Journal of Analytical Toxicology, 2018;1–16

doi: 10.1093/jat/bky095
Article

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Article

Quantification of Trace Elements in Different

Dokha and Shisha Tobacco Products using
EDXRF
Ayesha Begum Mohammad1,*, Shabber Hasan Khan Mohammad2,
Masrath Khathoon Mohammad3, Abdus Sayeed Khan4,
and Mohamed Saleh Al-Hajjaj5
1
Department of Chemistry, College of Sciences, University of Sharjah, PO Box 27272, Sharjah, UAE, 2Department of
Medical Sciences, College of Medicine, Jazan University, PO Box 114, Jazan, Saudi Arabia, 3Department of
Applied Medical Sciences, College of Medicine, Jazan University, PO Box 114, Jazan, Saudi Arabia, 4Department
of Physics, University Laboratories, Khalifa University, PO Box 127788, Abu Dhabi, UAE, and 5Department of
Clinical Sciences, College of Medicine, University of Sharjah, PO Box 27272, Sharjah, UAE
*Author to whom correspondence should be addressed. Email: ayeshabegum11@hotmail.com;
aymohammed@sharjah.ac.ae

Abstract
The present study aims to quantify trace metals in different dokha (medwakh) and shisha tobacco
products available in local markets. Recent research has shown that these products have higher
amounts of nicotine and tar compared to various other tobacco products. No specific data are
available on the concentration of trace elements in dokha (medwakh) and shisha tobacco products
in the Middle East and North Africa (MENA) region. Harmful health effects due to the toxicity of
these elements in tobacco and its smoke have not been adequately emphasized. Concentrations
of trace elements were extensively studied using HORIBA XGT-7200 EDXRF fluorescence absorp-
tion spectroscopy. The mean concentrations of aluminum, calcium, chromium, copper, iron, mag-
nesium, manganese, nickel, potassium, strontium and zinc in 13 dokha products in μg/g were
406.92 ± 41.72, 14703.27 ± 271.73, 11.73 ± 2.12, 25.58 ± 2.63, 753.85 ± 14.87, 5306.54 ± 134.94,
82.31 ± 4.55, 25.58 ± 2.50, 2212.12 ± 39.04, 816.92 ± 15.26 and 35.96 ± 2.63, respectively; and those
in the three shisha products in μg/g were 244.83 ± 25.11, 8235.77 ± 144.51, 3.40 ± 0.38, 22.77 ± 4.50,
569.13 ± 10.22, 2096.20 ± 130.69, 72.13 ± 7.13, 27.67 ± 5.31, 4467.50 ± 168.06, 320.20 ± 6.03 and
36.40 ± 3.57, respectively. In our study, the quantified trace metal concentrations in dokha and
shisha tobacco using the EDXRF method were ten times higher than the LODs. The percentage of
RSD was <10%, validating the precision of the method. Tobacco smoking is a major source of con-
sumption of toxic elements, not only in the smoker but also in non-smokers through passive smok-
ing. In dokha (medwakh) and shisha tobacco products, compared with cigarettes, Ni levels were
significantly higher, Cr, Cu and Zn levels were higher, and Fe levels were similar, while Al and Mn
levels were lower. The dokha and shisha tobacco products have no filters; many toxic metals can
quickly enter the lungs and cause different pulmonary diseases and oral infections. Tobacco smok-
ing causes lung and oral cancers, chronic obstructive pulmonary disease and cardiovascular
diseases.

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2 Mohammad et al.

Introduction The World Health Organization (WHO) expert panel on

tobacco regulation newly issued a research document on metalloids
Tobacco is an important industrial crop all around the world.
and metals in tobacco products and its smoke, concluding that lead
Smoking tobacco products are usually made of valuable tobacco
(Pb), cadmium (Cd), arsenic (As) and nickel (Ni) need to be moni-
leaves, but the metals and metalloids are extremely toxic to humans
tored (18). Biologically, some heavy metals are essential in nutrition,

