Aiming for "realism" in a fantasy game is still hotly debated, as a design objective for this genre, it'is often counterproductive.
Many players don't complain about realism when they're willing to accept the idea of clean, healthy people in a preindustrial society without running water or knowledge of immunology and similar topics. Or the odd fact that many dungeons don't have lavatories. Where do all those orcs and dragons to the bathroom? Combat is debatably the most abstract, least realistic part of the game. Add magic and supernatural powers into the mix and debating realism gets even more shaky.
If my players complain about realism, I give them an encumbrance audit and start tracking rations and water religiously. Not because I'm trying to be a jerk, but because it's a realistic thing within the rules and players usually like to gloss over it.