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The Fullness of Midlife

“If you’re thirsty, you’re already dehydrated.”

by Dr. Barb DePree MD

Dana Cohen with Dr. Barb

Dr. Dana Cohen

Dana Cohen, MD, is an internal and integrative medicine specialist and author of Quench: Beat Fatigue, Drop Weight, and Heal Your Body through the New Science of Optimum Hydration. Cohen believes that medicine is an art and that a patient-centered, holistic approach is critical to overall health and wellness. By working with patients on diet and lifestyle and using nutritional supplements, she helps them reduce their use of prescription medications.

A graduate of St. George’s University School of Medicine, Cohen completed an internal medicine residency at Albany Medical Center. She served on the Board of Directors of the American College for the Advancement of Medicine (ACAM), the leading voice of integrative medicine for health care providers.Through ACAM, she also developed an integrative medicine boot camp for practitioners. Cohen trained under the late Dr. Robert Atkins, author of Dr. Atkins’ New Diet Revolution, and Dr. Ronald L. Hoffman, a pioneer of integrative medicine. She was also co-host for “Healthy for Good,” a radio show that aired in New York City, and “New Vitality Live,” a nationally syndicated show on WOR Radio Network.


Dr. Barb: Today we’re talking with Dr. Dana Cohen, an internal and integrative medicine specialist, who trained under Dr. Robert Atkins. She believes medicine is art as well as science and uses a variety of conventional and complementary therapies to help patients get and stay healthy. In some cases she’s able to help them reduce their prescription medications. Dana is also the author of Quench: Beat Fatigue, Drop Weight and Heal Your Body through the New Science of Optimum Hydration.  Welcome Dana!

Dana: Hi, thank you for having me.

Dr. Barb: Thanks for joining me today. Just to start, I wonder if you could you further describe for our listeners the approach of integrated medicine and how that might be a bit different from the traditional approach to medicine we’re mostly familiar with.

Dana: Yes, I would love to. Integrative medicine is, basically, we incorporate the best of holistic medicine with allopathic—or regular medicine. But, my theory and my philosophy is to try to keep people off of medications, using nutrition, lifestyle, supplementation, whatever it may take, really. I pride myself on my list of referrals for the best acupuncturist and bodyworkers and energy healers, whatever it takes. And it’s looking at the person as a whole, really looking at each system in your body and trying to look for root cause of disease, as opposed to just putting a bandaid on it by just prescribing another kind of medication, that kind of thing.

Dr. Barb: When did you decide to integrate that approach to practicing medicine? Was it pretty early or was it something you discovered after being in practice for some time?

Dana: Yeah, I’m very fortunate that right as I was finishing up residency in internal medicine, I was at Albany Medical Center; as I was finishing up, I happened to see an ad for a world-renowned wellness center looking for a doctor in New York City. And I was thinking wow, that sounds really cool, I thought it was going to be some kind of spa [laughs] something like that. And I remember calling it and it was for Dr. Atkins, it was for Atkins of the Atkins Diet, and I happened to be on the diet at the time, feeling amazing, never felt better, having so much energy. And I was curious; I went on the interview, and I got the job, and he changed the way I thought about medicine. And I fought him, I fought him that whole first year, I fought him on everything. What are you doing? Where are the studies? And I saw, literally, miracles on a daily basis, people just changing their diet, and it improving their lives just so dramatically in such a short period of time that I was convinced and I never looked back.

Dr. Barb: Wow, fascinating story. So, why do you think traditional medicine has been somewhat resistant to incorporating more whole-wellness approaches to health?

Dana: I mean... you know... I think it’s scary, number one. It’s scary. When I first started talking about this, it’s really deep biochemistry; you’re looking at nutrition and vitamins and the biochemistry of it, things that we never learned in medical school. It is a whole new paradigm of thinking. Number one, I graduated and was $200,000 in debt to begin with. If I had to go and then spend another twenty-five, thirty thousand dollars to learn another type of medicine—and it is, it’s a whole new way of thinking—it’s terrifying. First of all, who has the time? So that, I think is a big thing. But, I will tell you from twenty years ago to today, it’s changed dramatically. I speak to doctors now, I’ll always call a patient’s primary care doctor or their doctor, to sort of touch base, tell them what we’re doing, and I got a lot of push-back twenty years ago. I don’t get the same push-back I got back then. Doctors are generally interested and saying, oh, that’s so great; where can I learn this? And I’m hearing it time and time again. I think it’s changing, I think it has to change, patients are demanding it. But, it’s a lot. Doctors are already overburdened and overworked and to then have to learn a completely new way of thinking is not fun or easy.

