Hazel Wallace - aka the Food Medic - is passionate about nutrition and women’s health. Here she talks about how women have been perceived by medicine. We also have some delicious recipes from her new book The Female Factor for you to try.

 The Food Medic was born out of a passion project of mine back in 2012 while at medical school. After losing my father suddenly to a stroke in my teens, I became fascinated by how nutrition and lifestyle can influence our health and genetic predisposition to disease. However, in lectures, only lip service was paid to non-medical interventions like diet, physical activity, sleep and stress management, so I set out to learn more about how our lifestyle shapes our health and started to blog about my findings in accessible, easy-to-follow articles and social media captions as ‘The Food Medic’.

I wrote and published my first book – The Food Medic – in 2017, while working full-time as a first-year doctor in London, and released my second book – The Food Medic for Life – in 2018. Over this time, my passion for nutrition and public health continued to grow, which brought me back to university the following year to complete my master’s in clinical nutrition and public health at University College London (UCL), allowing me to become dual-registered as a doctor and a nutritionist.

Nutrition will always be my biggest passion, but as a woman, and as a doctor to many women, I wanted to expand the work I do, especially when I discovered there was an unmet need within medicine and healthcare. I realised that our current model of male-centric medicine meant that women were understudied, underdiagnosed, misdiagnosed and undertreated. In most of the research I studied, it appeared that medicine sees our reproductive organs and hormones as our greatest source of difference to men and holds the assumption that pretty much everything else works in the same way, so can be fixed in the same way. But, in the words of Dr Stacy Sims, ‘women are not small men’.

The more I shared female-focused research (albeit limited) and content online, the more women responded. My direct messages on Instagram would be filled with women who had similar experiences and felt like they weren’t being listened to. Every post I curated that examined health topics under a female lens turned into an engaged and empowered discussion among my followers – among many of you. It made me want to learn more, to share more, to empower more. I knew there was an unmet need here and wanted to find some answers.

And so, for the past three years (in between COVID shifts at the hospital), I’ve dedicated most of my time to researching how to help women live healthier, happier lives.

And The Female Factor was born.

How Science Sees Women

The male body has always been the default body in biomedical research, and female subjects have been historically excluded. Here’s the thing, we have so much incredible medical research available to us now, but most of it is based on male cells, male mice and male bodies, then simply applied to women. I’ll say that again for the people in the back: Most clinical research ignores the female sex and is centred around cis (a person whose sense of personal identity and gender corresponds with their birth sex.), endosex (a person born with sex characteristics that are considered typically male or female) men. It is also worth highlighting that transgender women are similarly excluded from medical research, even if their healthcare needs are not the focus of this particular book.

Even when it comes to research based on animals, there is a significant male bias in eight out of ten areas of biology. For example, in studies of drug treatments, there is a five-to-one male-to-female ratio. That’s quite concerning considering women typically respond to drug treatments differently and experience adverse drug reactions nearly twice as often as men. An analysis of prescription drugs withdrawn in the US market from 1997 to 2001 found that eight out of ten posed ‘greater health risks for women’. This is not simply because women are ‘smaller men’ (though on average we are smaller humans), but we also have smaller organs, more body fat (which can trap certain drugs), slower gut motility (affects drug absorption) and excrete drugs slower via the kidneys – all of which increase the risk of overmedication and adverse reactions, if not accounted for.

Historically, researchers have argued that the female body is too complex to be included in studies due to fluctuating hormones and the risk of pregnancy, or that women are too difficult to recruit because of their caregiving responsibilities and the inflexibility of research trials. The latter being an argument that is simply infuriating and underpins the complex relationship between our sex (biology) and gender stereotypes (and the social norms that come with it), and how they both influence our health and the healthcare we receive.

Research into unique reproductive or gynaecological health problems that affect women and people assigned female biologically at birth isn't any better. For example, only 2.5 per cent of publicly funded research is dedicated to reproductive health, despite the fact that one in three women in the UK will suffer from a reproductive or gynaecological health problem in their life. Indeed, inequalities in health and research for women is also compounded by race and class. While it takes on average an already unacceptable eight years for a woman to be diagnosed with endometriosis, in the UK black women are shockingly half as likely as white women to be diagnosed. Our deeply embedded beliefs and unconscious biases that we hold about women and their health experiences are causing unnecessary – and preventable – suffering.

Crispy cod tacos

I - Source of Iron: recipe provides 15% of the daily Reference intake (RI) per serving

P - Source of Protein: at least 12% of the calories come from protein

F - Source of Fibre: recipe provides at least 3g of fibre per 100g or at least 1.5g per 100kcal

Serves 4

This is one of my go-to dinner party dishes, because everyone can build their own tacos and add their favourite fillings. Fish is usually a safe option for most people in terms of food preference, but for veggies or vegans you could use tofu or cauliflower, and for a meat option chicken works really well too.