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even when consumed at low concentrations (1). These products con-
and these metals are known as macronutrients and micronutrients
tain toxic elements that enter a human’s body daily in different forms,
(19). Tobacco plant acquires trace elements from the environment,
so it is essential to know the concentrations of trace metals (2). The
in which some elements are toxic (or) non-essential (20). The grow-
presence of toxic metals in tobacco products is a major concern of ele-
ing region, environmental conditions and soil composition may
mental analysis. Generally, toxic metals are found in the soil fertilizers
affect the constituents of elements in tobacco (21).
(3). More than 4,000 chemical compounds have been found in
However, tobacco exposure is complicated. The toxicants in
tobacco leaves. Several thousand chemical compounds have been
tobacco smoke are divided into various chemical classes according
reported in tobacco smoke, among which 11 are metals or metalloids,
to health diagnosis. The carcinogenic agents have been categorized
and 98 are associated with risk values (4). Inhalation of these carcino-
by the International Association for Research on Cancer (IARC)
genic substances affects every organ of the human body.
(22). Naturally, both macro- and micronutrient elements are present
Annually, 5 million deaths (1 in 10 deaths) are reportedly due to
in tobacco, such as Cu, Co, Mn, Zn, Fe and toxic heavy metals such
consumption of tobacco, including over 2.41 million deaths in
as Pb, chromium (Cr), As, Cd, platinum (Pt), magnesium (Mg) and
developing countries and 2.43 million in developed countries (5). In
Ni (23, 24). Many diseases in humans due to the toxicity of trace
2030, it is predicted that the death toll will increase to 10 million,
elements have been investigated.
with 7 out of 10 deaths occurring in developing countries (6). In the
Tobacco smoking allows for routine entry of metals into the
year 2000, the most prevalent causes of death were cardiac diseases
human body that may be toxic. Moreover, it creates an exposure
(1.69 million deaths) and lung cancer (0.85 million deaths) (5), as
route for most of the toxic heavy metals. The inhaled heavy metals
smoking damages every organ of the human body (7).
have a long half-life in the body, depending on excretion mechanism,
Smoking causes an estimated 443,000 deaths each year in the
detoxification and bioavailability (25). Thus, it is essential to know
USA (8). Tobacco-associated illness is the consequence of addiction
the concentrations of trace elements in these tobacco products (2).
to nicotine (9). Smoking entails repeated intake of different toxi-
According to the International Agency for Research on Cancer, the
cants, such as volatile organic compounds, polycyclic aromatic
most common health effects associated with heavy metals are Cd, Ni,
hydrocarbons, nitrosamines and several trace metals in tobacco
As, Pb and chromium (Cr), all labeled as human carcinogens (26).
smoke (10). Few studies have been conducted on the role of toxi-
Pb, classified as a Group 2 A carcinogen by IARC, affects the
cants and heavy metals on dokha and shisha smoking-related dis-
human nervous system and neurodevelopment (27, 28).
eases, so more research needs to be done to find the trace metal
The biological response to stress exposure depends on both time
concentrations in these tobacco products.
and level. The levels of toxicant exposure are high in smokers due to
In the Eastern Mediterranean region, dokha and shisha smoking
the high amounts of heavy metals in tobacco products. The classifi-
is gradually increasing, and 38% of men and 4% of women are con-
cation of exposure is based on various levels of exposure for the par-
suming tobacco products. Forty-two percent of boys and 31% of
ticulate period. Exposure is classified as acute if it is short and
girls smoke tobacco products, which is extremely worrying (11). In
chronic if it is long or frequently repeated. Due to tobacco consump-
total, 77.4% of youth smoke cigarettes, 15.0% dokha, 6.8% shisha,
tion, some heavy metal and metalloids accumulate in lungs and
0.66% cigars and 6% use different tobacco products (12).
other tissues (29).
Dokha is made of fine dry leaves of tobacco from the desert. The
Different techniques, such as inductively coupled plasma mass
leaves are not processed, so they contain a high content of nicotine
spectrometry (ICP-MS), atomic-absorption spectroscopy (AAS) and
and tar. Dokha is smoked using a medwakh pipe, consisting of a
(ICP-OES), have been used to quantify metal concentrations present
bowl, stem and mouthpiece. Each time, ~0.5 g of tobacco is filled,
in tobacco products. However, these instruments quantify a limited
and a single-shot smoker inhales two times. Usually, a smoker con-
number of elements and require long digestion time (30). In the pres-
sumes 6 g of dokha in a day (13).
ent study, we quantified the trace elements in dokha (medwakh) and
Shisha tobacco is smoked using a hookah. It contains a head,
shisha tobacco products using the Horiba XGT-7000 XRF
body, water chamber and tube for inhalation of vapor. A molasses
instrument.
mixture of tobacco flavored with vegetables or fruits is placed in a
In recent years, EDXRF has been used for elemental analysis by
shisha head cup. Heated charcoal is placed on top of the shisha mix-
several authors (31–34). In EDXRF, the spectrum of a sample is
ture bowl wrapped in aluminium foil, and the shisha smoke travels
generated by calculating and mapping the relative values of individ-
through the pipe and reaches the water-containing bowl. During
ual energies generated by the X-ray source. The main principle of
inhalation, the smoke is chilled as it leaves through the water-
EDXRF is capturing generated electron-hole pairs in a semiconduc-
containing bowl to the smoker’s mouth (14).
tor detector.
Tobacco smoke has many toxic compounds, such as heavy
metals, carbon monoxide, tar, hydrogen cyanide (HCN), VOC and
nitrosamines. Traditional dokha and hookah pipes have no filters, No. of electron−hole pairs = EX /EEHP
so toxicants can quickly enter the lungs (15, 16). Dokha (medwakh)
and shisha tobacco brands are available in many flavors that may where EX is incident X-ray energy and EEHP is the energy fixed for
attract young people and falsely present as it is healthier, natural that material.
than cigarettes (14). The primary source of heavy metal exposure to Once the pairs are formed, the detector pulls the electrons and
human from inhalation of contaminated air, intake of food and con- generates the current, i.e., directly related to the electron-hole pairs
sumption of tobacco products (17). formed, which corresponds to the energy of X-rays.
Quantification of Trace Elements in Different Dokha and Shisha Tobacco Products using EDXRF
The process is repeated at a high rate, and the result is arranged
into energy channels. In quantitative analysis, the peak height is pro-
portional to the element concentration of a given sample. An X-ray
beam is used to quantify the concentrations of elements based on
intensities of peaks. XRF analysis is a rapid and accurate method to
analyze tobacco samples in various experimental conditions and
matrices with adequate sensitivity, minimal sample preparation and
short analysis time (2, 35).
Experimental work
Sample collection
Popular dokha (medwakh) and shisha tobacco products were pur-
chased from different local stores that are frequented in the UAE.
All samples were labeled, packed in airtight polyethylene bags and
stored at room temperature until they were analyzed.
Sample preparation
The tobacco samples were dried at 60°C, powdered using an agate
mortar and pestle to reduce the size to fit through a 400-mesh sieve
and ground for 20 min to get a fine homogenized mixture. Then,
2.5 g of the pellet of 3.20 cm diameter and 0.4 cm thickness was pre-
pared by pressing the sample powder under 15 tons pressure.
Apparatus and chemical reagents
(1) Horiba XGT-7000 XRF instrument; (2) pellet maker; (3) agate
mortar and pestle; (4) analytical balance and (5) standard reference
material Merck ICP multi-element standard IV.
Hazards
Precautions were taken while preparing pellets to avoid contamina-
tion, including wearing a mask while grinding the sample with an
agate mortar. In addition, the tobacco samples were never tasted or
smelled and were stored in a secure container.
Methods
The trace elements were quantified by the Horiba XGT-7000 using
EDXRF fluorescence absorption spectroscopy. The concentrations
of eleven trace elements (Al, Mg, Ca, K, Cr, Mn, Fe, Cu, Ni, Zn, Sr)
were analyzed. Samples with different sizes, both micro and macro,
can be analyzed by the Horiba XGT-7000.
The Horiba XGT-7000 had an X-ray source with a tube voltage
up to 50 kV, tube current 1 mA and a Rh target. Elements Na to U in
a sample were detected from emitted fluorescence by a Peltier cooled
silicon drift detector (SDD). The final spectrum showed the intensity