Dr. Barb: Well, I’m heartened to hear that you feel that your approach to treating people has become more acceptable. I’m not surprised, but I’m glad that that’s the sense, and I assume that it will continue to be more and more mainstream. How do most patients find you? Are they referred into your practice or do they self-refer?

Dana: Both, I have people that—I have a lot of doctors that refer to me, I have a lot of, like I said, body workers, acupuncturists, chiropractors, they refer to me, and then patients Google. They are looking for different ways of treating themselves, and they’re actively searching it out, so I get it from all ways.

Dr. Barb: Let’s talk now about your new book. It’s called Quench; it’s all about hydration.

Dana: Yes.

Dr. Barb: Why did you decide that this was a topic that needed its own book?

Dana: This is a fun story, I—like I said, I’ve been practicing for twenty years, and I worked for Bob Atkins. I worked for some really big holistic doctors, too, I’m very very proud of my mentors in my life. I worked for Dr. Ronald Hoffman, Glenn Rothfeld, Michael Schackter—these are all truly pioneers in the field, and I’ve always known I had to write my book. I could never figure out what I wanted that book to be on. I didn’t want to write another book on hormones or thyroid, I didn’t know how to write that, meaning you have to go to the doctor and you have to have blood tests, and then they write you a prescription. I know there’s a lot more than that, but I couldn’t find the words to write that, I didn’t know how to say those kind of things, and I definitely didn’t want to write another diet book.

So I got a call from my co-author, Gina Bria, who asked if she could come and talk to me about the research that she had done (she’s an anthropologist) in the work she had done about how desert people hydrate. And I was thinking at the time, well, that’s interesting: She’s going to talk to me about some kind of alkalinized water filter product that she wants to sell me. And the truth is, I was thinking, well, I do need to know about these things, so I said sure, come on in. So she came in and basically just wanted to relay information and the information was about this new form of water that’s been discovered and it’s a new phase of water. We know that water exists as liquid, ice, and vapor, but now we also know that water—there’s a fourth phase of water and it’s gel water or structured water, and she was telling me about the research that Dr. Gerald Pollack did at the University of Washington in Seattle.

She blew my mind, and I'm listening to her and meanwhile, here’s somebody who—I always ask my patients, “Do you think you’re hydrated enough?” “Do you drink enough water?” It’s one of my top questions I ask in my history, and I’ve always known the importance of hydrations and I looked at her and said, “Oh my God, Gina, this is so interesting, this is right up my alley. Do you want to write the book on this?” and she said yes.

The most important first step is making sure you know how to hydrate effectively.And that was how it started; that was about three-and-a-half years ago, and then we really delved into the research on hydration and water and structured water, and it’s been mind-blowing. First of all, I had no idea how complicated water was, you know; we think it’s the simplest molecule in the world—it turns out it’s not. And then three-and-a-half years later we’re really helping people by making sure that they are optimally hydrated. It is the first step in treating and preventing any kind of chronic illness, you have to make sure it’s up there—obviously with sleep and shelter and food, nutrition—is hydration. For me, what I’ve really learned, is this is the most important first step you need to take before embarking on any kind of diet, nutrition program, you need to make sure and how to hydrate properly and effectively, and it’s not hard to do.

Dr. Barb: I saw nice coverage of this topic, which quoted you in the book on in a recent Oprah article...

Dana: Yes

Dr. Barb: … which did a really nice job of giving an overview and talking about this concept of gel water and H302, I think is how it was referenced.

Dana: Yes, the gel water, this is based on Dr. Pollack’s work, H302, when water, these simple H20 molecules, water molecules, when they structure or they get together or they layer upon each other, which is how they are, they form this other phase of water. We need minerals, we need UV light, there’s other things we need to make sure this happens, but when that happens it forms this new kind of structure, called H302, and that allows more energy from the water, so you’re getting extra ions to be able to be used for energy. And therefore, water is actually fuel, it’s not just hydration, it’s literally fuel in our body; it gives us energy.

