The Gullible vs The Gulpable: Hydration Myths Meet Quantified Self

I’ve written several times about hydration myths, such as the misguided belief in a dehydration epidemic, the unfounded advice that we all need to drink at least 64 ounces of water a day, and the old wives tale linking coffee to dehydration.

I first wrote about hydration in an ezine I published in the late 90′s, only to find that my message was greeted with an onslaught of hate email. Subscribers, soon to be unsubscribers, told me I’d lost all credibility. They argued the facts I presented about hydration (and dehydration) with anecdotes about how drinking more water cured their migraines, fatigue, stress, constipation, ADHD, obesity, and skin problems. To support their arguments, readers reported that they’d received their hydration counseling from chiropractors, physicians, nutritionists, chiropractors, coaches, trainers, naturopaths, and chiropractors. Who was I to muddy the issue with facts? But every few years, after I recover from the previous episode, I revisit the issue of hydration myths.

Today, it may be more important than ever to review the facts about water-drinking, as several developments are converging in a way that may lead to a rising flood of interest in hydration:

  • New technology — such as a forthcoming app and smartwatch from Apple
  • Unbridled enthusiasm for quantified-self health tracking
  • A groundswell of demand for hydration programs in employee wellness programs.

Okay, here are some facts about hydration, based on what research has shown to date:

  • Odds are, you’re not dehydrated. And you weren’t… even before
    Mindmap: Myths and Facts about Water, Hydration, and Dehydration

    Click for larger version of hydration research mindmap, with references to studies cited.

    you started guzzling all that water.

  • In industrialized nations chronic dehydration is not prevalent in healthy people.
  • Caffeinated beverages, like cola and coffee, do not dehydrate you. In fact, they can help you stay hydrated.
  • Thirst is a good indicator of your need to hydrate. It’s certainly more reliable than the color of your pee.
  • There’s no justification for the general advice to drink at least 64 ounces of water a day.

There are exceptions, like people with chronic diseases or who are acutely ill, people living in arid climates, soldiers on the march, or old folk. As for athletes… don’t get me started. I’ll alienate my running friends in another post. For now, I refer you to The history of Hydration: A lesson in the scientific method and the Hype cycle. from Steve Magness’s magnificent blog, The Science of Running. (And, before you write to me with your anecdotal evidence about how drinking more water has transformed your life, remember a central tenet of this blog is that “anecdotal evidence” is an oxymoron.)

In 2007, Aaron Carroll, MD, shed light on hydration fallacies when, in an article he co-authored in the British Medical Journal, he included foremost in a list of medical myths the belief that people “should drink eight glasses of water a day.” Dr. Carroll revisited the issue recently in his Incidental Economist blog, in response to a new study confirming that moderate consumption of coffee hydrates regular coffee drinkers at a level about the same as drinking water. (My “incidental” endorsement: Dr. Carroll is a compelling policy analyst and inspired communicator. His YouTube channel, “Healthcare Triage,” is must-see viewing for anyone interested in an evidence-based approach to…well…anything.)

In his blog post, Dr. Carroll asked, “Do people still not get the hydration thing?” Clearly, people don’t. Not only do they still not get it, but — judging by the proliferation of quantified self apps that prompt users to track hydration — people “get it” less than ever. Fitbit, the popular activity tracking device, devotes a section of its app to tracking daily water consumption. The default goal? 64 ounces. Indeed, dozens of mobile apps — such as Water Alert, Water Tracker, Water Alarm, and Quench — cater to users’ misguided notions about hydration.

The second most popular habit users are trying to adopt using habit-tracking app Lift? Drinking more water. In its blog, Lift developers pose the question, “How could something so simple be so hard?” Yes, how? Fortunately, Lift has a 21-day plan to help us guzzle up.