of X-rays as a function of energy. XRF is a rapid, economical, sensi-
tive technique that can be used to determine the composition of ele-
ments in plant foliage, including tobacco. We used the fundamental
parameters method (FPM) for quantification. It depends on the inten-
sity of X-ray beams. The quantitative study of XRF spectra often
depends upon matrix correction methods (36, 37).
The samples were placed in the XRF sample holder, and three
different points were chosen for analysis to get their mean and stan-
dard deviation values. LODs were calculated from standard devia-
tions of three repeat analyzes of samples. The limit of detection and
limit of quantification were computed by the formulas
3
LOD = 3 × Standard Deviation
and
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LOQ = 10 × Standard Deviation
The standard reference material Merck ICP multi-element stan-
dard IV was analyzed as certified a reference material to calculate
the reliability and accuracy of the method:
%Recovery = (Experimental Value /Certified Value) × 100
Results
The body needs both macro- and microelements under certain per-
missible limits for better health and growth. There is a lack of
research on trace element concentrations in dokha (medwakh) and
shisha tobacco products. In this study, we quantified the trace ele-
ments in the dokha (medwakh) and shisha tobacco commonly
smoked in the MENA region by EDXRF FPM. The concentrations
of eleven elements in dokha and shisha tobacco, Al, Cu, Fe, Cr, Ca,
Ni, Zn, Mn, K, Mg and Sr are listed in Table II. Some trace elements
are essential for human and plant growth under the permissible lim-
its. However, if trace metal concentrations exceed the critical levels,
then they are toxic to both humans and plants (38).
Limit of detection
The LODs of various trace elements (in μg/g) in the dokha and
shisha tobacco products were as follows:
Mg (dokha 404.81, shisha 392.07), Al (125.17, 75.33), Ca
(815.19, 433.53), Cr (6.35, 1.14), Mn (13.65, 21.40), Fe (44.62,
30.67), Ni (7.50, 15.93), Cu (7.88, 13.50), Zn (7.88, 10.70), Sr
(45.77, 18.10), K (117.12, 504.17).
The obtained concentrations of trace metals were ten times high-
er than their LOD values, so we quantified the above trace elements
by 95% confidence limits using EDXRF absorption spectroscopy.
The calculated RSD was less than 3% for Mg, less than 10% for
Al, <3% for Ca, <10% for Mn, <6% for Fe, <10% for Ni, <10%
for Zn, <6% for Sr and <4% for K, validating the precision of the
method.
Recovery and accuracy of the technique
The percentage of recovery of ICP multi-element standard is in
excellent agreement with the certified values tabulated in Table I.
The percentage recovery of elements was 90.33–107.56%, whereas
the percentage relative standard deviation (% RSD) was <2.83.
EDXRF was effective in quantifying trace elements in dokha and
shisha samples, an accurate, sensitive and reproductive to quantify
metal concentrations.
The amounts of Cr, Cu, Zn, Sr and Mg in dokha tobacco were
higher than in shisha, while Al, Fe, Mn, Ca and K were higher in
shisha than in dokha tobacco. Dokha and shisha had similar con-
centrations of Ni, as shown in Figure 1 and Table II
4 Mohammad et al.
Table I. The percentage recovery and relative standard deviation of Merck ICP multi-element standard IV with the certified values
Element Certified value (ppm) Uncertainty (ppm)
Co 990–1100 ±5
±5
Ni 990–1100
Cu 990–1100 ±5
Zn 990–1100 ±5
Sr 990–1100 ±5
Pb 990–1100 ±5
Trace metal concentrations of various dokha and shisha tobacco
products relatively compared with other tobacco products are tabu-
lated in Table III.
Discussion
Trace metals can both benefit and harm human health. Some of
them are used as dietary supplements, and others are toxic even con-
sumed at low concentrations. During smoking, the inhaled smoke is
deposited in the lungs (47), causing the deposition of trace metals in
the lungs. Alveoli are small air sacs that exchange the oxygen and
carbon dioxide between lungs and blood vessels. The efficiency of
gas exchange is lowered due to the deposition of trace metals and
tar in the lungs, which block the alveoli and cause lung cancer. A
brief discussion of metals in tobacco and their toxicity to humans
follows.
Aluminium
A post-transition metal, aluminium is found at high levels in tobacco
and its smoke, which is why smokers have a higher content of Al
than non-smokers (48, 49). During smoking, the volatile form of
aluminium metal particles enters the lungs. The duration of smoke
being in contact with surrogate lung fluids (SLF) is short corre-
sponding to the duration of the inhalation of smoke in lungs. The
time for lungs to trap aluminium is remarkably high due to its sur-
face area and the hydrophobic and liquid fluids, such as mucin, pres-
ent in lungs (50).
Aluminium exposure in aerosols is related to lung disease (49,
51, 52) and neurological disease (53, 54). Smoking is associated
with neurological dysfunction and lung disease (55–57). The high
content of aluminium in tobacco may lead to diseases such as osteo-
porosis, inflammation and microcytic anemia (25, 58).
Out of the 13 dokha samples, Alward Alahmar Green Dokha
had the highest level of aluminium, whereas TURBO Dokha Black
−2 had the lowest. Out of three shisha samples, Iranian Shisha
Arguilla had more aluminium compared to Al Fakher Double Apple
Shisha, as tabulated in Table II. The concentrations of Al in various
tobacco products in ascending order were as follows: dokha <
shisha < chew tobacco < cigarette < little cigar < tobacco leaves <
smokeless tobacco (Figure 2).
Chromium
Chromium (Cr) is a transition metal known for its toxic nature, and
the carcinogens are divided as Cr(III), and Cr(VI), whereas Cr(VI) is
genotoxic, causing lung cancer.
Cr(III) is essential in humans and animals as a function of carbo-
hydrate metabolism and ameliorates mild glucose intolerance (59–
62). Cr(VI) can cause oral, pulmonary, and skin diseases (63–69)
and is found in tobacco smoke and its ash.
Experimental value (ppm) %RSD %Recovery
1033.00 1.53 98.85
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985.00 0.29 94.26
1024.00 2.83 97.99
1047.00 0.49 100.19
1124.00 1.56 107.56
944.00 1.62 90.33
Collection of Cr in lungs is associated with the history of smok-
ing, verifying that Cr reaches lung tissues (70, 71).
Tobacco smoke contains chromium. Therefore, this metal can be
a health concern associated with smoking, but it is difficult to evalu-
ate its impact on pulmonary and oral exposures because there is
insufficient data to correlate its concentration with the consequences
associated with the chromium oxidation state.
Yusuf Redha Dokha-Gold 50 had the highest level of chromium,
while Yusuf Redha Dokha-White, TURBO Dokha Premium-3, TURBO
Dokha Premium-1, TURBO Dokha Black-2, TURBO Dokha Premium-
2, Scorpion Gold Dokha 2 and Jaguar Tobacco Green 1 had the lowest
chromium concentrations. In the shisha samples, Al Fakher Double
Apple Shisha had the highest amount of chromium, while Iranian
Shisha Arguilla and MAZAYA Watermelon Mint Shisha had lower
amounts of chromium, as tabulated in Table II.
The Cr levels of various tobacco products in ascending order
were as follows: bidi < cigarettes < cigar < shisha < chew tobacco <
snuff < dokha (Figure 2). The Cr values were higher in dokha and
shisha compared to cigarettes.
Copper
Copper is a micronutrient or organic fertilizer, which is an essential
element for plant growth. It enters food by different routes, such as
soils to crops in mineralization, processed foods and contamination
of the environment. It plays an important role in human and animal
health (72, 73).
At a lower level, copper is nutritious, but copper inhalation
causes respiratory discomfort and can lead to eosinophilia, pulmo-
nary fibrosis, alveolar movement of macrophages (74). Copper is an
active oxidation and reduction metal, similar to iron. The redox
properties of copper and iron are of toxicological importance.
However, in exhaled breath condensation, the concentration of cop-
per is lower in COPD subjects than in healthy non-smoking subjects
(75). It has higher concentrations in smokers’ blood compared to
non-smokers (76).
TURBO Dokha Premium-1 surprisingly had a higher content of
copper than the other tobacco products. Yusuf Redha Dokha-Gold
50 had the lowest content. In the shisha samples, Al Fakher Double
Apple Shisha had a higher content of copper than Iranian Shisha
Arguilla, as tabulated in Table II.
The copper levels of different tobacco products in ascending order
were as follows: bidi < shisha < cigars < snuff < cigarettes < tobacco
leaves < chew tobacco < dokha (Figure 2). The copper levels were
significantly higher in dokha and shisha tobacco than cigarettes.
Iron
Iron is found in the ferrous state in human organs; it reacts with oxi-
dizing reagents to generate free radicals. These free radicals are con-
trolled and naturally eliminated as antioxidants in a normal state,
Quantification of Trace Elements in Different Dokha and Shisha Tobacco Products using EDXRF 5

