5 Causes Of Abnormal Vaginal Odour Every Woman Should Know About

Vaginal odour is mostly normal, but not always.
Last week, we covered 7 Common Things That Make Your Vagina Smell Strange. Here, the low-down on what constitutes abnormal vaginal odour.

Also featured on Women’s Health.

Last week, we covered normal causes of vaginal odour. Here, the low-down on what constitutes abnormal vaginal odour.

There are two infections causing abnormal vaginal odour. The first is called Bacterial Vaginosis. This is very common infection, where normal bacteria in the vagina are replaced by higher concentrations of characteristic sets of aerobic and anaerobic bacteria.  All of the things mentioned playing a role in your vaginal pH and microbiome can cause it. The most common complaint is a thin grey-white discharge and vaginal itch. Associated symptoms include fishy odour, especially after sex and during menstruation. Treatment is a course of antibiotics, and this condition should not be left untreated, as it can cause complications like pelvic inflammatory disease and premature labour..

The second condition is a sexually transmitted infection, called Trichomoniasis. It occurs anything between 4-28 days after intercourse, and symptoms include a yellow green discharge, painful urination, a pungent vaginal odour, red and inflamed vaginal walls, and pain and bleeding after sex. Treatment is an antibiotic as a single dose or a course, and it is important that your partner should also be treated.

Candida, which is a yeast infection caused by bacterial overgrowth, is the most common vaginal infection, but it should not cause vaginal odour. Patients usually complain of vaginal itch and a cottage cheese like discharge. Treatment is an intravaginal or oral antifungal.

A serious, but rare condition causing vaginal odour is a rectovaginal fistula (a tunnel between the vagina and rectum causing leakage of faeces). This is a complication of pelvic surgery, complicated child birth, Crohn’ s disease or radiation in the pelvic area. Vaginal cancer is another rare cause, mostly associated with immunosuppressive conditions like HIV. Cervical cancer may cause vaginal odour. It is caused by HPV virus, a sexually transmitted infection. detected by routine pap smears. Doctors can now test for high risk HPV, which means earlier detection of pre-cancer lesions and less frequent pap smears. Great news for us individuals who dread going for this uncomfortable procedure. Ask your doctor for more info.

7 Common Things That Make Your Vagina Smell Strange

When it comes to vaginal odour, we can all agree that our flowers unfortunately do not smell like it. It’s not something we feel comfortable sharing, even though most of us have faced this problem at some point.

So, what should it smell like?

(also featured on Women’s Health SA)

When it comes to vaginal odour, we can all agree that our flowers unfortunately do not smell like it. It’s not something we feel comfortable sharing, even though most of us have faced this problem at some point.

So, what should it smell like? Your vagina’s smell is highly individualized and influenced by many factors. During certain periods of time, we notice the smell more than usual. The take home message is if you have a noticeable vaginal odour associated with symptoms like discharge, itch or burn, there is a problem. Without these symptoms, it is likely to be normal. The reason why your vagina has a characteristic smell, is because it secretes fluids and normal bacteria, to keep your vaginal pH slightly acidic at 4.5. This plays a role in helping your vagina stay free of infection.

Here are the things that contribute to the smell of your vagina:

  1. Your menstrual cycle and hormones. Estrogen lowers your vaginal pH, protecting you against infections. During the second half of your cycle till before your period, when estrogen is low, you might be more susceptible to vaginal infections and odour. When your cycle is irregular, you are also more susceptible to increased pH and infections.
  2. Your diet. Any sugary foods are a perfect environment for yeast infections, causing a change in odour from the vagina. However, yeast infections do not really have a characteristic smell. Strong smelling foods like coffee or onions have a general effect on bodily fluids, including vaginal discharge and odour. There is some evidence showing that sweet smelling foods like watermelon, celery, pineapple and apple might help with vaginal odour. Lastly, eating foods rich in probiotics like sauerkraut, kefir or kombucha supports your vaginal microbiome, preventing infections.

