Dr Hazel Wallace wants to change the way women are treated

‘WOMEN ARE STILL BEING TREATED WITH OUTDATED GUIDELINES BASED ON MALES’

You may know Dr Hazel Wallace, aka The Food Medic, for her glossy Instagram and two books of delicious healthy recipes. A doctor who trained as a nutritionist and personal trainer, her MO has always been to share practical and evidence-based health and lifestyle advice.

Now she’s back with a third book and a radical new direction. This time… it’s political. Her new focus is women’s health; specifically, how we’re being short-changed by healthcare. Her book The Female Factor was born out of Dr Wallace’s frustration. ‘As a woman, and a doctor with female patients, I saw there was an unspoken, unmet need,’ she tells me. ‘I saw that women’s health is under-researched, under-diagnosed. As a result, women are misdiagnosed and under-treated.’

There are many factors feeding into this, she says, so it’s not a simple problem to unpick. But she hopes this book will become part of a bigger drive for more research into women’s health.

‘Women are still being treated with outdated guidelines based on male subjects. We are treated like small versions of men,’ she says. One reason is that, historically, ‘most clinical research has ignored the female sex, due to us having hormones, a risk of pregnancy and caregiving responsibilities’. The results can be shocking. For example, when a woman takes a medication, she is twice as likely as a man to have an adverse reaction.

Dr Wallace describes writing the book as a three-year wake-up call: ‘I discovered that all I’d known about medicine was skewed from a male-centric view.’ She says it’s also worth highlighting that transgender women have been similarly excluded, even if their healthcare needs are not the focus of her book.

Women are not only excluded from research, but studies about reproductive health are woefully lacking, too. There’s a joke that says, ‘If men gave birth, contraception would be 100% effective.’ We might also know a lot more about treating endometriosis, postnatal depression, PMS and menopause, too.

‘Reproductive health makes up only 2.5% of publicly funded research,’ says Dr Wallace. ‘Currently, it takes up to eight years to be diagnosed from onset of symptoms of endometriosis.’

One big problem comes from our deep-rooted bias. We as a culture (including our doctors) have preconceptions about women’s health. This can affect how we’re treated and the investigations we’re given. For example, think of someone having a heart attack. Who did you picture? It’s likely to be a man, aged 50-plus.

Dr Wallace became aware of her own bias on an acute medical ward shift when a middle-aged woman came in with chest pain. ‘She said she was busy and needed to pick up her grandkids; that it was her anxiety or reflux playing up,’ she says. ‘She almost convinced me.’ But Dr Wallace ran the blood tests and ECG, ‘They were suggestive she was having a heart attack.’

The kicker is that heart conditions are, in fact, the biggest killer of women – more than breast cancer. Shockingly, figures show women in England and Wales are twice as likely to die from a heart attack as men.

Alongside campaigning, Dr Wallace realised she wanted the book to be practical, too. She discovered that women have ‘periods of vulnerability’ – namely puberty, after birth and menopause. And so it’s a manual of how we can navigate specific health needs throughout our lives, from mental health and exercise to nutrition and sleep.

Researching mood, she says, was particularly revealing. Women are twice as likely to suffer from anxiety and depression, partly down to the difference in how men and women respond to stress: ‘Our mood and mental health are not just due to our biology but tied up in the culture we’re raised in. For example, boys are taught to be stoic, but it’s more acceptable for girls to cry.’

Things are changing. At the end of 2021 in England, the Women’s Health Strategy called for evidence to support women in health care. And medical study guidelines must show they are taking steps to include women, if applicable. Dr Wallace says it’s good we’ve begun to normalise talking about our symptoms, that periods and the menopause have lost much of their taboo – but we should be careful not to normalise the symptoms themselves. ‘So many women are told, “it’s just your period,” but it’s not normal to take days off work because you can’t function,’ she says. ‘We don’t have to accept or endure, for example, incontinence or debilitating pain. I want to make women feel empowered by their bodies, ready to support themselves in ways they never have before.’