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Figure 1. Bars represent the trace metal concentrations (in μg/g) in different dokha and shisha tobacco products. D1–D13: dokha tobacco samples; S1–S3: shisha
tobacco samples.

but they accumulate if the iron concentration increases. Tobacco high levels of iron in the form of ferritin-bound iron in the extracel-
contains a high amount of iron, resulting in the production of free lular milieu (77).
radicals, causing toxicity to the liver though liquid peroxidation and Due to redox reactions, ferrous ions are converted into ferric
elimination of the hepatic mitochondria. Smokers’ lungs contain ions, liberating hydrogen free ions, result in increases the metabolic
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6
Table II. Trace metal concentration in (μg/g) of various dokha and shisha tobacco brands

Tobacco Brands Mg (μg/g) Al (μg/g) Ca (μg/g) Cr (μg/g) Mn (μg/g) Fe (μg/g) Ni (μg/g) Cu (μg/g) Zn (μg/g) Sr (μg/g) K (μg/g)

Dokha Tobacco
D1 Alward Alahmar Green 6585 ± 148.33 545 ± 50 13595 ± 271.67 20 ± 4.17 87.5 ± 5 957.5 ± 18.33 25 ± 2.5 17.5 ± 2.5 22.5 ± 2.5 750 ± 14.16 2117.5 ± 40.83
D2 Alward Alahmar Red 5607.5 ± 157.5 425 ± 45 14665 ± 322.5 25 ± 5.83 67.5 ± 4.17 587.5 ± 14.16 22.5 ± 2.5 12.5 ± 2.5 25 ± 3.33 867.5 ± 19.16 1987.5 ± 35
D3 Alward Alahmar Gold 6012.5 ± 142.5 415 ± 47.5 14782.5 ± 271.67 20 ± 4.17 80 ± 5 812.5 ± 15.83 27.5 ± 2.5 40 ± 2.5 32.5 ± 2.5 867.5 ± 15.83 2022.5 ± 38.33
D4 Yusuf Redha Dokha- 4952.5 ± 127.5 470 ± 41.67 15330 ± 267.5 52.5 ± 5 75 ± 4.17 672.5 ± 12.5 27.5 ± 2.5 10 ± 2.5 17.5 ± 2.5 1117.5 ± 20 1507.5 ± 25.83
Gold 50
D5 Yusuf Redha Dokha- 5455 ± 133.33 422.5 ± 44.17 15290 ± 289.17 77.5 ± 5 775 ± 15.83 27.5 ± 2.5 15 ± 2.5 47.5 ± 2.5 795 ± 15 2447.5 ± 41.67
White
D6 TURBO Dokha 4572.5 ± 312.5 ± 41.67 14765 ± 300 80 ± 4.17 657.5 ± 14.17 22.5 ± 2.5 32.5 ± 3.33 45 ± 3.33 1050 ± 21.66 2910 ± 51.67
Premium-3 125.83
D7 TURBO Dokha 4482.5 ± 452.5 ± 42.5 14665 ± 309.17 87.5 ± 5 1220 ± 26.67 25 ± 2.5 82.5 ± 3.33 77.5 ± 2.5 760 ± 16.67 2850 ± 50
Premium-1 128.33
D8 TURBO Dokha Black- 5552.5 ± 255 ± 15.75 14202.5 ± 232.5 70 ± 4.17 607.5 ± 10.83 17.5 ± 2.5 12.5 ± 2.5 30 ± 2.5 805 ± 13.33 2142.5 ± 35.83
2 130.83
D9 TURBO Dokha 6075 ± 155.83 427.5 ± 45 13795 ± 245 87.5 ± 4.17 700 ± 12.5 35 ± 2.5 52.5 ± 2.5 47.5 ± 2.5 777.5 ± 14.17 2385 ± 43.33
Premium-2
D10 Scorpion Gold Dokha 6407.5 ± 142.5 430 ± 49.17 13087.5 ± 250.83 97.5 ± 5 780 ± 15.83 30 ± 2.5 10 ± 2.5 20 ± 2.5 745 ± 13.33 1952.5 ± 36.67
2
D11 Jaguar Tobacco Green 4695 ± 120.83 372.5 ± 39.17 15550 ± 263.33 87.5 ± 4.17 750 ± 13.33 22.5 ± 2.5 17.5 ± 2.5 37.5 ± 2.5 725 ± 12.5 1892.5 ± 30.83
1
D12 Jaguar Tobacco Red 3 3867.5 ± 355 ± 36.67 15847.5 ± 238.33 20 ± 4.17 85 ± 4.17 662.5 ± 11.67 22.5 ± 2.5 15 ± 2.5 30 ± 2.5 700 ± 10.83 2295 ± 37.5
109.17
D13 Jaguar Tobacco Yellow 4720 ± 131.67 407.5 ± 44.17 15567.5 ± 270.83 15 ± 4.17 87.5 ± 5 617.5 ± 11.67 27.5 ± 2.5 15 ± 2.5 35 ± 2.5 660 ± 11.67 2247.5 ± 40
2
Shisha Tobacco
S1 Iranian Shisha Arguilla 4785 ± 136.67 632.5 ± 43.33 16872.5 ± 123.33 115 ± 5 1375 ± 11.67 20 ± 3.33 12.5 ± 2.5 30 ± 2.5 885 ± 7.5 765 ± 8.33
S2 MAZAYA Watermelon 591.6 ± 108.8 102 ± 32 3990.6 ± 115.6 52.2 ± 6 151.2 ± 6.4 26.4 ± 5.2 27.6 ± 4.8 45.6 ± 3.8 34.8 ± 4.8 6527.5 ± 184.17
Mint Shisha
S3 Al Fakher Double 912 ± 146.6 < LOD 3844.2 ± 194.6 10.2 ± 1.14 49.2 ± 10.4 181.2 ± 12.6 36.6 ± 7.4 28.2 ± 6.2 33.6 ± 4.4 40.8 ± 5.8 6110 ± 311.67
Apple Shisha