Vaginal microbiome is the environment of normal organisms found in your vagina. Their role is to protect you from the overgrowth of unwanted yeast and bacterial infections. The vaginal microbiome and your gut microbiome are connected. Ways to maintain a healthy vaginal microbiome include avoiding oral antibiotics as far as possible and supplementing with a specific probiotic strain called lactobacillus rhamnosus (GR-1) and lactobacillus reuteri (RC-14). Feminine hygiene products used internally, vaginal douching and scented soaps disturbs your vaginal microbiome, putting you at risk of infection. Our natural response is to think when something smells, we need to wash it, but these efforts have the opposite effect in solving the problem.

  1. Your pH. Your vaginal pH should be between 3.5-4.5, that is slightly acidic. At this pH level, your vaginal microbiome should be normal. Anything above that puts you at risk of infections and odour. Things that increases your pH include menstrual blood and tampons, which is often the trigger of vaginal infections, sperm, scented soaps, hot tubs, vaginal douching and hormonal contraception.
  2. Leakage of urine/menopause – After normal childbirth associated with increased age, bladder control becomes more difficult. A cough or a sneeze can cause leakage of urine. Walking around with soiled underwear can cause an unwanted odour emanating from down south. If you are prone to this, I recommend Kegel/pelvic floor exercises, wearing a panty liner or having extra underwear in your bag.
  3. Personal hygiene and sweat. This is a very common cause of a musky or fried onion like odour of the vagina. Staying hydrated by drinking enough fluids, prevent bacterial overgrowth and strong odour from bodily fluids. If you are prone to sweat a lot, I would recommend wiping yourself in the afternoon with feminine wipes (not to be used inside the vagina but rather in the outside folds) and changing your underwear during the day. Baby powder will also help, but once again- for external use only. Lastly, hairy areas are more prone to sweat, so treat yourself to a Hollywood or laser.
  4. Sexual intercourse. Semen has a strong ammonia smell, and it can also increase your pH, putting you at risk of vaginal infections. It is important to urinate after sex, and wash properly with water after.
  5. Your choice of underwear. First, make sure your underwear is clean. It could be the root of all evil. Washing your underwear in the machine is often not enough, you need to wash it properly by hand. Tumble drying for 30 minutes also helps to get rid of any bacteria. Secondly, throw the old ones out. If your undies are stained, worn with holes, and just not looking sexy, get rid of them. You owe it to yourself and your partner. Lastly, the type of fabric is very important. Avoid synthetics like nylon and spandex, as they are non-breathable. Rather choose cotton.

 

What your period says about your health

When you think about your period, what comes to mind?

Maybe it’s reassurance that you’re not pregnant, or disappointment that you’re not. Maybe it’s pain, frequent bathroom breaks, an excuse to their partner for some, or just genuine bad timing for others.

But your period can mean so much more than that. The American College of Obstetricians and Gynaecologists released a statement, saying that your menstrual cycle can be used as a vital sign, just like any other vital sign e.g. temperature, pulse rate and blood pressure, in assessing overall health status.

When you think about your period, what comes to mind?

Maybe it’s reassurance that you’re not pregnant, or disappointment that you’re not. Maybe it’s pain, frequent bathroom breaks, an excuse to their partner for some, or just genuine bad timing for others. Maybe you can’t remember when last you had a period because you’ve been on the pill or some form of hormonal contraception.

your menstrual cycle can be used as a vital sign

But your period can mean so much more than that. The American College of Obstetricians and Gynaecologists released a statement, saying that your menstrual cycle can be used as a vital sign, just like any other vital sign e.g. temperature, pulse rate and blood pressure, in assessing overall health status.

What can your period say about your health? Most often, your period is influenced by factors like nutrition, stress, exercise and weight. One of the common reasons for your period to stay away is a low carb diet or undereating.  There are other conditions to think of.

