In a typical presidential election year, voters might wonder how the candidates’ views stack up on issues such as abortion, tax cuts, gun rights and immigration policy.

But this year, as a 78-year-old Republican Party nominee campaigned to replace an 81-year-old Democratic incumbent, a different question rose to the forefront of many voters’ minds: What’s in their medical files?

That issue eclipsed all others after President Biden’s blundering performance in last month’s debate against Donald Trump, triggering widespread concern about Biden’s physical and cognitive health. It became even more salient after Trump sustained a gunshot wound to his ear and Biden came down with COVID-19.

When Biden withdrew from the presidential race Sunday, House Speaker Mike Johnson (R-La.) kept the health question alive by calling on the commander in chief to resign.

“If Joe Biden is not fit to run for President, he is not fit to serve as President,” Johnson wrote on the social media platform X.

Biden’s doctors have denied speculation that the president is being treated for Parkinson’s disease or another neurological disorder. Meanwhile, Trump’s campaign has released limited information about the former president’s condition after he was grazed by a rifle round.

Is the public entitled to know more than either man has willingly disclosed?

“In the ideal world, it would be great if there were full transparency,” said Dr. Robert Klitzman, a psychiatrist and bioethicist at Columbia University. But no patient — not even a president — should be forced to share medical information they’d rather keep between themselves and their doctor, he and other experts said.

The reason is simple: A successful relationship between a doctor and patient relies on trust, and that includes trusting a doctor to not share information that might be considered embarrassing, unflattering or stigmatizing.

“To be able to help a patient as much as possible, we need the whole story,” Klitzman said. “We need to know if the patient is depressed, if the patient can’t pee, if the patient’s in pain, if the patient is forgetting things. We need that information to make an accurate diagnosis and figure out the best treatment to help.”

Without the assurance of confidentiality, a president might well decide he’s better off steering clear of doctors altogether, said George Annas, a professor of health law, bioethics and human rights at Boston University.

“You want him to have access to whatever treatment there is, and he ain’t going to get it if he’s not going to get tested,” Annas said. “That’s why we keep this stuff confidential, and why it makes perfect sense to do it even though everything in you screams, ‘I want to know what’s the matter with him.’”

The principle of doctor-patient confidentiality goes back to ancient Greece and is enshrined in the Hippocratic oath: “Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.”

About 2,400 years later, the notion that a patient’s medical information should remain private was codified into federal law as part of the Health Insurance Portability and Accountability Act of 1996, better known as HIPAA.

There are limited circumstances where doctors have a duty to disclose a certain amount of information about their patients.

For example, if a patient presents a danger to himself or others, a doctor has a duty to warn law enforcement or potential victims of the threat, said Dr. Bandy X. Lee, a forensic psychiatrist and educator in Harvard Medical School’s program on psychiatry and the law.

If a patient has a reportable sexually transmitted infection such as syphilis or HIV, that diagnosis must be shared with a public health department, along with the names of the patient’s past partners so they can be informed and get tested, Klitzman said.

And if doctors notice a spike in cancer cases among people clustered in a geographic area, that too is passed along for public health officials to investigate.

Beyond cases such as these, the consensus fades, Annas said.

Congress could try to carve out an exception to HIPAA and require presidents and presidential candidates to release their medical records to the public. But in the unlikely event that the law were to change, it’s unclear whether it would survive a challenge in court, said Bert A. Rockman, a professor emeritus of political science at Purdue University who specializes in the American presidency.

“It raises a lot of questions to which we don’t know the answers,” he said.

Besides, forcing sitting and would-be presidents to waive their right to doctor-patient confidentiality wouldn’t guarantee that voters learn the truth, Rockman said. A president could simply shop around for a doctor willing to obfuscate in a medical report, for instance.

“There are always going to be ways to get a work-around,” he said.

Even if a president is forthcoming, knowing their diagnosis wouldn’t necessarily tell you much about their ability to function. A White House occupant could have a mild case of Parkinson’s but be able to carry out the job just fine with proper treatment, Klitzman said.