Mohammad et al.
Quantification of Trace Elements in Different Dokha and Shisha Tobacco Products using EDXRF
acidity and free ions enter the liver, heart, and brain cells, changing
the DNA causing mutation and cellular damage (78).
Recent studies suggested that initiation of oral cancer caused by
cigarette smoke. Generation of free radicals in tobacco smoke and
saliva depends on the redox reaction of active metals (e.g., iron).
Due to the interaction between saliva and free radicals of iron, the
saliva loses its natural antioxidant property (79, 80).
Inhalation of iron, copper in tobacco smoke may cause lung injury
due to its oxidative property (81). The concentration of iron is markedly
higher in chronic smokers’ serum than in non-smokers’ serum (82).
Clearly, iron plays a significant role in human health. It is essential to
know the concentration of iron in dokha and shisha tobacco products.
TURBO Dokha Premium-1 had the highest amount of iron, and
Alward Alahmar Red Dokha had the lowest amount of iron. Iranian
Shisha Arguilla had a higher level of iron compared to MAZAYA
Watermelon Mint Shisha (Table II).
The results of various tobacco products in ascending order were
as follows: bidi < dokha < chew tobacco < shisha < cigarettes <
cigar < tobacco leaves < snuff (Figure 2). The iron concentrations in
dokha and shisha were high compared to that of cigarettes.
Manganese
Manganese is a transition metal and an essential micronutrient to
humans. Higher levels of manganese are toxic to the central nervous
system. No traces of manganese have been observed in smokers’
blood (25). The manganese concentrations are low in smokeless
tobacco, cigarettes and other tobacco products, and its concentra-
tion in soil depends on the pH (83).
Scorpion Gold Dokha 2 had the highest level of manganese, and
Alward Alahmar Red had the lowest level, whereas Iranian Shisha
Arguilla had a higher level compared to Al Fakher Double Apple
Shisha, as tabulated in Table II.
The results in various tobacco products in ascending order were
as follows:
chew tobacco < dokha < shisha < smokeless tobacco < cigar-
ettes< cigar < tobacco leaves (Figure 2). The manganese concentra-
tions in dokha and shisha were low compared to that in cigarettes.
Nickel
Nickel is a toxic transition metal, classified as a group 1 and group
2 carcinogen by IARC. Some metallic compounds of nickel are toxic
to human health. Inhaled tobacco smoke contains more Ni and
deposited in lungs (25, 59–61, 84, 85).
At low concentrations, nickel is considered a nutritionally essen-
tial element and is classified as a group 2b human carcinogen by
IARC at higher levels (86, 87). Nickel is higher in smokers’ lungs
than in non-smokers’ lungs (88).
TURBO Dokha Premium-2 had the highest content of nickel,
and TURBO Dokha Black-2 had the lowest content, whereas Al
Fakher Double Apple Shisha had more nickel than Iranian Shisha
Arguilla, as tabulated in Table II.
The results in various tobacco products in ascending order were
as follows: tobacco leaves < cigarettes < chew tobacco < bidi <
cigar < snuff < dokha < shisha (Figure 2). From the above compari-
son, the dokha and shisha tobacco had higher concentrations of
nickel compared to cigarettes.
Zinc
Zinc is a transitional metal, an essential micronutrient for plants
and humans. Due to the phytotoxicity of accumulated zinc, it is
7
essential to know its concentration. Zinc levels are relatively higher
in smokers’ kidney cortices than non-smokers’ (89). Zinc plays an
important metabolic role in plants. Zinc in plants functions in the
metabolism of proteins, carbohydrates, and phosphates and the
formation of the RNA ribosome. It triggers the resistance of a plant
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to bacteria, fungi and dry and hot weather (90).
TURBO Dokha Premium-1 had the highest amount of zinc, and
Yusuf Redha Dokha-Gold 50 had the lowest amount. In the case of
shisha, MAZAYA Watermelon Mint Shisha had a higher level and
Iranian Shisha Arguilla had a lower level of zinc, as tabulated in
Table II.
The results in various tobacco products in ascending order were
as follows: bidi < shisha < cigar < snuff < dokha < chew tobacco <
cigarettes < tobacco leaves (Figure 2). The zinc concentrations in
dokha and shisha are lower compared to cigarettes.
Potassium
Vital biological activities, such as regulation of blood pressure,
osmotic pressure and acid-base balance at the intracellular fluid
level, are governed by potassium (91). Potassium ions (K+) are
essential for all living cells. Diffusion of potassium ions plays a key
role in nerve signal transmission, and depletion of K+ in humans
results in different cardiac dysfunctions.
Tobacco products have high levels of potassium. According to
Wannamethee et al., smoking tobacco products increased the potas-
sium in blood serum. There was a dose-response relationship
between smoking and potassium level.
In non-smokers, the potassium level in blood was <5.2 mmol/L,
which was in contrast to smokers. Higher levels of potassium in
smokers caused non-cardiovascular diseases such as lung cancer
(92).
From Table II, TURBO Dokha Premium-3 had the highest
amount of potassium, and Yusuf Redha Dokha-Gold 50 had the
lowest amount. In the case of shisha, MAZAYA Watermelon Mint
Shisha had a higher level and Iranian Shisha Arguilla had a lower
level of potassium.
Calcium
Calcium is an alkali earth metal and an essential macronutrient for
living organisms. In cell physiology, the cytoplasm acts in signal
transmission for the cellular process due to the in-and-out movement
of calcium ions. Calcium is essential to maintain strong bones and
teeth (93).
In 1999, Krall found that low bone mineral density (BMD) and
osteoporotic fractures in elderly men and women were associated
with smoking. Smokers who smoke 20 cigarettes per day have accel-
erated bone loss from the femoral neck, and the total body has a
lower calcium absorption than non-smokers (94).
From Table II, Jaguar Tobacco Red 3 had the highest amount of
calcium, and Scorpion Gold Dokha 2 had the lowest amount. In the
case of shisha, Iranian Shisha Arguilla had a higher level and Al
Fakher Double Apple Shisha had a lower level of calcium.
Magnesium
Magnesium is a vital element for both plants and humans. It is a biva-
lent cation and has a significant role in the central nervous system.
The imbalance of magnesium is involved in different pathological
states, such as attention/hyperactivity disorders (95), ischemic brain
injury (96), seizures (97) and others.
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Table III. Trace metal concentrations in (μg/g) of various tobacco products

8
Tobacco Type

Cigarettes Cr (μg/g) Cu (μg/g) Ni (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Reference Al (μg/g) Reference

1.2 16 0.9 46 434 277 (39) 648 ± 82 (40)