Dr. Barb: And you talk about how the water does the body good and list a number of conditions that typically we wouldn’t associate with hydration. Can you cover a couple of those?

The first sign of low-grade dehydration is fatigue and brain fog.Dana: Sure. The first, the simple things that everyone thinks we know about are: headaches, fatigue. In fact, I think the first sign of this low-grade dehydration is fatigue and brain fog. I think if we reached instead of for that candy bar in the afternoon, because we think our blood sugar is dropping, we need to try hydrating properly first. And most often it’s that, rather than a drop in blood sugar. So, fatigue, headaches, constipation, chronic constipation, fibromyalgia. And these are things that, I think, we instinctively know that dehydration causes or I think we’ve all learned that already, but I think some of the interesting things (and we make a really good point about them in the book and show the research to back them up) but certain cancers—this low-grade dehydration puts you at risk for certain cancers, specifically bladder cancer and colon cancer. And then even more interesting is that this low-grade chronic dehydration is a risk factor for Type II Diabetes and Alzheimer's Disease. By becoming properly hydrated, effectively hydrating yourselfs at a cellular level, we could prevent Type II Diabetes and Alzheimer's.

Dr. Barb: Fascinating. So, let’s talk now about the approach to proper hydration. How do you talk patients through considering, I’m assuming, thirst has very little to do with it.

If you're thirsty, you're already dehydrated.Dana: Well, I say if you’re thirsty you’re already long gone, you’re already overtly dehydrated. Plus, thirst is not the best way to look at it. We learn to override our thirst, we learn to ignore our thirst, because a lot of us don’t want to get up and go to the bathroom [laughs]. Which, by the way, we’re meant to, we’re meant to urinate every two or three hours. So, and I know, there are days I’ll be at work for ten hours and not have peed all day: That’s a problem. We’re literally meant to pee every two or three hours.

A good way to look at whether or not we’re hydrating perfectly is to look at the color of our urine. We want our urine to be a pale yellow or straw-colored urine. You don’t want it to be too orange or too yellow, that tells me it’s concentrated, so a pale yellow, you want it to be a nice pale yellow. One caveat to that, if you take B vitamins, that can falsely color your urine, so don’t use that test at home. If you take B vitamins, it doesn’t count. So those are a few, a few ways to sort of think. The other thing I talked about just earlier, for us, the first sign of this low-grade dehydration is brain fog and fatigue, and if you’re feeling that throughout the day and you can’t understand why, try getting hydrated better.

Dr. Barb: And are there any general rules of volumes of fluids, the eight glasses, eight ounces for adult individuals? I assume there are so many variations to activity and size and so on that probably make that vast an overstatement.

Dana: Yes, you’re very correct. The eight glasses a day of water, it doesn’t make sense, it doesn't fit. We’re all different body sizes, we’re all different shapes, we all do different activities, we sweat differently, we eat differently, we live in different environments. By the way, the environment is a factor that I think is important to talk about. One of the reasons why we are so chronically dehydrated is our environments. You know we live in these air-conditioned or heated environments, don’t get hardly any UV sunlight or fresh air, we’re eating all this processed food, we’re taking medications that are dehydrating us. And, by the way, I’m not talking about medications that are known to dehydrate us, like diuretics, I’m talking about everyday medications, things like even the purple pills, or Prilosec have been shown to dehydrate people. So we’re all kind of in this low-grade chronic dehydration—is playing a huge role on us. And now I forgot the question, I’m sorry I went off [laughs].

Dr. Barb: Just wondering if there are any standards by which we can understand how much fluid intake we should have.

If you need a rule, drink half your weight in ounces of water.Dana: Oh, yes, sorry. So the eight glasses a day doesn’t make sense. If you had—basically what the book Quench tells us to do, what it really teaches us, is as an individual, what is your optimal hydration—and it does have to be individual. You have to feel it for yourself to know when you are perfectly, optimally hydrated. But, if you need a number, I think a better rule of thumb is if you drink half your weight in ounces of water. It still is not the perfect thing, because we’re not taking into account eating more hydrating foods or drinking more hydrating beverages. So one of the things in the book, we talk about smoothies. We talk about a green smoothie which is basically macerated or blended vegetables with possibly a little bit of fruit if you want, but there’s water added to it and then the vegetables are providing fiber, it’s providing greens, it’s providing minerals that helps structure that water. So those smoothies, and I don’t have an exact number, and I’d like to say and I mean we’ve proven this, we can’t say, but if you try for yourself you will see, drinking a green smoothie is most likely as hydrating as drinking three glasses of water.  It’s much more effective at getting that hydration into your cells—intracellularly where we need it.