How can I get the most out of a GP consultation?

Many women tell me they feel their GP doesn’t listen. I have been the patient and felt like this. It’s important we feel we can advocate for ourselves. If you can, keep a diary of your symptoms to take to your appointment, ideally for a couple of weeks. Finally, if you feel the GP isn’t listening, you can ask to see a different GP in the same practice; a female doctor if you prefer.

Is it normal to skip a period?

Yes! Most women will sometimes skip a period when they are sick or stressed. However, if you don’t have a period for three months, see your GP. Your period isn’t ‘just’ a period. You could see it as a fifth vital sign along with blood pressure, temperature, heart rate and breathing rate. And if your period stops, there will not only be effects on your fertility, but also your skin, hair and bone health.

One reason for skipping periods is functional hypothalamic amenorrhea (FHA); this is common among avid gym-goers, runners or triathletes. In one study of women who exercised regularly, half had menstrual disturbance and over a third had no period at all. It’s when your periods stop due to a mismatch in the number of calories available to the body, and the amount it needs. When you don’t fuel appropriately, your body down-regulates, switching off non-essential tasks, including reproduction. This is a sign that your body is under stress, so please don’t ignore it. It’s not spoken about enough and is under-diagnosed. How to recover? Increase energy intake, reduce the amount and intensity of your exercise, find ways to manage your stress and include more recovery days, rest and sleep.

What can I do to decrease PMS symptoms?

1 Movement. This helps relieve both physical and psychological symptoms, such as pain, constipation, breast tenderness, anxiety and anger. It doesn’t need to be intense exercise: walking, cycling or swimming will all work.

2 Rest and recovery. Find ways to relax and reduce stress. Women tend to report worse sleep around this phase of their cycle, so it’s even more important to go to bed early and ensure you’re practising good sleep hygiene.

3 Eat well. Complex carbohydrates (whole grains, legumes, fruits and vegetables) may help control cravings and support mood and energy levels by stabilising your blood glucose levels. Also include omega-3 fatty acids (found in oily fish, flaxseed, chia seed and walnuts), increase your intake of iron-rich plant foods (beans, pulses, nuts and seeds), add in some soya products (tofu, tempeh and soya milk) and reduce your intake of caffeine, alcohol and salt.

Why do I crave chocolate before my period?

In the second part of your cycle after ovulation – the luteal phase – your resting metabolism is slightly higher. That means you may be burning up to 300 extra calories a day. A lot of women report cravings at that time. These are usually for high sugar carbs (hello chocolate!). We can be a bit smarter about the foods we’re eating: increase your carbohydrates but opt for complex carbs that sustain you and give you energy. At this time, there’s also a slight increase in the breakdown of protein, so you need to refuel that, too, as well as healthy fats.

A BALANCED PLATE

‘You probably know what a healthy diet is, but there’s so much misinformation. As a rough guide, a balanced meal will contain one third to a half plate of colourful fruit and non-starchy veg, one third to a quarter plate of grains or starchy veg (eg potatoes, bread and cereals, ideally whole grain), one third to a quarter plate of lean protein (eg meat, fish, dairy, pulses, tofu), a sprinkle/ drizzle of fats (including nuts and nut butter, seeds, avocado and plant oils) and occasional (optional) extras, such as sweets and savoury snacks. This poke bowl recipe (below) is a good example of a balanced meal.’

DIY protein poke bowl

MAKES 2

The beauty of a poke bowl is that it’s super customisable, convenient, nutritious and filling. This one is like a pick ‘n’ mix.

1 Dressing: Whisk 2tbsp soy sauce, 1tbsp sesame oil and ½tbsp rice wine vinegar together in a bowl.

2 Choose one from each of the following sections, arrange in a bowl, then add the dressing: Protein (1 palm-sized portion each): tuna or salmon fillet; chicken; tofu; prawns; falafel or 2 soft-boiled eggs.