3.1 14.3 1.2 54 548 272 (39) 522 ± 77 (40)
3.2 12.2 2 59 428 305 (39) 666 ± 36 (40)
2.3 14.1 1.4 29 566 121 (39) 588 ± 56 (40)
2.9 10.2 2.3 40 510 228 (39) 786 ± 128 (40)
3.9 15.4 2.4 48 601 173 (39) 718 ± 146 (40)
0 22.1 2.5 87 469 320 (39) 763 ± 73 (40)
3.1 42.2 3.3 100 306 309 (39) 802 ± 60 (40)
1.7 15.8 1.4 50 436 255 (39) 862 ± 189 (40)
2 16.3 2.3 51 498 247 (39) 614 ± 59 (40)
1.9 20.8 1.5 61 347 188 (39) 846 ± 57 (40)
3.5 19.6 2.6 33 669 146 (39) 778 ± 92 (40)
3.3 16.9 2.6 33 854 154 (39) 826 ± 314 (40)
3.3 15.6 2.9 51 455 232 (39) 1060 ± 300 (40)
2.8 11.8 2.8 35 505 236 (39) 640 ± 86 (40)
5.1 20.4 3.4 73 430 316 (39) 578 ± 85 (40)
3.9 13.8 2.5 44 677 258 (39) 776 ± 148 (40)
5.5 13.2 6.4 36 876 263 (39) 717 ± 50 (40)
4.9 26.5 3.1 26 676 61 (39) 754 ± 87 (40)
3.9 26.1 2.3 28 568 55 (39) 369 ± 27 (40)
3.9 17.9 2.6 85 452 260 (39) 347 ± 30 (40)
2.8 14.1 1.3 48 399 234 (39) 641 ± 144 (40)
2.1 12.6 1.2 59 720 283 (39) 994 ± 330 (40)
2.9 18.9 1.7 53 592 265 (39) 735 ± 124 (40)
3.3 14 2.3 59 1444 226 (39) 823 ± 180 (40)
7.7 16.4 9.2 39 966 308 (39) 783 ± 112 (40)
5 9.1 3.1 43 829 195 (39) 628 ± 75 (40)
3 16.6 2.7 44 530 247 (39) 849 ± 100 (40)
4.1 18.2 2.4 51 538 328 (39)
3.5 15.8 1.6 57 583 (39)
3.9 19.1 3.3 38 810 (39)
4.5 17.6 4.2 46 721 (39)
3.8 16.6 5.8 45 504 (39)
2.9 19.5 2.1 51 555 (39)
4.8 16.1 4.1 33 845 (39)
3.2 17.3 3.7 37 361 (39)
2.6 16.3 3.3 35 329 (39)
5.6 17.7 5.6 51 604 (39)

Mohammad et al.
3.8 12.9 2.6 46 580 (39)
3.8 12.9 2.9 48 532 (39)
2.8 14.6 2.5 43 490 (39)
3.5 14.8 2.2 58 443 (39)

Table continues
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Table III. Continued

Quantification of Trace Elements in Different Dokha and Shisha Tobacco Products using EDXRF
Tobacco Type

Cigarettes Cr (μg/g) Cu (μg/g) Ni (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Reference Al (μg/g) Reference

4.8 17.7 2.4 29 592 (39)

4.6 13.3 2.4 50 732 (39)
3.8 11.7 1.9 45 569 (39)
4.6 14.5 2 54 702 (39)
3 15.3 1.7 70 380 (39)
3.5 16.7 2.8 49 588 (39)
3.5 16 2.5 48 555 (39)
1.3 5.2 1.5 15 200 (39)
Biri Cr(μg/g) Cu(μg/g) Ni(μg/g) Zn(μg/g) Fe(μg/g)
4.25 ± 1.09 16.67 ± 1.13 11.78 ± 1.91 23.42 ± 0.84 858.91 ± 43.35 (41)
4.83 ± 0.75 13.42 ± 1.02 7.42 ± 0.75 18.15 ± 0.78 1137.67 ± 38.6 (41)
6.75 ± 1.06 19.58 ± 0.74 2.83 ± 0.87 23.02 ± 0.72 796.84 ± 48.14 (41)
4.75 ± 0.69 19.25 ± 0.54 8.14 ± 1.09 24.85 ± 1 1037.03 ± 19.41 (41)
5.35 ± 1.14 15.94 ± 1.11 5.33 ± 1.74 21.01 ± 1 986.86 ± 50.39 (41)
Chew Tobacco Cr (μg/g) Cu (μg/g) Ni (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Reference Al (μg/g) Reference
0.69 ± 0.07 16.0 ± 0.55 1.50 ± 0.07 9.15 ± 0.27 176.96 ± 5 27.37 ± 0.7 (42) 111.27 ± 8.17 (42)
10.44 ± 0.3 17.5 ± 0.42 9.27 ± 0.51 17.07 ± 0.6 762.1 ± 20 40 ± 1.03 (42) 736.6 ± 24.90 (42)
1.95 ± 0.10 16.0 ± 0.29 2.75 ± 0.17 47.72 ± 1.1 563.1 ± 13 41.87 ± 0.9 (42) 454 ± 14.70 (42)
1.12 ± 0.09 14.68 ± 0.4 1.46 ± 0.15 35.75 ± 1.1 580.2 ± 14 51.07 ± 1.3 (42) 542.7 ± 20.70 (42)
7.01 ± 0.069 61.51 ± 2.83 2.42 ± 0.65 82.71 ± 2.4 770.43 ± 38.64 (41)
6.86 ± 1.67 47.87 ± 3.91 1.66 ± 0.55 53.43 ± 6.64 354.14 ± 45.61 (41)
6.21 ± 0.7 46.91 ± 3.32 2.92 ± 0.92 62.15 ± 1.65 1297.79 ± 58.14 (41)
4.48 ± 0.83 9.02 ± 1.24 3.5 ± 0.85 27.48 ± 1.52 936.75 ± 55.26 (41)
10.27 ± 1.65 47.06 ± 2.24 1.33 ± 0.51 56.25 ± 2.7 905.21 ± 41.89 (41)
Cigars Cr (μg/g) Cu (μg/g) Ni (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Reference Al (μg/g) Reference
2.68 ± 0.57 17.87 ± 1.58 9.9 ± 0.99 39.84 ± 2.32 528.31 ± 28.12 (41) 1260 ± 170 (40)
4.5 ± 0.87 26.83 ± 2.07 12.53 ± 1.31 45.66 ± 7.55 444.27 ± 40.05 (41) 1550 ± 360 (40)
9.75 ± 0.53 14.72 ± 0.58 6.13 ± 1.19 13.71 ± 1.14 2168.44 ± 128.76 (41) 1250 ± 410 (40)
6.14 ± 0.65 37.75 ± 1.23 7.44 ± 1.8 56.15 ± 1.3 642.56 ± 35.42 (41) 937 ± 237 (40)
8.09 ± 0.78 17.48 ± 1.39 8.3 ± 0.69 19.21 ± 0.78 853.34 ± 54.21 (41) 901 ± 210 (40)
6.46 ± 0.9 4.36 ± 0.45 202 ± 15 (43) 1270 ± 370 (40)
1.24 ± 0.3 1.58 ± 0.08 138 ± 12 (43) 834 ± 190 (40)
0.88 ± 0.19 1.67 ± 0.15 202 ± 6 (43) 1740 ± 220 (40)
1.58 ± 0.23 1.97 ± 0.26 160 ± 13 (43) 1290 ± 220 (40)
2.29 ± 0.16 2.8 ± 0.28 139 ± 11 (43) 944 ± 359 (40)
1.84 ± 0.53 2.29 ± 0.49 146 ± 11 (43) 1570 ± 300 (40)
0.88 ± 0.19 1.5 ± 0.06 210 ± 8 (43) 903 ± 220 (40)
3.34 ± 0.65 3.14 ± 0.29 166 ± 20 (43)
1.88 ± 0.14 4.37 ± 0.19 156 ± 9 (43)
1.26 ± 0.04 1.93 ± 0.1 202 ± 8 (43)
1.83 ± 0.05 1.69 ± 0.13 374 ± 27 (43)
1.33 ± 0.05 1.97 ± 0.07 169 ± 14 (43)