If you have irregular periods longer than a 35-day cycle, you might have a condition known as PCOS, or thyroid dysfunction. It can also mean that your corpus luteum, the structure responsible for ovulation, is not working properly. This could be a result of insulin resistance or nutritional deficiencies like B vitamins, vitamin D, magnesium, zinc, iodine and selenium.  If you struggle with period pains and heavy periods, you might have endometriosis, fibroids or adenomyosis. It can also  be the result of a diet high in inflammatory foods like wheat, dairy and sugar, or low in zinc. Severe breast pain just a few days before your period could be a sign of iodine deficiency.

 with irregular periods, you might have a condition known as PCOS, or thyroid dysfunction

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The menstrual cycle, with a rise in estradiol (estrogen) for the first 14 days en progesterone in the last 14 days.

Did you know? When you’re on the pill, you can’t use your period as a vital sign, because it is not actually a period. The bleeding you experience when using your inactive tablets, is called a pill bleed, which is basically a withdrawal bleed because you are not exposed to any hormones on those days. A real period is the result of ovulation (the release of an egg) and changes in hormones like progesterone and estrogen.

having a normal menstrual cycle, uninterrupted by hormonal contraception has many proven benefits.

The pill or any hormonal contraception contains a synthetic form of estrogen and or progesterone. This suppresses your own production of these hormones. The synthetic form does not give you the same benefits that your own hormones do. New pills on the market like Qlaira and Zoely contains the natural form of estrogen, called estradiol, but there is no substitute for progesterone, and all contraceptives can only give you the synthetic form known as progestogen.

Having a normal menstrual cycle, uninterrupted by hormonal contraception has many proven benefits. In short, you want the benefits of a rise in estrogen leading up to ovulation during the first half of your cycle, you want to ovulate in the middle, and lastly and most importantly- you really want progesterone, produced after ovulation during the second half of your cycle. Progesterone is produced by the corpus luteum, a temporary structure that forms after a follicle releases an egg i.e. ovulation. No ovulation equals no progesterone. A follicle takes 100 days to develop, meaning that ovulation can be influenced by what happened 100 days before.

Estrogen is good for your mood, libido, bones, skin and metabolism. It also helps to prevent obesity as well as type 2 Diabetes.  Think of how you mom complains that she started struggling with her weight after menopause.

Progesterone is important in preventing breast cancer and cardiovascular disease. It promotes thyroid function, better sleep, and plays an important role in coping with stress by calming your nervous system. Low progesterone causes acne, PMS and is associated with hair loss.

It is clear that you want to have the benefits of these hormones to boost your health. One in three women take the pill to regulate their cycles. In reality, the pill can’t regulate your cycle, it just suppresses it. In treating acne, the pill works by suppressing sebum production, resulting in less oily skin and breakouts. Once again, treating symptoms but not the root cause.

the pill can’t regulate your cycle, it just suppresses it

Don’t get me wrong, I am not against hormonal contraception, especially if it is used for the reason intended, to prevent unwanted pregnancy. But I do want to make you aware of the benefits of having a natural cycle, and I want to advocate not to use the pill to suppress symptoms.

One of the newer natural forms of contraception is called the fertility awareness method. It is not the same as the rhythm method, which is just based on your calendar cycle. In terms of efficacy, it is best to look at typical use failure rate, that is taking into account human error. The FAM has a typical use failure rate of 1.8%, so this is taking into account that you maybe calculate the wrong fertile days. The pill has a typical use failure rate of 9%, that is skipping a pill here and there, like most women do without wanting to admit it. With perfect use, FAM has a failure rate of 0.6% compared with the pill’s failure rate of 0.3%.

The FAM is a method of tracking your period, ideally by means of Apps like Glow or Flo, and being sensitive to your body’s cues of changes in your cycle. You need to look for signs of ovulation, by looking out for signs around day 14 including fertile mucus, mittelsmerz (which is a sharp lower abdominal pain experienced for about an hour when ovulating), breast pain and most importantly a constant rise in basal body temperature. Fertile mucus looks like raw egg white and is seen when your estrogen is at its highest, just before ovulation.