Dr. Barb: And then one of your statements you talked about, you could have two glasses of water or a glass of water and an apple and the glass of water plus apple would be more hydrating for you than two glasses of water. So, somehow this source of food as water sounds like a better approach to trying to be properly hydrated.

Food is a source of hydration.Dana: It’s everything, yes, exactly. We’ve forgotten that food is a source of hydration and that is the whole gist of the book: how to get better at properly hydrating by eating your water [laughs] as opposed to ever drinking more water. We can’t, we can’t sustain it, and I know. If you just try this little experiment, which I did. I went to Las Vegas on a conference once, and I sat in that lecture hall in that air-conditioned environment, literally in the desert, sitting all day. And there was a pitcher of water in front of me that they kept refilling all day, and I said, “I’m going to hydrate really, really well today.” And I kept drinking more and more and more water all day, and after every lecture I’d get up and go to the bathroom. By the end of the day my pee was crystal clear—there was no color to it—and I was exhausted and nothing happened and I was still exhausted and thirsty and tired. And when I did it differently, another time where I said I’m going to hydrate differently by, I’m going to drink some smoothies, I’m going to try to get some structured water into my diet that day, and it was a completely different ball game. I felt energized, I was thinking clearly by the end of the day, I was ready to go out to dinner. So you know, it’s a very different thing than drinking more and more water.

Dr. Barb: So the primary source of structured water, as you say, in addition to smoothies, would be generally fruits and vegetables?

Dana: Well, that is the most—that’s some of what we know right now. So we know that some of the water inside fruits and vegetables is structured water; it’s in a different form, and that’s the same type of water that’s inside our cells. And they’re coming up every day with how to make structured water, and there’s now also new ways of testing for it, that you can actually test for structured water, I know that Dr Pollack is doing outside of the University of Washington in Seattle. So, there are always tests for it, but the thing that we know is, yes, fruits and vegetables are a great, fantastic source for structured water.

Dr. Barb: What can you say about the intersection between movement and hydration?

Dana: Great question. So, movement is the second part of the equation of hydration, or hydrating optimally. A few years ago there was a French scientist, I think either a hand surgeon or a plastic surgeon, who decided to put a microscopic camera under the skin of a living person, to look specifically at fascia. Fascia is that connective tissue that envelopes every organ, every cell in our body. And prior to him doing this it had only ever been studied on dried, desiccated cadavers, so we had no idea how fascia worked, and when we look at the video of what he showed us, and quite interesting, is that fascia acts as a hydraulic pump for fluid. Which is a very fascinating thing to see, because we’ve always thought that fluid only gets moved via blood and lymph. And now we know that the fascia is a whole new delivery system.

Fascia basically, literally, works as a hydraulic pump. When we move our head or neck up and down saying yes—bobbing our head up and down—that’s getting fluid in and out of our brain. So when we’re sitting all day, we’re actually squelching the delivery of fluid to our peripheral cells. And nobody has ever thought about that before. Although, once again, it is instinctual, we’ve always been told you’ve got to move your joints to lubricate them. Now we really understand, it’s fascia, it’s not so much blood and lymph—well it is blood and lymph too—but fascia plays a huge role in hydration.

Dr. Barb: Fascinating.

Dana: Yep. And in the book we give you easy recipes for micro-movements. It doesn’t replace exercise, but at the very least we should be doing, like as soon as we wake in the morning—very simple, and anyone can do them—micro movements that are simple and make a huge difference in moving that fluid around and getting your body going in the morning.

Dr. Barb: You have a very specific five-day program. Would you describe a day in the life for optimal hydration?

Dana: Yes, easy. The five-day program, we laid it out because, number one, it’s easy, you could do it during your work week. And you will know by the end of that week what your point of optimal hydration is. And you’re going to feel a difference in a very short period of time.