INGREDIENTS:

12 corn tacos

1 small head of lettuce, shredded

2 avocados, peeled, pitted and sliced

FOR THE CRISPY COD

4 skinless cod fillets (approx. 500g)

1 egg

60g ground almonds

40g oats

2 tbsp fajita seasoning

FOR THE SALSA

2 large tomatoes, finely chopped

½ red onion, diced

1 garlic clove, grated

1 tbsp extra virgin olive oil

Salt and black pepper

ADDITIONAL EXTRAS

Sour cream, fresh coriander, jalapeños, lime

wedges, grated cheese

METHOD

1 Preheat the oven to 220°C fan/475°F/gas mark 9 and line a baking tray with baking parchment.

2 Slice the fish fillets into large chunks.

3 Whisk the egg in a bowl, then put the ground almonds, oats and fajita seasoning into another bowl. Dip each fi sh fi nger into the beaten egg and then into the almond and oat mix so that they are fully coated, and lay them on the baking tray. Bake for 10 minutes. Warm the taco shells in the oven for a few minutes while the oven is still warm.

4 For the salsa, combine all the ingredients together in a bowl.

5 Lay out the lettuce, salsa, avocado and additional extras.

6 Grab a taco shell and load it up with crispy cod and all your favourite toppings.

Mushroom, tomato, kidney bean + feta stuffed peppers

V – Vegetarian

I - Source of Iron: recipe provides 15% of the daily Reference intake (RI) per serving

P - Source of Protein: at least 12% of the calories come from protein

F - Source of Fibre: recipe provides at least 3g of fibre per 100g or at least 1.5g per 100kcal

This recipe is pretty impressive but it’s actually incredibly easy and super versatile. While this combo works a treat, feel free to make this dish your own; the kidney beans can be swapped out for another bean or chickpeas, or perhaps you could swap the feta out for some halloumi cubes or vegan cheese.

∂ 4 red peppers, halved and deseeded

∂ 3 tbsp extra virgin olive oil

∂ Salt and black pepper

∂ 300g mushrooms (e. g. button, shiitake, portobello), thinly sliced

∂ 1 onion, finely chopped

∂ 3 garlic cloves, crushed

∂ 1 x 400g tin of kidney beans, drained and rinsed

∂ 150g cherry tomatoes, roughly chopped

∂ 100g feta cheese, crumbled

∂ 20g fresh flat-leaf parsley, leaves only, finely chopped

METHOD

1 Preheat the oven to 200°C fan/425°F/ gas mark 7. Line a baking tray with baking parchment.

2 Put the peppers on the lined baking tray and coat with 1 tablespoon of the olive oil. Season well with salt and pepper and place in the oven for 15–20 minutes, or until beginning to soften, but still holding their shape.

3 Meanwhile, put the remaining oil into a pan and set over a medium–high heat. Add the mushrooms and onion and fry for 10 minutes, until the onion is translucent and the mushrooms are golden. Add the garlic and fry for another 2 minutes, until aromatic. Add the kidney beans, tomatoes, feta and most of the parsley. Combine and season to taste with salt and pepper.

4 Remove the peppers from the oven and divide the mixture between them. Return them to the oven for 12–15 minutes, until golden. Scatter over the remaining parsley and serve immediately.

Banana, Flax + Walnut Bread

V – Vegetarian

Serves 8-

One can never have too many banana bread recipes, right? I’ve loaded this one up with walnuts and flaxseeds, which adds a boost of essential omega-3 fatty acids.

220g unsalted butter, at room temperature

150g light brown sugar

4 ripe bananas; peeled, 3 mashed and 1 left whole

1 tsp vanilla extract

3 eggs, beaten

100g walnuts

2 tbsp flaxseeds, plus an extra 2 tsp for the top

150g wholemeal flour

2 tsp baking powder

Preheat the oven to 180°C fan/400°F/gas mark 6. Grease a 20cm x 10cm loaf tin and line with baking parchment.

Beat together the butter and sugar, until light and fluffy, at least 5 minutes. Fold in the mashed bananas, vanilla, eggs, walnuts, flaxseeds, flour and baking powder, until thoroughly combined.

Transfer the mixture to the loaf tin and level the top. Scatter over the remaining 2 teaspoons of flaxseeds and gently pat down so they stick to the surface. Cut the remaining banana in half lengthways, and lay on the surface of the loaf. Bake for 50–60 minutes, until golden and firm and a skewer comes out clean. Cover with foil if the loaf browns too quickly.

Remove and leave to cool for 10 minutes, then turn out onto a wire rack.

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