This unbridled enthusiasm for hydration tracking is consistent with a steady stream of input we receive from employee wellness participants. They experience our programs for tracking exercise and food consumption — longstanding wellness cornerstones now bolstered by the quantified self movement — and, in great numbers, demand to know why we are not similarly promoting what they have convinced each other is the single most important health behavior …drinking more water. In wellness, we seek to take an evidence-based approach, but we also seek to accommodate what employees say they want. Not just sometimes, but often, what employees want — such as hydration programs — and what evidence shows will actually benefit their health are two different things. Such is the case with hydration programs. And many employers do, I regret to report, offer drink-more-water promotions.

We humans need to consume water, of course. It’s essential for life. But most of us do not need to drink more water. Chronic dehydration is not an epidemic and isn’t a population-health problem for our employees. They get all the water they need, much of it from the water content in their food. It’s popular, but ludicrous, to suggest that drinking more water is as important as physical activity, healthy eating, psychosocial well-being, safety, care-seeking, and being tobacco-free. Most of us do not need to drink more water any more than we need, say, to breathe more air. Our bodies know how much air to breathe…and how much water to consume.

Dried apple

If Apple sets off hydration hysteria, perhaps a dehydrated apple should be its new logo.

In 2014, we have reason to anticipate a surge of interest in quantifying hydration. The latest buzz in technology media is about the next version of the iPad and iPhone operating system, iOS 8, and the iWatch that Apple is expected to launch later this year. iOS 8 will be bundled with a new Healthbook app, and according to rumors, the app will include tracking for blood sugar, heart rate, respiration rate, weight, physical activity, and — you guessed it — hydration.

MobiHealthNews reports that the forthcoming iWatch is rumored to feature hydration sensors, but the m-health website is skeptical. “Sources with inside knowledge of iWatch development have told MobiHealthNews that the device will not include hydration sensing,” they report. “Including a manual hydration tracking feature (how many glasses of water have you had today?) would be a less than impressive Healthbook feature.”

Whether it’s a sensor or manual entry, the very inclusion of hydration-tracking in what is likely to be a revolutionary piece of popular technology will undoubtedly embolden dehydration believers and place ever-increasing grassroots pressure on employee wellness program managers to offer hydration tracking programs. (All bets are off if the iWatch includes a truly valid hydration sensor that reveals to users — once and for all — that they are perfectly well hydrated.) Our best bet is that Apple takes the high road and abandons its plan to drown us in unnecessary tracking. Perhaps Apple will realize that the market doesn’t need a hydration tracker. Everyone already has one. It’s called… thirst.

The risk of adopting employee hydration programs is that we abdicate our responsibility as health educators: We resign ourselves to implicitly endorsing fads rather than delivering evidence-based strategies.

I suspect that the seductiveness of hydration myths is the same as the appeal of many medications, so-called superfoods, and the full array of unproven alternative therapies. It’s tempting to believe that better health and well-being come in the form of a pill, a tea bag, a mystical realignment of energy…or eight glasses of water. It’s all so effortless.

Do Employees Cheat for Wellness Incentives?

Do employee wellness program participants cheat in order to collect incentives?

CC Image courtesy of La Tête Krançien on Flickr

In the shadowy corners of the incentive debate — eclipsed by overstated cases for and against wellness incentives’ capacity to evoke change — lurk equally important tales of intrigue, greed, conspiracy, fraud, and hubris. They are tales that have been told only in bits and pieces, without context, concealing by omission a wellness pitfall of unknown depth.

It was the middle of the 2012 holiday season when many of us first heard about it, in headlines like, Workers Indicted for Defrauding Employer-Sponsored Wellness Program. Upon closer examination, we learned that six Kansas City (Missouri) employees and one from Jackson County were indicted for defrauding the wellness incentive program provided, through their employer, by their health plan. The program awarded gift cards and debit cards to employees who self-reported, on the plan’s website, completion of wellness activities. According to many initial reports, these employees collected $310,960 by falsely claiming they had completed triathlons, marathons, and other strenuous events. But there was more to it than that. Continue reading

