Hot Source
By: Abigail Teye
In a modest apartment in Labadi, One Don, a young man in his late twenties, rolls a joint with practiced ease. He explains that he quit drinking alcohol years ago in favour of smoking weed.
“I stopped drinking and started smoking weed because drinking brings shame,” he says. “Weed is very healthy for the body. It makes your skin look good and helps you gain weight. As you can see, I wasn’t like this before, I was very skinny but since I started smoking weed, I looked good now and everybody keeps saying it. I only resort to cigarettes when I don’t have weed, and honestly, smoking sometimes brings opportunities your way.”
One Don’s perspective reflects a growing belief among Ghanaian youth that cannabis use is harmless or even beneficial.
Medical research indicates that smoking in any form; cigarettes, shisha, or weed can impact insulin sensitivity and increase the risk of Type 2 diabetes. Cigarette smoking has been shown to impair insulin action and promote insulin resistance, a precursor to diabetes.
Dr. Jonathan Caleb Akuaku, a medical officer in Accra, explains that the assumption of smoke in any form could have devastating long-term effects on metabolic health.
“From a medical standpoint, shisha and smoked cannabis are not safer alternatives and pose significant, distinct risks to your metabolic health, which increases the risk of developing Type 2 Diabetes.”
He states that while many young people think the water in shisha pipes filters out toxins, “this is a dangerous myth.”
“Shisha smoke contains nicotine, carbon monoxide, heavy metals, and many of the same metabolic-disrupting toxicants found in cigarette smoke,” he said. “International studies consistently link shisha use to hyperglycemia and hypertriglyceridemia — what we normally refer to as high blood sugar and cholesterol.”
What international research says about shisha and diabetes
According to the World Health Organization (WHO, 2021), shisha smokers are exposed to the same toxic substances as cigarette smokers, including heavy metals, carcinogens, and volatile chemicals that compromise vascular and metabolic health.
The WHO found that regular shisha users face an increased risk of metabolic syndrome, elevated blood glucose, and Type 2 Diabetes.
Similarly, research from the American Diabetes Association (ADA, 2020) reported that habitual hookah smokers had significantly higher fasting blood sugar and insulin resistance levels than non-smokers. The ADA concluded that even “recreational” shisha use contributes to hyperinsulinemia and impaired glucose metabolism, conditions that pave the way for Type 2 Diabetes.
A 2019 study by the Journal of Diabetes and Metabolic Disorders compared data from over 50,000 participants and found that those who smoked shisha at least once a week had a 36% higher risk of developing diabetes than non-smokers.
These studies reinforce Dr. Caleb’s warning that shisha is not a safer alternative to cigarettes but a metabolic hazard in disguise.
The hidden dangers of Shisha and Hookah smoking
Research conducted by Brighton and Sussex Medical School found that smoking shisha significantly increases the risk of developing type 2 diabetes and obesity. The research revealed that smokers were more likely to gain weight and develop diabetes compared to non-smokers after inhaling hookah fumes. (bsms.ac.uk)
The study’s findings challenge the misconception that shisha is a safer alternative to cigarettes. The researchers explained that a single session of hookah smoking may be equivalent to more than a packet of cigarettes, and the inhaled toxic compounds may even be greater. This underscores the importance of addressing all forms of smoking in public health discussions.
Dr Caleb described this as “a serious but often overlooked public health concern,” noting the increasing popularity of shisha among Ghanaian youth.
“The rise in shisha use among Ghanaian youth is especially concerning. The evidence is complex but still concerning. Observational studies show cannabis can alter appetite (the well-known “munchies”), change fat distribution, and impact the regulation of insulin and glucose in ways that can negatively affect cardiovascular and metabolic health over time.
“While the data is mixed compared to the clear link with tobacco, cannabis is not a protective substance and can contribute to a worse metabolic profile in many users,” he said.
However, not everyone shares One Don’s confidence. Nii Odoi, a long-term cigarette smoker, has been smoking for years but questions the idea that it could lead to diabetes. Yet, when asked if he ever goes for routine check-ups, he admits, “I’ve never gone for a general body check-up. So, I don’t really know what’s happening inside my body, but I don’t believe smoking is harmless.”
Emerging Ghanaian research on shisha and cannabis use
Research conducted by the University of Ghana School of Public Health (2022) survey of young adults in Accra found that shisha use had doubled in five years, with nearly 60% of users believing it was less harmful than cigarettes. Researchers warned that this false sense of safety was driving a silent health crisis, particularly among tertiary students.
A BMC Public Health (2023) study examining metabolic profiles of cannabis users in Kumasi observed elevated fasting blood glucose and triglyceride levels compared to non-users. The study linked these changes to early markers of insulin resistance and central obesity — both major risk factors for Type 2 Diabetes.
These reports show that cannabis and shisha smokers in Ghana showed higher oxidative stress levels, indicating long-term damage to blood vessels and liver function. These findings mirror global evidence and validate Dr Caleb’s concerns.