You can buy a basal thermometer online, which is basically a more accurate thermometer that you use to measure your temperature under the tongue first thing in the morning when you wake up, before you have eaten, drunk or even climbed out of bed. After ovulation, your temperature rises by 0.3C, for example from 36.41 to 36.71, and stays elevated till your next period. You should take extra precautions like condoms for 5 days before ovulation and one day after, because these are your fertile days. This means, it is much easier to use this method if you have a regular cycle, needing to be able to predict when you will ovulate. I want to reiterate – in order for you to use this method, you must know exactly what you are doing, and in my opinion, you must be okay with the risk of contraceptive failure.

If you are on hormonal contraception and it is just not working for you, or you want to experience what it feels like to have a normal natural cycle, I really want to urge you to consider other methods.

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The Period Repair Manual – Lara Briden

Don’t make any hasty decisions without chatting to your partner, doctor, and doing thenecessary research. I recommend reading Lara Briden’s book called the Period Repair Manual, which gives great insight about period health and the FAM. It is unfortunately not an easy road after stopping your hormonal contraceptive, and you can expect skin breakout and irregular cycles for a few months after stopping, but there are supplements and treatments you can use to treat that and get you back into a regular cycle.

May you start to see your period as a sign of health, and enjoy all benefits of the cycle you were designed for!

 

Preventing Breast Cancer

Breast cancer is still the leading cause of cancer in women today. What’s even more scary, is that it can occur at a young age. I lost a classmate from medical school to breast cancer this year, at the mere age of 26. I recently also read about 28 year old Kyla Comins’ journey with breast cancer.

This prompted me to start with regular self-examinations. As a result, paranoia crept in, and every irregularity was seen as a potential threat to my life. I decided to take action, and made an appointment with a breast Consultant at Appfelstaedt and Associates.

I would highly recommend this to all ladies.They were extremely professional, did a thorough history and examination and a breast ultrasound (since a mammogram is not indicated before the age of 40). They reassured me that what I was feeling was normal breast tissue, and educated me on what I should look out for in the future.

Ignorance is not bliss. you have a 3-12% chance of developing breast cancer during your lifetime, with higher incidence in developed countries,  most probably because of lower screening rates in developing countries – making the stats look lower than it truly is. Studies show that from the cancers diagnosed through screening mammograms, 31% are in situ (not invasive) and of the invasive cancers, 81% have not spread to nodes. This confirms the importance of going for regular mammograms from  the age of 40 to pick it up at a stage where it can still be cured. We all have a responsibility towards ourselves and our loved ones to do what we can to protect ourselves against this lethal illness.

Here is what you need to know:

The most important risk factors are

  1. age>50
  2. genetics – BRCA1 or 2 (5-10% of breast cancers are hereditary)
  3. early first period before age 12
  4. late menopause after 55
  5. late first pregnancy after 30
  6. physical inactivity
  7. being overweight after menopause
  8. dense breasts – making new lumps difficult to pick up
  9. women on hormone replacement
  10. taking oral contraceptives – previously seen as a risk factor due to high levels of estrogen, but the pills on the market are all low dose estrogen
  11. history of previous breast cancer 
  12. history of certain non-cancerous breast conditions,
  13. first degree relative with breast cancer (this includes a mother, sister or daughter)
  14. previous radiation to the chest/breast area
  15. drinking alcohol

What about diet? Diet alone cannot cause or prevent cancer, but studies have shown that maintaining a healthy diet full of fruits and vegetables, with low red meat intake and taking vit B12 if you’re a wine drinker, may lower your risk.

How often do I need to self examine? Once a month from the age of 20, ideally one week after your period. (less nodularity and sensitivity). It is important to have the right technique. From the age of 30, consider going for a clinical breast exam by a doctor every three years, with yearly mammograms from the age of 40.

What are the warning signs? Even though breast cancer often presents with a lump, it was found that one in 6 women presents with other signs, that is often ignored – making the prognosis worse. These red flags are inflamed, or dimpling of the skin, nipple changes or discharge, changed in shape and size of the breast, and nipple or breast pain and tenderness.

In summary, breast cancer can be largely prevented by taking ownership of our bodies, and doing what we can to pick it up early.