Table continues

9
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Table III. Continued

10
Tobacco Type

Cigarettes Cr (μg/g) Cu (μg/g) Ni (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Reference Al (μg/g) Reference

1.92 ± 0.19 2.97 ± 0.17 225 ± 12 (43)

2.74 ± 0.17 3.13 ± 0.15 177 ± 10 (43)
2.42 ± 0.14 2.96 ± 0.2 176 ± 10 (43)
1.54 ± 0.17 2.08 ± 0.08 166 ± 10 (43)
2.75 ± 0.13 3.15 ± 0.25 178 ± 10 (43)
Tobacco Leaves Cu (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Al (μg/g) Reference Ni (μg/g) Reference
28 41 360 58 716 (44) 4.51 (45)
20.1 26.3 270 28.7 822 (44) 4.81 (45)
25 25 652 87 542 (44) 4.52 (45)
19.4 22.7 411 58.7 651 (44) 4.28 (45)
16 26 2539 66 3637 (44) 6.81 (45)
17.3 37.1 3156 60 3756 (44) 5.54 (45)
12 31 834 92 2136 (44) 8.18 (45)
9.2 29.8 723 67.4 1487 (44) 4.71 (45)
16 53 1278 106 2036 (44) 4.28 (45)
21.2 64.9 820 70 1460 (44) 4.68 (45)
29 52 848 75 1011 (44) 4.52 (45)
19.4 46.1 782 49.6 811 (44) 7.83 (45)
55 104 1344 106 1226 (44) 7.55 (45)
54.4 107.1 1131 108 887 (44)
22 44 734 73 1399 (44)
15 31.3 708 78 760 (44)
30 87 611 152 1196 (44)
25.9 95.7 226 104 955 (44)
24 42 626 224 560 (44)
28 36.5 550 232.5 543 (44)
20 59 876 73 1379 (44)
12.1 51.6 774 43.8 1058 (44)
7 28 774 51 1649 (44)
5.6 25.3 550 51.4 1478 (44)
14 8 2412 151 2267 (44)
10 13.2 2581 113.7 2400 (44)
12 15 1288 98 2470 (44)
17.2 39.1 1020 57.6 1828 (44)
18 43 1083 80 1682 (44)
14 50 989 412 1740 (44)
Snuff Cu (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Reference Al (μg/g) Reference Ni (μg/g) Cr (μg/g) Reference
11.13 ± 1.91 30.79 ± 2.91 2942.77 ± 177.05 (41) 501 ± 28 (40) 6.12 ± 0.8 5.25 ± 1.07 (41)

Mohammad et al.
9.29 ± 0.96 36.54 ± 2.47 2863.91 ± 230.06 (41) 474 ± 45 (40) 6.83 ± 0.79 13.87 ± 3.28 (41)
26.73 ± 1.17 45.92 ± 1.36 3168.02 ± 91.3 (41) 271 ± 27 (40) 12.61 ± 0.95 21.92 ± 1.42 (41)
16.95 ± 1.39 37.15 ± 1.66 2671.26 ± 94.48 (41) 387 ± 45 (40) 7.05 ± 1.16 17.71 ± 1.58 (41)
16.86 ± 1.92 32.74 ± 1.67 3213.11 ± 284.14 (41) 13.05 ± 1.31 19.24 ± 2.24 (41)

Table continues
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Table III. Continued

Quantification of Trace Elements in Different Dokha and Shisha Tobacco Products using EDXRF
Tobacco Type

Cigarettes Cr (μg/g) Cu (μg/g) Ni (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Reference Al (μg/g) Reference

12.8 ± 0.05 34.9 ± 0.20 1940 ± 14.2 83.6 ± 0.1 1496 ± 9.28 (42) 1.39 ± 0.11 0.86 ± 0.16 (46)
16.6 ± 0.05 40.8 ± 0.15 2220 ± 8.57 82.3 ± 0.51 2080 ± 15.00 (42) 2.7 ± 0.95 1.71 ± 0.07 (46)
13.6 ± 0.23 34.9 ± 0.51 1980 ± 19.4 79.2 ± 0.73 1500 ± 19.67 (42) 1.85 ± 0.1 1.32 ± 0.12 (46)
17.7 ± 0.15 17.3 ± 0.30 908 ± 5.36 41.5 ± 0.15 1000 ± 4.81 (42) 2.48 ± 0.21 2.16 ± 0.18 (46)
37.9 ± 0.15 29.5 ± 0.05 840 ± 1.36 36.6 ± 0.11 670 ± 1.22 (42) 2.49 ± 0.05 1.9 ± 0.18 (46)
16.2 ± 0.35 15.4 ± 0.05 1440 ± 12.2 42.8 ± 0.32 1400 ± 15.50 (42) 2.45 ± 0.1 2.58 ± 0.26 (46)
31.9 ± 0.50 58.3 ± 0.25 7400 ± 21.3 217 ± 1.03 6500 ± 40.07 (42) 2.49 ± 0.13 2.2 ± 0.11 (46)
30.4 ± 0.20 63.2 ± 0.10 7340 ± 23.6 183 ± 0.35 6400 ± 6.87 (42) 2.29 ± 0.03 2.04 ± 0.12 (46)
13.8 ± 0.15 42.7 ± 0.05 4600 ± 31.0 130 ± 0.69 4300 ± 13.34 (42) 2.73 ± 0.06 2.79 ± 0.03 (46)
20.5 ± 0.20 49.8 ± 0.10 2130 ± 13.7 178 ± 0.9 4500 ± 15.89 (42) 2.37 ± 0.05 2.16 ± 0.11 (46)
14.9 ± 0.10 32.4 ± 0.25 3800 ± 11.5 104 ± 0.2 3200 ± 15.10 (42) 2.32 ± 0.11 1.81 ± 0.14 (46)
11.3 ± 0.05 23.4 ± 0.11 2440 ± 10.9 77.5 ± 0.35 2420 ± 16.20 (42) 2.58 ± 0.05 2.13 ± 0.19 (46)
20.9 ± 0.15 48.4 ± 0.25 6900 ± 56.3 189.8 ± 1.2 5600 ± 30.05 (42) 1.87 ± 0.1 1.75 ± 0.09 (46)
12.6 ± 0.03 45.3 ± 0.43 2930 ± 22.1 128.5 ± 1 2340 ± 23.20 (42) 1.88 ± 0.03 1.86 ± 0.02 (46)
12.2 ± 0.05 66.9 ± 0.32 1500 ± 11.8 98.5 ± 0.75 1300 ± 12.80 (42) 2.01 ± 0.12 1.95 ± 0.11 (46)
13.1 ± 0.15 40.5 ± 0.30 2900 ± 19.1 124 ± 0.7 2100 ± 16.14 (42) 2.34 ± 0.05 2.15 ± 0.15 (46)
Dokha Cr (μg/g) Cu (μg/g) Ni (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Al (μg/g)
20 ± 4.17 17.5 ± 2.5 25 ± 2.5 22.5 ± 2.5 957.5 ± 18.33 87.5 ± 5 545 ± 50
25 ± 5.83 12.5 ± 2.5 22.5 ± 2.5 25 ± 3.33 587.5 ± 14.17 67.5 ± 4.17 425 ± 45
20 ± 4.17 40 ± 2.5 27.5 ± 2.5 32.5 ± 2.5 812.5 ± 15.83 80 ± 5 415 ± 47.5
52.5 ± 5 10 ± 2.5 27.5 ± 2.5 17.5 ± 2.5 672.5 ± 12.5 75 ± 4.17 470 ± 41.67
15 ± 2.5 27.5 ± 2.5 47.5 ± 2.5 775 ± 15.83 77.5 ± 5 422.5 ± 44.17
32.5 ± 3.33 22.5 ± 2.5 45 ± 3.33 657.5 ± 14.17 80 ± 4.17 312.5 ± 41.67
82.5 ± 3.33 25 ± 2.5 77.5 ± 2.5 1220 ± 26.67 87.5 ± 5 452.5 ± 42.5
12.5 ± 2.5 17.5 ± 2.5 30 ± 2.5 607.5 ± 10.83 70 ± 4.17 255 ± 15.75
52.5 ± 2.5 35 ± 2.5 47.5 ± 2.5 700 ± 12.5 87.5 ± 4.17 427.5 ± 45
10 ± 2.5 30 ± 2.5 20 ± 2.5 780 ± 15.83 97.5 ± 5 430 ± 49.17
17.5 ± 2.5 22.5 ± 2.5 37.5 ± 2.5 750 ± 13.33 87.5 ± 4.17 372.5 ± 39.17
20 ± 4.17 15 ± 2.5 22.5 ± 2.5 30 ± 2.5 662.5 ± 11.67 85 ± 4.17 355 ± 36.67
15 ± 4.17 15 ± 2.5 27.5 ± 2.5 35 ± 2.5 617.5 ± 11.67 87.5 ± 5 407.5 ± 44.17
Shisha Cr (μg/g) Cu (μg/g) Ni (μg/g) Zn (μg/g) Fe (μg/g) Mn (μg/g) Al (μg/g)
12.5 ± 2.5 20 ± 3.33 30 ± 2.5 1375 ± 11.67 115 ± 5 632.5 ± 43.33
27.6 ± 4.8 26.4 ± 5.2 45.6 ± 3.8 151.2 ± 6.4 52.2 ± 6 102 ± 32
10.2 ± 1.14 28.2 ± 6.2 36.6 ± 7.4 33.6 ± 4.4 181.2 ± 12.6 49.2 ± 10.4

