In this episode of the Intelligent Medicine Podcast, Dr. Ronald Hoffman discusses the importance of hydration with Dr. Dana Cohen Integrative Medical Doctor and co-author of “Fuel Up: Harness the Power of Your Blender and ‘Cheat’ Your Way to Good Health.” They explore the often-overlooked role hydration plays in maintaining health and preventing chronic diseases. Dr. Cohen emphasizes practical strategies to improve hydration through diet and lifestyle changes. They highlight the risks of both dehydration and overhydration, discuss the impact of processed foods, and offer realistic solutions to help listeners incorporate better hydration practices into their lives. Too often doctors are dismissive of pop culture exhortations to pay attention to hydration. Except for those with specific medical conditions, the conventional mantra remains “In ordinary healthy individuals, thirst is a good guide to how much fluid you should consume.” In medicine, we routinely query patients about their diets, their exercise, their sleep, their stress levels, drug, alcohol and tobacco use, their social interactions, their spirituality, even their sexuality. But so seldom do we ask “How’s your hydration?” A recent review found that “Hypohydration is known to reduce mental and physical performance, and more recent evidence suggests hypohydration also impairs vascular function and cardiovascular regulation.” But adequate fluid intake is not merely a matter of optimization; a recent medical study sampling 1200 adults aged 51-70  suggests that it may literally be a matter of life and death: “. . . underhydration was significantly associated with increased prevalence of obesity, high waist circumference, insulin resistance, diabetes, low HDL, hypertension, and metabolic syndrome. Over 3–6 years of follow-up, 33 chronic disease deaths occurred in the sample, representing an estimated 1,084,144 deaths in the U.S. Alongside chronic health conditions, underhydration was a risk factor for an estimated 863,305 deaths. Independent of the chronic health conditions evaluated, underhydration was a risk factor for 128,107 deaths.” How prevalent is underhydration in a sample of American adults? According to the study: “Nationally representative data from the National Health and Nutrition Examination Survey (NHANES) indicate that over 65% of adults aged 51–70 years in the U.S. do not meet hydration criteria.” The episode also touches upon broader health issues, contrasting dietary extremes, and the importance of accessible, enjoyable healthy eating habits.