Voters should also keep in mind that there’s a difference between the president and the presidency, Rockman said.

“The presidency can work even if the president is diminished,” he said. “In all likelihood, unless the president is completely out to lunch for some reason or another, either physically or mentally, the office itself functions.”

Indeed, U.S. history is rife with examples of presidents concealing serious medical problems from the public.

John F. Kennedy was taking narcotic painkillers, amphetamines and steroids to treat his Addison’s disease and other ailments while trying to avert a nuclear crisis with the Soviet Union in the early 1960s.

Grover Cleveland said he was going on a four-day fishing trip when he boarded a yacht in 1893 to have a malignant tumor — along with part of his jaw and five teeth — surgically removed from the roof of his mouth.

Woodrow Wilson suffered a stroke in 1919 that left him partially paralyzed, bedridden and unable to feed himself for the remainder of his presidency. When pressed for details about Wilson’s condition, his doctor said “the President’s mind is not only clear but very active.”

It’s not OK to lie to preserve a patient’s privacy, Klitzman said, but that doesn’t necessarily mean a doctor must reveal “the truth, the whole truth, and nothing but the truth.”

“You can say, ‘The President’s not feeling well today,’ or you can say, ‘The President has COVID,’” he said. “You want people to trust the government, and if people feel the government is lying all the time and we can’t trust anything they say, that’s not good.”

The young whale was seen off Southern California, struggling, its tail flukes dangerously entangled in rope. The animal may have been injured for as long as half a year.

After a week of tracking and near-misses, a crew from the National Oceanic and Atmospheric Administration freed the juvenile humpback whale Friday.

On July 13, a whale-watching boat encountered the rope-snarled animal and reported it to NOAA. For the next week, crews from its large whale entanglement response network made near-daily excursions to find the injured whale, said Justin Viezbicke, the agency’s California marine mammal response stranding coordinator.

On July 15, the team spotted the whale off Dana Point, but the weather turned bad before they could attempt to free it. The next day they found the animal in the same area, but nearby jet skiers accidentally scared it away before rescuers could get close enough to help.

It was seen near Newport Beach on Wednesday and Thursday, then returned to Dana Point on Friday. The rescue attempt was on.

For several hours, the NOAA boat traveled alongside the animal as it surfaced for air and dove back into the sea. The mammal was about 30 feet long, with rope from fishing equipment wrapped tightly around both tail flukes.

“Being in the right place at the right time was very difficult,” Viezbicke said. “This whale was super skittish and wasn’t comfortable with us being around it.”

At last the crew got close enough to cut through the rope. For the next 60 to 90 minutes, the whale swam, dove and slapped its tail against the water in an effort to dislodge the remaining equipment, Viezbicke said. Once it had, it slipped back into the water and swam off. Whale-watching boats in Orange County have spotted it swimming in the days since.

Though the rope is gone, there is still concern for the animal’s future. NOAA estimated that the mammal had been entangled in the fishing line for at least three to six months, causing “some serious damage” to the flukes, Viezbicke said. It also appeared to have a significant amount of whale lice, which is often an indicator of poor health.

“We are hopeful that with the gear off it will make a full recovery,” he said.

Instances of humpback whale entanglements with fishing gear have climbed sharply in the last decade, thanks to a chain of events sparked by warming seas.

From 2014 to 2016, a Pacific Ocean heat wave forced anchovies and other humpback prey closer to shore and into the path of Dungeness crab fishing equipment. The same heat wave also delayed the crab fishing season to a time that coincided with the whales’ migration season.

Statewide, NOAA typically receives 15 to 20 reports per year of whales trapped in fishing lines or other human-made debris in the ocean, Viezbicke said. Yet such reports are likely only a small percentage of total cases.

“Unfortunately, most whale entanglements go undetected,” said Ashley Blacow-Draeger, Pacific policy and communications manager for Washington, D.C.-based nonprofit Oceana. Researchers who have tracked observation of entanglement scars on whales estimate that only 5% to 10% of such incidents are recorded.