11
12
Figure 2. Boxes represent the range of trace metal concentrations (in μg/g) among various tobacco products.
Zinc and magnesium regulate presynaptic transmitter release in
an agonist-induced response at the level of some receptors (human
glycine receptor, P2X receptor) (98, 99). Magnesium has been used
in the treatment of neurosis, in eclamptic and pre-eclamptic states,
and in traumatic and ischemic brain injury. This cation is recom-
mended to be combined with antidepressant drugs in the treatment
of major depression.
Magnesium acts faster than nicotine, before the stimulation of
dopamine receptors. Some authors suggest that magnesium can
decrease the dopamine receptor function, leading to lower nicotine
Mohammad et al.
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dependency (100) and that magnesium reduces the nicotine addic-
tion and smoking of tobacco products (101). However, contrary to
bupropion, magnesium improves memory (102). The central role of
magnesium is to lower nicotine dependency. The plasma level of
magnesium in long-term smokers is significantly lower compared to
non-smokers (101, 103).
The reward system stimulation can be improved by the increas-
ing levels of magnesium and reducing nicotine addiction. The treat-
ment of intracellular and plasma magnesium deficit could be a way
to minimize the development of tobacco smoking.
Quantification of Trace Elements in Different Dokha and Shisha Tobacco Products using EDXRF
From Table II, Alward Alahmar Green Dokha had the highest
amount of magnesium, and Jaguar Tobacco Red Dokha 3 had the
lowest amount. In the case of shisha, Iranian Shisha Arguilla had a
higher level of magnesium than MAZAYA Watermelon Mint
Shisha.
Conclusion
In the MENA region, no specific data are available regarding the
concentrations of trace elements in dokha (medwakh) and shisha
tobacco products. Recent research proved that dokha (medwakh)
and shisha tobacco have higher levels of nicotine and tar compared
to other tobacco products. Dokha and shisha (hookah) pipes have
no filters, so during smoking, the toxic metals can easily enter
human organs and cause cardiovascular diseases, chronic obstruc-
tive pulmonary disease (COPD), lung diseases, and kidney diseases.
The trace metal concentrations, such as Al, Ni, Cu, Cr, Mn, Fe, K,
Ca, Zn, Mg and Sr, in dokha and shisha tobacco are significantly
higher compared to cigarettes. These metal contents need to be mon-
itored and these tobacco products taxed to lower the risk of the
above diseases. A 1-h shisha tobacco smoking session is equal to
smoking a whole pack of cigarettes smoked in one day. Shisha clubs
are populated with many smokers in a small area and are not
equipped with proper ventilators to aspirate the smoke to help it
exit quickly. Many shisha smokers use a single mouthpiece, which
can be associated with oral diseases and infections such as herpes,
tuberculosis and hepatitis B. Awareness programmes should be con-
ducted among smokers about the harmful health effects of toxic
metals, nicotine and tar in dokha (medwakh) and shisha products,
namely pulmonary diseases, cardiovascular diseases, respiratory
inflammation and oral problems.
Nicotine dependence and tobacco smoking can be decreased by
increasing the concentration of magnesium in intra- and extracellu-
lar fluids. A few studies have suggested that nicotine addiction is
reduced using magnesium treatment, and zinc may modulate the
consumption of tobacco addiction. The initiation of smoking in
young people can be reduced by hypomagnesaemia treatment.
More research must be conducted on these products. Due to the
availability of different flavors and varieties, these products are pop-
ular among high school students and young teens. Smokers become
addicted to these products due to their high content of nicotine. At a
young age, they are at risk of getting cardiac arrest and lung diseases
due to the deposition of high levels of tar and toxic heavy metals.
Acknowledgments
The authors are grateful to the College of Medicine at the University of
Sharjah for the research grant. Special thanks to Dr Hussain Alawadhi, Head
of the Centre for Advanced Materials Research at the University of Sharjah,
for use of the XRF research facility. The authors are thankful to Loubna
Chaabi and Muath Khairi Mousa for providing a multi-element standard
solution.
Funding
This research is funded by the University of Sharjah with grant number
(1801090133-P).
Declaration of Interests
None.
13
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