Front-load your water with sixteen ounces first thing in the morning.So you want to wake up in the morning, you’re going to want to front-load your water—this is how desert people operate, by the way. You’re going to want to start with about sixteen ounces; put a little pinch of sea salt in there, because you’re getting those minerals and electrolytes that we need. Sea salt is different, by the way, than regular table salt; you want a good natural sea salt that has that whole spectrum of minerals that we need. I also squeeze a little lemon or lime in there. So, sixteen ounces first thing in the morning.

You want to do a few simple micromovements before you even get your head off that pillow. You want to wake up, you want to make a morning smoothie—and we give you over fifty different recipes; we give you recipes for winter, for summer, for the different weather. And then you can do another smoothie later in the day. This is for the five-day plan: You’re going to see if that works for you. I’ll typically go in and out of doing two in a day, but if I get one in a day for my patient, I’m really happy.

A glass of water before a meal has been shown to help with weight loss.And then we lay out some very simple eating guidelines: lower sugar, lower glycemic, real food. We give you some natural recipes for soups and some foods; you want to get good healthy fats in your diet. And then certain key places where you should have some extra water throughout the day. We do recommend a glass of water before every meal, about a half an hour or just before a meal—that’s been shown to help with weight loss. But there are people who always worry, well, is that going to take away from my digestive enzymes when I eat my food? No, it’s not, it’s when you start to chew that food that your body begins to release those digestive enzymes, so you’ll be fine. So that’s the basic basis of the Quench plan.

Dr. Barb: So my practice focuses primarily around midlife women, perimenopausal and menopausal women, their health. And a number of the symptoms that you mentioned are probably more likely to occur for women transitioning through menopause: weight gain, brain fog, general joint pain, etc. Do you know of any unique physiology that goes on at the perimenopausal or menopausal time that might put women more at additional risk for those symptoms?

Dana: Good question. You know, it is, it’s probably about 95 percent of my practice is that group right there [laughs]. And I will tell you, it’s hard, it’s a really hard time; you’re chasing, sort of, hormones and symptoms. I can’t think off the top of my head any unique physiology, except that your hormones really are all over the place, and, literally, they can change in an hour. You’re getting this really acute drop of hormones in such a short period of time—as opposed to men whose testosterone drops much more slowly over time, and our hormones are all over the place. I think that probably plays the biggest role. I’m not sure anyone really knows the answer to that though.

Dr. Barb: Well it’s good news to hear that there may be a solution for women that includes something that’s available to each of us every day. So this will be a great added recommendation to patients.

Dana: Thank you. I think it’s simple, and I tell people this, too: It really is the first place you should start before doing any other kind of plan, including, whether it be a ketogenic diet or a vegan diet. This is the first step you need to take in how to hydrate properly, and then by all means do whatever you’re going to do to go from there. But, until you know what it feels like to be perfectly and properly hydrated, nothing else is really going to work. And especially if you are doing a ketogenic diet, I don’t know if you talk a lot about that on your program, but that is, in and of itself, a very dehydrating, it has a very powerful diuretic effect, so we need to know how to hydrate properly, especially, specifically on that plan.

Dr. Barb: Well, thanks so much for sharing this important information. In close today, are you willing to share with our listeners where you find richness at this stage of your life?

Dana: Yes, you know, I think it’s funny. I often go—it’s interesting. I wasn’t expecting this question, but the first place I go to is the richness I find in helping others. It really is everything that I do and every aspect of my life, it’s what I live for, it’s what I do. Which, the reason I say, ironically, because I’m not sure at this age, it’s put ourselves first in so many ways. And, by the way, I am in menopause this is where I am, and I think that we need to find our passion and… I’m collecting many of my patients and women's’ stories who are over fifty who are making changes in this world and putting themselves out there, more so, I think, than we ever have in the past. And it’s so fun and interesting and exciting for me to see and hopefully be a part of it.

Dr. Barb: Well, thanks, and I appreciate your enthusiasm in sharing that, because I feel like I’m where you are, as well—with you where I am at this time in my practice. And again, the balance of work and self-care is a fine balance, but when you love what you do, it’s easy to find that is your passion as well.

Dana: Yeah. Thank you for having me, I so appreciate it.


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