 

 

Contraception – the right one for you

I want to highlight that there is no single form of family planning that can be considered best across the board. It depends on the individual. Women respond very differently with regards to side-effects. Here’s a list from most to least effective, with common side-effects.

“…the first thing that comes to mind is side-effects – weight gain, moodiness and irregular periods…”

When I think of contraception, the first thing that comes to mind is side-effects – weight gain, moodiness and irregular periods. Even worse, the fear of falling pregnant on one of them – stories of babies being born with a intrauterine device in hand, women on the pill skipping a day and now they  have an unplanned pregnancy, or a romantic evening over Indian curry resulting in more permanent consequences than just a runny tummy – true story.

I want to highlight that there is no single form of family planning that can be considered best across the board. It depends on the individual. Women respond very differently with regards to side-effects.

I listed them from most effective to least effective, since the main aim is ultimately to prevent pregnancy.

1. The Implanon

implanon
The Implanon is inserted just underneath the skin on the inside of the upper arm

What is it? A small device inserted just underneath the skin  of the upper arm that secretes a hormone called progesterone.

“It is considered as effective as sterilization.”

How it works? It prevents ovulation, forms a thick mucus plug at the mouth of the womb to prevent sperm from entering and keeps the lining of the uterus thin.

How effective is it? It is considered as effective as sterilization (with a less than one in hundred risk of falling pregnant), and lasts for 3 years.

The Cost? R1700 in private, free in public.

Who should use it? I would advise this to all ladies wanting safe, long term contraception.

Who should stay away? Women with depression should first consult their doctor.

The Benefit? Long term, effective and convenient contraception. Quick and painless insertion.

The Downside? Irregular bleeding or spotting:

  • 22% amenorrhoea (no periods – the goal!),
  • 34% infrequent (less than 3 episodes in 90 days – amazing!),
  • 19% no changes in bleeding patterns (3 episodes in 90 days – fair!),
  • 18% prolonged (more than 3 episodes in 90 days – not so nice),
  • 7% frequent (more than 5 episodes in 90 days – horrible!)

Other side effects? Headaches (25% with insertion – subsides over time), weight gain, (average weight gain of 1.3kg after one year) acne, (13.5%) and moodiness (6.5%).

“You could be having no periods and no side-effects.”

Counselling points? Although I agree that these side-effects are horrible, it doesn’t mean they will happen to you – every individual is different. My advice is that unless contraindicated by your doctor, every women should at least try this contraceptive for a period of 3 months – this is a predictor of your future bleeding patterns. You could be having no periods and no side-effects. Even if you are experiencing abnormal bleeding patterns, there are a number of medications your doctor can prescribe to stop the bleeding while your body adjusts, e.g. tranexemic acid (cyclokapron).

2. Mirena

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What is it? A T-shaped device that releases progesterone, inserted from the vagina into the uterus.

How it works? It forms a thick mucus plug at the cervix, preventing passage of sperm. It also prevents survival of sperm inside the uterus and keeps the lining of the uterus thin.

How effective is it? You have a less than one in a 100 risk of falling pregnant, and lasts for 5 years.

The Cost? The device costs R2000 in private, excluding the cost for insertion.

“It is ideal for women with heavy periods.”

The Benefit? Reduced bleeding or amenorrhoea (20% of women). Effective and convenient.

The Downside? Painful insertion and cramping (23%) during the first few days – especially in women who haven’t been in labour.

Who should use it? It is ideal for women with heavy periods.

Who should avoid it? Women who have/are at risk of STD’s and pelvic inflammatory disease (PID).

Other risks? Initial headaches/migraines (17%) – subsides with time, perforation of the womb (rare – one in a 1000) and expulsion of the device with loss of contraception (4.5% risk over 5 years).

Counselling points? Women should be warned that insertion can be quite painful, but despite this, women are extremely happy with the Mirena. There is the option of having it inserted under general anesthetic in theatre. Cramping can be expected in the beginning, as well as headache and irregular bleeding.

3. Copper T

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What is it? The copper T is also an intrauterine device, but does not contain any hormones.