Oceana has been working with fisheries to test ropeless fishing gear that vastly reduces the risk of wildlife entanglement, Blacow-Draeger said. California issued experimental permits for the pop-up, ropeless equipment in 2023, and permitted fishermen started selling crabs caught with the new gear that season.

Oceana is pressing for the state to authorize widespread commercial use of the whale-safe equipment by spring 2025, Blacow-Draeger said.

You see them crowding checkout counters at grocery stores — a rainbow of bubble-gum pink, lime green and blueberry packets, slender and upright, like a multicolored chorus line of dancers tempting an impulse purchase. At the gym, they’re dissolved into enormous jugs of cherry-tinted water.

They’re especially prevalent on TikTok. Just search #watertok for a flood of #watergirlies, clutching Stanley tumblers at their #waterstations, which are crammed with neon-bright hydration powders and flavored syrups. #Wateroftheday? How about Strawberry Birthday Cake Water. Or Caramel Apple Sucker Water.

In L.A., water rules everything around us. Drink up, cool off and dive into our stories about hydrating and recreating in the city.

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“If your water isn’t turning your mouth blue, you’re apparently hydrating wrong,” one skeptical dietitian observed on TikTok last year.

Hydration supplements in the form of powders, tablets and liquid additives have become a norm among consumers over the last decade, and are more popular than ever. The global electrolyte hydration drinks market was valued at $1.72 billion in 2023, according to Data Bridge Market Research. And it’s growing. The business of boosting one’s H2O is projected to reach $3.26 billion by 2031.

Hydration supplements are sold at most major grocery stores around L.A. The market for these powders has grown in recent years.

Why hydration is important

This bonanza of new hydration products plays to a basic but critical need: More than 50% of people around the globe, including in the U.S., are chronically underhydrated, according to the National Institutes of Health, which cites worldwide surveys. (“Underhydration” refers to people who don’t meet the recommended daily fluid intake, whereas “dehydration” refers to a more severe fluid deficit.)

Those statistics are concerning, considering hydration is the oil to our body’s engine. It aids in muscle repair, digestion, energy and focus. It’s necessary for lubricating joints, regulating body temperature and removing toxins from the body. It carries nutrients to cells and is crucial for hormonal balance, which can affect blood pressure and the menstrual cycle. Our level of hydration also contributes to our hair and skin health.

“Proper hydration keeps every system of the body running smoothly,” says dietitian-nutritionist Vanessa King, a spokesperson for the Academy of Nutrition and Dietetics.

After years of striving to adhere to a 1945 U.S. Food and Nutrition Board recommendation of eight glasses of water a day, it tracks that we’d want to zhuzh up the ritual. (Some studies, however, suggest we need less water daily and that water requirements vary for individuals.) But is there any actual health value to these water additives? Do they aid with hangovers, enhance our workouts or energize us? Or are they simply there to make plain old water taste like a piña colada?

It depends on what product you’re peppering into your Hydro Flask.

“Hydration supplements can replenish you when your fluid status is down — so after workouts, for hangovers or when you’ve been sick,” says Dr. Vijaya Surampudi, an endocrinologist, nutrition specialist and professor at UCLA. “Depending on their composition, some get better absorbed and improve your hydration. Some are just for flavoring and they can have a lot of sugar or artificial coloring — it can be like drinking a soda.”

Hydration supplements can help replenish your body’s fluid status after workouts, colds or when you’re hungover, according to UCLA professor Dr. Vijaya Surampudi.

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She notes that because these powders and tablets are categorized as supplements, they aren’t regulated by the U.S. Food and Drug Administration. “So you just have to trust what’s on the label.” (To fill this gap in regulation, some sleuthing social media users have even carved out a niche content genre in which they analyze the ingredients listed on the labels of celebrity-backed supplements.)

What’s in hydration supplements?

More often than not, a hydration powder or tablet includes a mix of four main ingredients: electrolytes (such as sodium, potassium, magnesium and chloride), a carbohydrate (such as glucose), vitamins (typically B vitamins, sometimes C) and amino acids. Depending on their quantity, and how they interact with one another, those ingredients may help hydrate your body more efficiently.

