The Sugar-Coated Lie of Oral Rehydration Solutions

A decade ago, Dr. Sivaranjani Santosh’s clinical conviction ignited a crusade against sugary packaged juices masquerading as life-saving oral rehydration salts (ORS) in India. Her relentless campaign on social media raised red flags for consumers and pushed the Indian food regulator to ban non-standard drinks from using the ORS label.

However, the problem of misleading advertisements and crafty labeling persists, causing ongoing risks for children’s health. In 2018, Dr. Santosh treated patients who had been given sugary electrolyte beverages instead of proper ORS. These drinks contained alarming amounts of sugar and artificial sweeteners that worsened dehydration.

The stakes are high: every year, 100,000 children die in India due to diarrhea, accounting for 13% of all child deaths in the country. Dehydration and loss of essential salts that come with diarrhea kill 1,200 children a day worldwide. The World Health Organization recommends a specific formula for ORS, but manufacturers are exploiting health markets by altering this ratio.

The Indian pharmaceutical industry is among the world’s biggest manufacturers of WHO-compliant ORS. However, the market is flooded with electrolyte-filled fruit juices whose names sound similar to ORS. These drinks dominate shelves in pharmacies, general stores, online grocery delivery apps, and even school stores. Consumers are often unable to tell them apart from sugary electrolytes.

The confusion between ORS and sugary electrolytes can be attributed to India’s complex drug and food licensing system. Medical-grade ORS is licensed by the Central Drugs Standard Control Organization (CDSCO), while energy drinks are licensed by the Food Safety and Standards Authority of India (FSSAI). Manufacturers are exploiting loopholes in this regulatory framework.

The lucrative wellness market is driving companies to push non-medical electrolytes over ORS, marketing them as post-workout drinks or healthy alternatives to sugary carbonated beverages. By doing so, they tap into a more profitable market than the modest ORS meant only for treating severe dehydration. Dr. Santosh’s warnings have created awareness among patients, but more needs to be done.

The FSSAI allowed beverage makers to use the term ORS in 2024 with a disclaimer that the product is “NOT an ORS formula as recommended by WHO.” This move has raised eyebrows, given the ongoing risks for children’s health. The Indian regulator must take a closer look at labeling and advertising practices.

Dr. Santosh’s campaign continues to raise awareness about the dangers of sugary electrolyte beverages masquerading as ORS. It is imperative that regulators and manufacturers take concrete steps to address this issue. The fate of thousands of children hangs in the balance, and it is time for decisive action.

The Indian food regulator must ensure that labeling and advertising practices are transparent and do not mislead consumers. Manufacturers must be held accountable for producing products that meet WHO-compliant ORS standards. Dr. Santosh’s crusade has sparked a national conversation about the dangers of sugary electrolyte beverages masquerading as ORS. It is time to turn this conversation into concrete action.

The battle for accurate labeling and advertising practices in India is far from over. But one thing is clear: the stakes are too high to ignore the sugar-coated lie of oral rehydration solutions any longer.