How it works? It works by creating a hostile environment inside the uterus – destroying sperm that enters as well as preventing implantation of a fertilized egg.

“…in contrast with the Mirena, it increases menstrual bleeding and period pains.”

How effective is it? It is also a very effective form of contraception with less than one in a hundred risk of falling pregnant. It is effective for at least 10 years and is free in the public sector.

The Benefit? Convenient and effective

The Downside? Pain with insertion and in contrast with the Mirena, it increases menstrual bleeding and period pains by up to 50%.

Who should use it? Women with light periods desiring long term contraception.

Who should avoid it? Women with heavy periods and period pains, women who have/are at risk of STD’s and pelvic inflammatory disease (PID). Also, if you are anti-abortion like me, there is a big debate on whether the Copper-T’s mechanism of action is similar to abortion.

Other adverse effects and risks are similar to those of the Mirena.

4. Injectables

depo-provera-injection

What is it? A type of progesterone injection that is available as a two monthly (Sayana Press) or three monthly (Depo-Provera) formulation. It costs anything between R90-R250 a shot in private, and is free in public.

How it works? It inhibits ovulation.

How effective is it? With correct use (strict injections every 10-14 weeks), the risk of falling pregnant is less than one in a hundred. With typical use, 6 out of a hundred women fall pregnant.

The Benefit? The injection is convenient, discreet and cheap. 50% of women have amenorrhoea after one year.

“…the average weight gain is 2.3kg after one year…”

The downside? Weight gain (average weight gain of 2.3kg after one year), initial irregular bleeding, bone mineral density loss (risk of osteoporosis) – reversible after stopping injection, delayed return of fertility (about 10 months) and non-reversible for prescribed period after injection.

Other adverse effects? Headache (16.5%), nervousness (10.8%), decreased libido (5.5%) and abdominal pain/discomfort (11.2%).

Who should use it? Women with a contraindication to estrogen.

Who should stay away? Women struggling with their weight. Women known with osteoporosis.

Counselling points? For the depo to be effective, it is crucial to get it every 10-14 weeks.

5. Oral contraceptives

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What is it? The pill is still a very popular form of contraception today.  Broadly, there are combination pills, consisting of estrogen and progesterone, and progesterone only pills, better known as the mini-pill. From low to high dose of estrogen, common combination pills in South African include Melodene/Yaz (20mcg), Yasmin (30mcg) and Diane/Ginette/Minerva (35mcg).

How it works? The constant levels of estrogen and progesterone inhibit ovulation, forms a thick mucus plug to prevent sperm to pass through the cervix and keeps the lining of the uterus thin.

“…as soon as you don’t use it as prescribed, your risk of falling pregnant increases to 8 in a hundred.”

How effective is it? The risk of falling pregnant with correct use, is one in a hundred. The problem with the pill is as soon as you don’t use it as prescribed, your risk of falling pregnant increases to 8 in a hundred. Certain medications or supplements like antibiotics also decrease the efficacy of the pill.

The Benefit? The pill has many advantages. It improves acne, regulates your cycle, decreases menstrual pain and bleeding, and if taken correctly, is an effective form of contraception.

The Downside? Irregular bleeding or spotting between periods for the first three months, breast tenderness and enlargement and weight gain. Even though there might be slight water retention initially, studies do not show a clear link between weight gain and the pill. Also, the risk of above side effects are higher with combination pills with high levels of estrogen. Most pills on the market (all of the combinations mentioned above) contains low doses of estrogen.

Other adverse effects? DVT’s (blood clots in the veins), which is higher with certain combinations, as well as headaches and mood changes.

Who should use it? Women with irregular cycles, acne, period pains, and where falling pregnant would not be the end of the world.

Who should stay away? women with a history or risk of DVT’s, women known with non-compliance when taking pills, and in the case where pregnancy is absolutely containdicated. Women known with migraine or depression should consult with a medical practitioner first.

Counselling points? It is important to know exactly how to take you pill, and to know about the symptoms of serious side effects.

6. Condoms

condoms

What is it? A non-invasive, barrier form of contraception. There are male and female condoms available. You can get them for free at any clinic, or if you’re picky you can buy them anywhere from a supermarket to a spaza shop.

