that can result in heart attacks

Abu Dhabi, United Arab Emirates, October 4, 2017:    A man smokes dokha from a medwakh pipe in the neighbourhood near the intersection of Delma and Sheikh Rashid Bin Saeed streets in Abu Dhabi on October 4, 2017. On October 1st the government introduced an excise tax on tobacco products and sugar-high drinks, with some prices doubling. Dokha has yet to be added to the list of taxed items though. Christopher Pike / The National

Reporter: Anna Zacharias
Section: News
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A new study has provided further evidence that smoking shisha or a medwakh pipe can seriously damage your health, according to scientists.

Researchers from The New York University Abu Dhabi found regular medwakh users experienced changes to the bacteria in their mouths that is linked to increased rates of cardiovascular disease.

Hundreds of different strains of bacteria - known collectively as the oral microbiome - exist in every individual's mouth.

The research found changes to the make-up of this bacteria induced by smoking could exacerbate the growth of pathogens or microorganisms, which can potentially lead to heart attacks.

Dr Yvonne Valles, a research scientist at NYUAD and the lead author of the study, said: "Smoking per se is associated with cardiovascular disease. When it's changing your oral microbiome, it may induce the growth of pathogens related to cardiovascular disease.

“When you break the equilibrium of the oral microbiome, these pathogens that are usually in check can grow and exacerbate the risk of having cardiovascular disease. We haven't yet shown there's direct causation, but it could be part of the higher prevalence that we see at the end.”

Smoking shisha or a medwakh pipe is hugely popular across the UAE, as well as the wider Arabian Gulf region. Medwakh users most often smoke a type of Arabian tobacco blend known as dokha while shisha tobacco is often soaked in molasses or honey, or mixed with fruit.

Under the research, carried out as part of a larger health programme known as the UAE Healthy Future Study (UAEHFS), scientists identified different types of bacteria in mouthwash samples of 330 Emirati participants, about one third of whom were smokers.

New research suggests a possible link between smoking Dokha and cardiovascular disease. Delores Johnson / The National
New research suggests a possible link between smoking Dokha and cardiovascular disease. Delores Johnson / The National

It found that smoking cigarettes and dokha caused a similar change in the overall make-up of the oral microbiome, potentially leading to increased incidences of cardiovascular disease.

The data also revealed that while smoking shisha was not found to have a statistically significant effect on the overall oral microbiome, it was still linked to reductions in the prevalence of certain types of bacteria and was likely to be damaging too.

Dr Valles said the lack of a concrete result in respect to shisha use was probably due to the study involving a relatively small number of participants. An increased sample size would probably confirm suspicions, she said.

"It's still a health-related problem,” she said.

“With shisha there's this traditional thinking that, because it goes through water, it's safer. But this is not the case. It doesn't mean it's okay for people to smoke shisha."

A 2011 study of more than 9,000 Abu Dhabi residents found 24.7 per cent were smokers, with cigarette smokers the single largest group.

Emiratis had the highest prevalence for smoking medwakh at 16.1 per cent.

The latest research, published in Scientific Reports, could provide useful findings to underpin scientists' future efforts to alter the oral microbiome of individuals and reduce the risk of disease.


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As the UAEHFS programme continues, data from more participants will become available and potentially lead to more significant breakthroughs.

Dr Malak Basim Alkhafaji, a dentist at the Canadian Specialist Hospital in Dubai, said it was to be expected that dokha would affect the oral microbiome.

She said dokha could be linked to a string of harmful effects in the mouth, including increased risk of gum disease, inflammation of the salivary glands, and a condition called leukoplakia, in which white patches form on the tongue and mouth lining and can lead to oral cancer.

Dokha users can also have more difficulty in recovering from major dental procedures and are at greater risk of complications afterwards. Bad breath and the build up of plaque and tartar are also more common.

“I make the patients aware about the dental problems that are caused by smoking shisha and dokha,” said Dr Alkhafaji.

Dr Mohaned Diab, a consultant medical oncologist at NMC Healthcare, the largest healthcare provider in the UAE, said it made sense that additional types of smoking, in addition to cigarettes, would cause changes to the bacteria in the mouth. He said he believed both shisha and dokha would have “the same harmful effects on the oral cavity” as regular cigarettes.

“We have a lot of cases in our hospitals of mouth cancer and we ask the patients if they're smoking – definitely the answer is yes,” he said.