My 10 Takeaways from the CoHealth Interview with RAND’s Soeren Mattke

On the Air microphone

If you have any interest in the truth about employee wellness, you must listen to the CoHealth interview with Soeren Mattke conducted by my friends and colleagues, Fran Melmed and Carol Harnett. Dr. Mattke was the lead author of the 2013 RAND Corporation study of employee wellness commissioned by the Department of Labor, and co-author of the PepsiCo disease management and wellness study published in the January issue of Health Affairs. I know it’s hard to find a half hour to listen to stuff on the internet, but you’d be remiss if you passed this up. It’s called “RAND’s Soeren Mattke Discusses: ‘Do Wellness Programs Produce a ROI?’”

I won’t recap the findings of the 2013 RAND study here. But I will say that its findings were wildly and consistently distorted Continue reading

8 Wellness Predictions for 2014 and Beyond

Woman with hula hoop, Folsum Street Fair, San ...

Hula hooping at the Folsum Street Fair, San Francisco. (Photo credit: Wikipedia)

I confess that I’m not much of a prognosticator. In 2008, I predicted that Facebook would go the way of the hula hoop. Little did I know that hula hoops were about to mount a major comeback.

Be that as it may, I recently was asked to share one employee wellness prediction for 2014 and beyond. Instead, I rattled off eight that immediately came to mind:

  1. As critics and advocates squabble over program effectiveness, wellness participants take a seat at the table to assert their primary concern: privacy.
  2. Vendors awaken to their Kodak moment: Those that cling to outdated models of wellness do so at their peril.
  3. Proliferation of dedicated wireless activity trackers decelerates as smartphones (sporting advanced processors) and smart watches elbow their way into the market.
  4. A hush falls over the industry as battle-weary wellness leaders take a pass on promoting their case studies in conference presentations, publications, and award applications.
  5. Stress – the leading health risk driver of wellness strategies globally – emerges front and center in employer wellness efforts in the US.
  6. The meteoric rise in popularity of e-cigarettes – and controversy regarding whether they are a gateway drug or a cessation aid – raises complex new questions about tobacco-free policies and tobacco surcharges.
  7. Employers run for cover under the umbrella of “employee engagement,” only to find that it is far leakier than their wellness umbrella.
  8. New cholesterol and blood pressure management guidelines awaken some employers — if they are paying attention — to the nuances of interpreting biometric screening values.

What are your predictions?

Will Employer Overreach Unite Wellness Critics and Smokers’ Rights Activists?

Clipping of old newspaper add for cigarettes

At Penn State, an impassioned faculty plea for smokers’ rights

At the peak of the Penn State employee wellness controversy, an epic meeting of the faculty senate was held. At last, it was faculty members’ chance to confront and question their oppressors face-to-face. The voice that grabbed the headlines was Prof. Maria Truglio, pressing the university about its health risk appraisal’s intrusive questions regarding women’s pregnancy plans. But perhaps of equal importance were remarks made by Prof. Marc McDill. Like others, McDill objected to the entire wellness program and its ill-conceived requirements. But he stood out from his fellow speakers by also offering an impassioned plea to protect smokers from Continue reading

Are E-Cigarettes the Big Reveal?

Electronic Cigarette Inhalation

As we’ve distracted ourselves throughout 2013 debating the very existence of employee wellness, one of the biggest issues facing employee health has stalked us under the radar: The proliferation of e-cigarette use.

Electronic cigarette manufacturers (which include Big Tobacco companies) claim Continue reading

This Week’s Wellness Files: The Truth Is Out There

Back in the day, I didn’t even know anyone else who’d ever heard of a health risk appraisal, and when I told my parents that I’d taken a job as a worksite wellness coordinator, they accused me of making the whole thing up.

Today, everyone seems to be talking about wellness. And sometimes they’re not talking — they’re yelling.

In the past week or so, there’s been so much wellness talk coming at us, it’s been hard to keep up. Here, I’m providing links to some of the most compelling Continue reading