“It is the only contraception providing protection against STD’s and HIV.”

How effective is it? When used correctly, condoms are 98% effective in preventing pregnancy. In reality, most people do not use them properly, and the risk of falling pregnant is 8 in a hundred.

The Benefit? It is the only contraception providing protection against STD’s and HIV, it is cheap, and there are minimal side-effects.

The Downside? Common risks or disadvantages of the condom include inconvenience, reduced tactile sensitivity, latex allergy and contraceptive failure.

Who should use it? Women who are at risk or have HIV/STD’s should use it in combination with other contraceptives.

Counselling points? Couples should make sure they know how to use the condom correctly, to prevent contraceptive failure.

No need to knead gluten free pasta

See how easy it is to make your own fresh pasta with this gluten free recipe, no pasta machine needed.

If you are like me, who’s lack of patience have caused for many food disasters, this recipe is perfect for you. Apart from the benefit that this pasta is gluten free, with no post meal bloating, there is no need for endless kneading to create the perfect dough, because the gluten does not have to develop. The guar gum/xanthan gum creates the smooth silky texture of fresh pasta. Best of all, you don’t need a pasta machine to make this easy recipe.

Ingredients:

  • one and a half cups (375ml) of brown rice flour
  • half cup ( 125ml) of tapioca flour
  • 1 teaspoon (5ml) guar gum/xanthan gum
  • 4 large eggs
  • pinch of salt

Method:

Sift the brown rice flour, tapioca flour and guar gum in a mixing bowl. Whisk them together, then add the eggs while whisking. Scrape the sides of the bowl into the mixture till everything is combined into a dough.

Dust a large, clean surface with rice flour and turn the dough out onto the surface. Knead a few times, till it has a smooth texture.

Divide the dough into four, using one quarter at a time to form the pasta sheets, while covering the rest with cling wrap to prevent it from drying out. Take your first quarter, and flatten it with your hand or rolling pin if you have one.

If you have a pasta machine, start with the widest setting, and roll  it through three times till fairly smooth. Continue taking through successively narrower settings, stopping at the second last setting. Tip: this pasta tends to break easier compared to gluten containing pastas, don’t pull the pasta coming out of the machine – if it gets too long, rather cut it in half before you feed it through. If you don’t have a machine, dust your rolling pin and surface with enough rice flour and roll till it is about 1.5-2 mm in thickness and in a rectangular/oval shape.

Now for the cutting. With the machine, use the fettuccine cutter. I encourage a two person technique- one feeding the dough from the top and turning the handle, while the other person catches the cut pasta. If you are doing it by hand, cut (press rather than cutting movements) with a sharp knife in 0.8cm pieces. Place the pasta on baking paper dusted with rice flour.

Bring a pot of salted water to the boil. When it is boiling, place the pasta in the pot for 5 minutes until cooked, and serve immediately with your desired sauce. Tip: cook the pasta in 4 batches, to prevent  it from sticking together.

Recipe adjusted from Serious Eats

Wine not

We justify our consumption with all sorts of explanations, of which the most convincing is the benefit of regular wine drinking on our health. But is it a convenient excuse that was enforced by now outdated research, or can we still drink with a happy heart, in the literal sense? This is what the latest research says…

“is it a convenient excuse that was enforced by now outdated research … ?”

Wine, whether you are a fan or not, plays a major role in the lives of people living in the Western Cape, South Africa. We are among the privileged, being able to choose from the best quality of wines, sourced locally. We justify our consumption with all sorts of explanations, of which the most convincing is the benefit of regular wine drinking on our health. But is it a convenient excuse that was enforced by now outdated research, or can we still drink with a happy heart, in the literal sense? This is what the latest research says…

1. Moderate drinking lowers your risk for metabolic syndrome

This statement is still supported by the latest research published in 2017. Metabolic syndrome is a cluster of 5 conditions, increasing your risk for cardiovascular disease (which could result in heart attacks), stroke and Diabetes.