Grains (250g shared between bowls): wholegrain rice; sushi rice or quinoa. Greens (1 large handful each): spinach; kale or mixed leaves. Toppings (divide between two bowls): 1 avocado, stone removed, peeled and chopped; 1 mango, stone removed, peeled and chopped; ¼ cucumber; thinly sliced; 6 radishes, trimmed and sliced; 1 carrot, shredded or 100g edamame, shelled and cooked according to packet instructions.

3 Finish with your choice of garnish: 1 sheet of nori seaweed, chopped; 1tbsp sesame seeds or lime wedges.

Do my hormones affect my mental health?

Yes, to a degree, but they’re not the only voice in the crowd. It’s easy to assume that a woman’s mood always links back to hormones, be that her period, post-baby or during the menopausal transition. While it’s true these major hormonal milestones make us vulnerable to mental health problems, other life factors play a role. A large study* exploring the link between mood changes and the menstrual cycle found that only one in 20 women showed any clear variation in mood based on where they were in their cycle. Stronger predictors of mood? Physical health, stress levels and social support.

Should I vary my workout across the month?

We don’t have enough research to provide exact guidelines on this but understanding some key changes will give you the potential to make the most of training and recovery. Be aware there’s a slight dip in both strength and endurance during your period. Then, just before ovulation, oestrogen is high which helps to boost energy levels, promote muscle-building and enhance recovery, including reducing next-day muscle soreness and swelling. The second half of the cycle is a time to emphasise recovery and hydration, as it’s thought higher progesterone inhibits some of the beneficial effects of oestrogen, as well as increasing body temperature, fluid retention and bloating.

What can I do to support my bones?

This is important at any age, because your bone health early in life affects it later down the line, including after menopause, when your risk of osteoporosis rises.

1 Don’t smoke. It’s a proven risk factor for osteoporosis.

2 Do weight-bearing exercises including some form of impact and muscle-strengthening.

3 Eat sufficient calories. This is not only key to build and maintain healthy bones but also because inadequate calorie intake often comes hand in hand with lower intakes of important bone health nutrients: calcium, vitamin D, protein, magnesium, phosphorus and vitamin K.

EXERCISE EATING

‘For any exercise lasting more than 60 minutes (for example, a long run or cycle), top up your energy stores with some extra carbs. Start fuelling 45-60 minutes into your workout with 30-60g of carbs an hour. Try the recipe below; just one of these bars contains 25g of carbohydrates. PS: they’re great even if you haven’t worked out!’

On-the-run fruit + nut bars

MAKES 12-14 bars

⚫ 200g rolled oats

⚫ 100g roasted hazelnuts,

finely chopped

⚫ 50g pumpkin seeds

⚫ Pinch sea salt

⚫ 150g Medjool dates, pitted

⚫ 1 ripe banana, peeled

⚫ 60g unsalted butter or coconut

oil, melted

⚫ 80g cashew nut butter

⚫ 50ml brown rice syrup

⚫ Zest ½ lemon

1 Preheat the oven to 220°C (200°C fan) gas mark 7. Line a 24 x 16cm tin with baking parchment. Put the oats and hazelnuts into a food processor and pulse on and off, until they resemble breadcrumbs. Transfer to a bowl, add the pumpkin seeds and salt, and mix.

2 Put the dates and banana into the food processor (no need to clean it) and blitz, until smooth. Transfer to a bowl. Add the melted butter (or coconut oil), cashew nut butter, brown rice syrup and lemon zest. Mix until smooth.

3 Add the date mixture to the oats and mix, ensuring the oats are coated. Spread out in the lined tin and firmly compact with the back of a wet spoon. Bake for 15-18min, until golden. Remove and leave to cool for 10min. Slice into bars and leave to cool completely. They will keep for a week in an airtight container in the fridge.