How these ingredients chemically interact with one another directly affects hydration. Water follows sodium for absorption, for example, and sodium molecules travel best with glucose molecules across the lining of the gastrointestinal tract, Surampudi says, so carbohydrates like sugar are not a bad thing in your supplements — they’re actually preferred.

Even so, it’s a delicate balance. A supplement with too much sugar may work against your aim to be healthier.

“The body stores excess sugar for energy later, and that’s stored as fat,” Surampudi says. “And if you drink too much [sugary fluids], that can lead to health complications.”

While sugar and sodium help fuel hydration, those with diabetes or high blood pressure should be careful with hydration supplements, paying attention to their sugar or salt intake.

“Use it with caution and discuss with your healthcare provider,” Surampudi says.

Do we need them?

Hydration supplements aren’t unsafe for most people to take daily if the sugar content is moderate — but they’re often not necessary, says Dr. Christopher Duggan, editor of the American Journal of Clinical Nutrition and a Harvard Medical School professor.

Most adults and children don’t meet daily hydration recommendations, he says, which is currently 13 eight-ounce cups of fluid for healthy men and nine for healthy women, according to the National Academy of Medicine. (Note this recommendation includes all fluids, not just water. And we tend to get 20% of our water intake from food.)

“So if adding a light flavoring gets them to drink more water, that’s probably not a terrible thing,” Duggan said. “But if the expense is high, it’s ultimately not worthwhile. Because unless you’re participating in vigorous exercise or your GI tract doesn’t work normally, water alone is probably an adequate hydration.”

Some hydration supplements even contain ingredients that are not hydrating when consumed in large quantities, such as caffeine. Though caffeine is a diuretic, consuming up to 400 mg of it daily can actually help with hydration, according to the Academy of Nutrition and Dietetics’ King. Other flavored powders contain various B vitamins, which may cause problems in excess.

“B6, if you consume too much of it because you’re getting it elsewhere, there’s a risk for some people of neuropathy, which means damage to the peripheral nerves (which are outside of the brain and spinal cord), and which can cause numbness and tingling, among other things,” Surampudi said.

Surampudi recommends consuming hydration supplements only in moments when your body is especially challenged.

“If there’s a situation where you’re fluid down, or in a high altitude or in an extremely hot climate, that’s where these things can be helpful,” she said.

How 8 top hydration supplement brands perform

So take your hydration boosters with a healthy dose of skepticism. Here’s an analysis of eight hydration supplements — the good, the bad and the meh — according to L.A.-based dietitian Katie Chapmon.

Liquid I.V.’s Hydration Multiplier.

(Rebecca Peloquin / For The Times)

Liquid I.V.’s Hydration Multiplier. “I would not have someone choose this to use every day because the added sugar is really too much — it’s the first and second listed ingredients. The other thing is: They boast, on their website, that the hydration multiplier has ‘3x the electrolytes of the leading sports drink.’ And that may be wonderful for someone who is doing very high-impact sports or who would require serious electrolytes replacement, but it’s not for the average person. Electrolytes balance out our cells, but if we have too much it throws off that balance and our cells can actually become oversaturated; it can make it harder for that cell to work and to get hydrated. This is why a more moderate amount of electrolytes may be a better option for athletes and heavy sweaters.”

Nuun Sport Hydration.

(Rebecca Peloquin / For The Times)

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Nuun Sport Hydration. “This one has a lower amount of added sugar. It might be for someone who wants to flavor their water — which, alone, would help increase fluid intake and therefore their hydration. It has electrolytes — your sodium, magnesium, potassium, chloride — but I would not have someone use this from a serious athletic standpoint because athletes need to not only replenish electrolytes lost but also sugars lost through expelling energy through exercise. Would it help hydrate cells? Sure, a little bit. But most people will end up drinking this because they like the flavors — and a lot of people like Nuun’s flavors.”