The level of alcohol consumption plays a role, as light drinking does not cause a lowered risk, while heavy drinking increases your risk of developing high blood pressure.

It is not wine per se that is linked to this benefit, but any alcohol.

What is moderate drinking?
Moderate drinking is classified as between 10-20g alcohol per day, which is equivalent to 90-180 ml of wine (other studies round it up to 100-200 ml, a little extra for us wine lovers), 35-70ml of gin, whiskey or brandy, and 250-500ml of 4,5% alcohol beer.

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alcohol increases your risk of developing breast cancer

2. Alcohol increases the risk of developing breast cancer

Women with light to moderate alcohol consumption (5-14.9g alcohol per day), has a higher risk of developing breast cancer. The most likely explanation is that the breakdown products of alcohol is considered a cancer forming agent by inhibiting normal DNA formation, and the breast tissue is more sensitive to these products, due to hormones like estrogen and androgen.

“taking vitamin B12 daily, reduces the risk of developing breast cancer from alcohol”

But ladies, don’t throw out the wine yet. Studies showed that taking folate (vitamin B12) daily, reduces the risk of developing breast cancer from alcohol significantly. 400 micrograms, which is the recommended daily intake for women of childbearing age, is enough to reduce the risk significantly.

3. Good for the teeth?

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In 2015, a study showed that red wine, even when the alcohol is removed, could prevent dental caries, by preventing oral biofilms, a combination of bacteria responsible for plaque and acid formation damaging the teeth.

“red wine also has some undesirable effects, … which increases the risk for other mouth infections”

However, the American Dental Association is not convinced about the findings for a number of reasons. The study didn’t show any effect against S. Mutans, the organism most responsible for caries. Also, the study was done under experimental conditions, not in real life settings. In theory, there is a clear benefit, but red wine also has some undesirable effects like staining of the teeth, as well as suppressing other normal bacteria in your oral cavity, which increases the risk for other mouth infections.

4. Alcohol and Alzheimer’s

Most of us have the idea that a glass or two of wine a day helps prevent Alzheimer’s disease.

The latest research suggests otherwise, showing that moderate drinkers were three times more at risk of developing signs of Alzheimer’s than abstainers. Light drinking did not show any benefit in reducing the risk. However, since these results are out of keeping with most other studies, I am not convinced of the accuracy of their findings.

“you have a 23% lower risk of developing Alzheimer’s or serious memory impairment with moderate alcohol intake”

Studies over the years have had conflicting results, but the largest analysis to date in 2011, which included data from 143 studies and 365 000 participants across the world, showed that you have a 23% lower risk of developing Alzheimer’s or serious memory impairment with moderate alcohol intake. Some studies showed that wine had more benefits than other alcoholic drinks, because of a compound called resveratrol, found in the skin of grapes.

In contrast, heavy drinking had a higher risk of memory impairment and dementia.

Even though there are many conflicting results, this analysis gives the best overall picture. It shows that there are some benefits to drinking one or two units of alcohol per day in preventing Alzheimer’s, even more so with red wine. More than that has the opposite effect. Abstainers or light drinkers shouldn’t increase their alcohol intake, since this benefit seems modest.

5. What does alcohol do to your immune system

This was the question that made me decide to write this blog post. Being diagnosed with TB, I read that certain factors increase the risk of TB infection, e.g. HIV, immunosuppressive drugs, and chronic alcohol abuse. I would classify myself as a moderate drinker, and wanted to make sure that this didn’t make me more at risk.

Chronic heavy alcohol abuse inhibits the immune system, making you more susceptible to infections. When babies are exposed to chronic alcohol abuse while in the uterus, it impairs the development of their immune system, which puts them at higher risk of developing infections into adulthood.

“Moderate drinking does not cause impaired immunity”

Moderate drinking does not cause impaired immunity, and some studies even show increased production of immune cells.

Conclusion

Red wine have multiple proven benefits for your health, but the key lies in the amount consumed. Moderate drinking, which is about one glass a day can be justified, but when pouring that second glass, we will need to look for another excuse!