Second-hand smoke: the silent threat
For non-smokers, the risks are not negligible. Dr Caleb warned that exposure to second-hand smoke in shisha lounges, homes, or shared spaces, significantly increases diabetes risk.
A Pneumon Journal (2023) study conducted in Accra’s Nima and Chorkor communities found that residents frequently exposed to indoor smoke, from tobacco, shisha, or burning biomass reported higher rates of metabolic symptoms, including fatigue, elevated blood sugar, and abnormal cholesterol.
A resident of Labadi, who spoke on condition of anonymity, described her experience with continuous exposure.
“I used to live close to a bar before I moved to my recent place. And anytime I inhale the smoke, I feel a tightness in my chest. I had to go to the hospital one time because I was really finding it difficult to breathe,” she says.
Dr. Caleb noted that second-hand smoke doesn’t just damage the lungs; it causes systemic damage by triggering “Oxidative Stress, Chronic Low-Grade Inflammation, and damages our blood vessels,” citing the Ghana STEPS 2023 Report, which emphasises enforcing indoor smoking bans and raising awareness about shisha’s metabolic risks to protect non-smokers.
“This is a critical, often-overlooked public health risk, especially in crowded social settings like shisha cafés or homes.
“Multiple large-scale reviews and meta-analyses show that non-smokers exposed to second-hand tobacco smoke have an increased risk of developing Type 2 Diabetes (approximately 25–30%) higher risk compared to unexposed non-smokers.
He added that, “All these biological effects impair insulin signaling, leading directly to insulin resistance, which is a key precursor to Type 2 Diabetes.
“As highlighted in the Ghana STEPS 2023 Report, strong enforcement of indoor smoking bans and educating the public about the risks of shisha and tobacco are essential to protect non-smokers in Ghanaian communities.”
Similarly, a University of Ghana Environmental Health Department (2023) report concluded that second-hand exposure in shisha cafés was linked to increased inflammatory biomarkers, which are precursors to insulin resistance and cardiovascular disease.
The WHO’s Global Report on Tobacco and Diabetes (2021) also supports these findings, confirming that prolonged exposure to second-hand smoke raises the risk of Type 2 Diabetes by 25–35%. The report emphasises that non-smokers face nearly the same metabolic consequences as light smokers when regularly exposed.
Misconceptions and short-term relief
Even among smokers, perceptions differ. Naa Klordey, a shisha enthusiast, says she prefers it to cigarettes.
“I love smoking shisha more than cigarettes because I have flavours. It feels more refreshing, and I don’t think it can cause any diabetes. That is not true, everyday you people are trying to create something; who has gotten diabetes because of shisha?” she quizzed.
Her statement highlights how ignorance, social habits, and personal experience shape beliefs about health risks.
Dr Caleb, however, insists that any perceived benefits are short-lived.
“Nicotine suppresses appetite, but it raises stress hormones that promote insulin resistance — the key driver of diabetes,” he explained.
“Shisha delivers a massive dose of smoke and toxins that cause systemic inflammation and oxidative stress, directly damaging the body’s ability to regulate glucose. Cannabis can acutely increase appetite (“munchies”), and long-term use is associated with adverse fat distribution in some users.
“Short-term relaxation doesn’t offset the long-term damage to metabolic health.”
The WHO Tobacco Ghana 2023 country profile revealed that nearly half of respondents under 30 believed shisha was “less harmful” because of its fruity flavours. However, carbon monoxide testing found shisha users inhaled equal or greater toxic exposure than cigarette smokers.
At the Harvard T.H. Chan School of Public Health (2020), researchers tracked nicotine’s short-term appetite suppression and found it leads to rebound hunger, higher cortisol, and worsening insulin resistance within weeks.
These findings highlight how temporary relaxation or appetite effects mask serious physiological harm that accumulates silently over time.
A call for stronger public health action
Dr. Caleb urged health authorities to act swiftly to address what he called a “hidden diabetes risk.”
“We need stronger enforcement of indoor smoking bans, regulation of shisha lounges, and youth-focused education campaigns that link smoking to metabolic risks like obesity and diabetes,” he advised.
He also recommended that clinics screen young patients who report shisha or cannabis use for early signs of insulin resistance and other metabolic markers.
“Local research funding is crucial,” he added. “We need Ghanaian data on how these substances impact our population. That’s the only way to make targeted, evidence-based interventions.”
The UNDP/WHO Ghana Tobacco Control Policy Brief (2023) calls for urgent enforcement of smoke-free laws and expansion of NCD screening services. It recommends that Ghana’s Ministry of Health partner with universities to fund local studies on the metabolic consequences of shisha and cannabis.
Likewise, the Ghana Non-Communicable Diseases Alliance (GNCD, 2024) has urged government to incorporate shisha and cannabis education into the national diabetes prevention strategy. The alliance emphasises that public awareness must move beyond lung cancer and addiction to include hidden metabolic risks that affect young adults.
The post Beyond cigarettes: How shisha, weed, and second-hand smoke trigger hidden diabetes risks appeared first on The Herald ghana.