Cure Hydrating Electrolyte Drink Mix. “I like this one as a water flavoring — out of all of them, it was one of my favorites for that. But it’s not a true electrolyte blend. It includes sodium and Himalayan salt. But there’s no chloride and magnesium. This would not be a recommendation for gym-goers or athletes as it doesn’t contain any sugars, which are needed for adequate electrolyte and energy replenishment. It’s just a water flavoring because it contains lower amounts of sodium and potassium than other hydration alternatives. The ingredients are straightforward and clean — it has no added sugar, which is great — but it’s not in the same boat as an electrolyte product, even though it’s advertised as that.”

MIO Strawberry Watermelon Liquid Water Enhancer and MIO Sport Electrolytes + B Vitamins.

(Rebecca Peloquin / For The Times)

MIO Strawberry Watermelon Liquid Water Enhancer and MIO Sport Electrolytes + B Vitamins. “Out of all of these, MIO is probably one of my least favorites. The first is just a water flavoring, but all these additives — like sucrose acetate and Red 40 — they’re not good for you. Red 40 is a synthetic food dye. It’s considered safe, but a lot of people can have allergies causing headaches. It’s safe but not as good as Cure, which uses a natural additive like beet powder for color. Mio Sport uses Blue 1 for coloring, also a synthetic dye. It does contain B vitamins — B3, B6 and B12 — but not the complete B complex of eight B vitamins. It’s also not as strong of an electrolyte blend. Like Cure, it is missing your chloride and magnesium.”

Ultima Replenisher, Broad Spectrum Electrolyte Mix.

(Rebecca Peloquin / For The Times)

Ultima Replenisher, Broad Spectrum Electrolyte Mix. “This one is OK from a standpoint that it’s going to flavor water and has the electrolytes that we’re looking for, like potassium, sodium, magnesium and chloride. But they’re relatively low amounts, containing one-sixth the amount of sodium in Nuun and Orgain; therefore, it is not for serious athletes.”

LMNT Zero-Sugar Electrolytes, Raw Unflavored.

(Rebecca Peloquin / For The Times)

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LMNT Zero-Sugar Electrolytes, Raw Unflavored. “This is a clean, straightforward brand and zero calories — just your electrolytes. It isn’t flavored, though, so would not be an adequate water flavoring product. It would be good for a smoothie boost or if someone is on an elimination diet. But you’d need to add in a carbohydrate source, like fruit, for this to be more hydrating. It would have to be a whole lemon squeezed in. Or, if doing a smoothie, add a quarter cup of frozen berries to help absorb the electrolytes and help hydration.”

Water Boy Hydration Electrolyte Drink Mix for Weekend Recovery.

(Rebecca Peloquin / For The Times)

Water Boy Hydration Electrolyte Drink Mix for Weekend Recovery. “I was nervous about the high sodium content here. Sodium is the first ingredient and it’s almost 50% of your daily value. Compared to the other electrolytes — potassium, magnesium and chloride — the sodium is very high and the others are low. It’s a really odd balance. But it has zero sugar and it has only 1 gram of carbohydrates, which, from the ingredient list, I’m assuming is coming from a natural flavor or potentially the vegetable juice. But it’s not enough carbohydrates to balance out the high sodium content. This product is marketed as a ‘hangover’ cure because alcohol dehydrates the body; dehydration is a major contributor to hangover symptoms. Rehydrating the body using alkaline salt neutralizes the acid from alcohol and dehydration; however, this product would benefit from a better balance of all electrolytes, not just high amounts of sodium.”

Orgain Hydro Boost, Rapid Hydration Drink Mix.

(Rebecca Peloquin / For The Times)

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Orgain Hydro Boost, Rapid Hydration Drink Mix. “I like this one for athletes. Sugar is the first ingredient, but for athletes that would help absorb the electrolytes. And it would also replenish glucose storage in the muscles. And I like the balance of sodium and chloride here too. There’s also potassium. It’s missing magnesium, but because the sodium and chloride are so well balanced it outweighs that. There’s also no synthetic flavoring. It’s all things like organic lemon juice and organic monk fruit. It’s not for everyday use because of the high sugar content, but great for athletes for specific use like a long-intense bike training, high energy, intermittent workouts or an event, like a sports game.”