Hey Bob, this is the first I’ve ever heard of ORS. Surgery salt water reminds me of the many colonoscopy preps I’ve done in a past life and I gag just thinking about it. Can you share with us how you mix your cocktail for an “improved” version?
(great info as always)
Sure can. When I got my shitbag back in Sep 2014 I was assigned to a home infusion company of the hospital's choice for my TPN. Heck, I didn't even know what a home infusion company was. I immediately started looking around for Gastros that had experience with Short Bowel folks and found none. Except a good Doc friend of mine told me to try Georgetown Hospital in DC. So I hooked up with a good Gastro there, but she wanted me to be seen (and cared for) by the hospital's Small Bowel Transplant Group, not for a transplant....but because they dealt with Short Gutters. The first thing they did after our initial consult was to switch my infusion company to one called ThriveRX. They were formed by a bunch of nurses and Dieticians who actually gave a crap and focused on weaning patients off TPN, rather than just supplying it to them until they croaked. That's where I got introduced to ORS. And the first time I tasted it I nearly puked.....it literally tasted like a cup of sea water that someone dumped a sugar packet into. YUKKK! But it was the only thing I drank that didn't immediately end up in my bag. So I figured there was something to the ORS stuff.....but I needed to work on it a bit before I could drink it. So I tried everything.......soda syrups.....diet iced tea, unsweetened Hawiian Punch.....Country Time lemonade.....all the natural and unnatural sugar substitutes.....you name it......I tried it. But they all were too sweet and with the added salt just tasted plain weird. But ThriveRX also assigned a really smart Dietician to my case and we became good friends. She understood that I wasn't just along for the ride, I was going to be in control of my health in every aspect. So she suggested I start with a very diluted form of ORS to let my tastebuds get used to it.....and I thought that was a good idea. It wasn't very helpful from a hydration point of view, but we were playing the long game here.......and I had a plan. Understanding that the body has a remarkable ability to adapt, if you give it a chance and sometimes a helping hand, I was betting I could make my bowels adapt to an ORS that I could stand to drink. On the way I determined that the World Health Organization's recipe for ORS was just plain wrong. When you dig into the subject of ORS you'll find they speak in terms of osmolarity, which is just a fancy way to say how concentrated the solution is, and I figured the WHO version had too high an osmolarity. So after doing all my experimenting I determined that a reduced osmolarity ORS worked just as well as the regular ORS, and tasted boatloads better! My Dietican friend was a bit skeptical, until she found out the WHO was also working on a reduced osmo ORS as well........and was about to introduce it to the world. Then she became a believer. So when you look up ORS you'll find two versions. The original osmolarity version and the newer reduced osmo version. Go with the reduced osmo!!
Ok, for the recipes.........the first one I found was also the simpliest. But you have to like lemonade. Ok, you don't, but I haven't tried too many other flavors with this one because I like the lemonade version. Just go get a quart of REGULAR Gatorade......the Lemonade flavor for me.......or any other flavor that you like. The Lemonade is NOT the Lemon-Lime original green version. It's sometimes hard to find, but is just a shade green paler than the Lemon-Lime, so you have to read the label. What you do is get another empty quart container......another Gatorade bottle works perfectly, as you can just pour one into the other until they line up with each other in their bottles and you've got half in each. Then add a 1/2 teaspoon of salt to it and fill it the rest of the way with water. The colder the better. Shake it up and you've got the fastest to make ORS on the planet. At first you might not really like the diluted taste, but your tastebuds will adapt and before long regular Gatorade will taste like pure sugar water. With all the Gatorade flavors to choose from you have lots of options. Just remember to use the orignal sugared version, not the G3 or whatever the artificially sweetened version is. Of course you COULD use the artifically sweetened versions to dilute the quart if you find it diluted too much by just topping off with water......so you have options.
My second recipe is soda based.......because I love cola. And you'll find that carbonation masks the taste a bit more. You can use any regular non-diet soda to start. I'm cheap so I buy the Coke clone at my local Weis Markets for something like 65 cents for 2 liters. But use whatever brand you like......Dr Pepper, Coke, Pepsi, whatever........as long as it also comes in a DIET version. The reason for this is that you need the diet version to dilute it....stay with me here. So first read the label of the non-diet soda you choose. It'll tell you how many grams of sugar are in one serving, which is typically 8 ozs, but check to be sure. You want to find out how much to use to get you only 25 to 30 grams in your quart (liter) container. So for example I think the Weis Cola has 43 grams per 8 oz serving. Just make a ratio of it by saying 8 ozs divided by 43 grams equals (the ozs I need) divided by 28 grams (or something close to make the math easy). So for my Weis Cola I say 8/43 = X/28 and solve for X. So for me I need a little over 5 ozs of Weis Cola in my quart container. Measure that out and dump it into your quart container......that's your sugar. Now add that 1/2 teaspoon of salt to get your sodium. And now you get to fiddle with making it taste the way you like. Fill the quart container about 3/4 full with plain seltzer or club soda. Seltzer is cheaper. Mark it on the bottle with a Sharpie marker and then fill the rest of the way with the DIET version of what you started with. This is your baseline to start modifying from. If you skip the seltzer and just fill it with the diet version it will be too sweet. If you skip the diet version and just fill it with seltzer.......it will be too diluted. Or at least that's how it is with me. But you now have a starting point and you can play with different amounts of diet and seltzer until you get what you like. And trust me........your tastebuds WILL adapt in short order.......and you'll actually like it to the point of not wanting regular or diet soda anymore. What's really neat is when you go out to most food places they now have the zillion flavor soda machines.......so you simply pick the regular and fill a 32 oz cup about 3/4 of an inch from the bottom.....dump a salt packet into it........and then fill with seltzer, diet version and ice! And you can make your favorite ORS almost anywhere in seconds. Plus the look people get on their face when they see you dump a salt packet into your soda is PRICELESS!
Once I got my hydration under control I continued to push the envelope with my ORS. I can now make it with an even lower osmolarity and it still works. So the sky is the limit with this stuff.....you just have to experiment. You can make an ORS with just about anything as long as you keep the salt to sugar ratio close. You can use fruit juices, even milk. Oh........if you do choose something to start with that also has lots of salt in it......you can just subtract off that amount of salt from your 1/2 teaspoon. But if that complicates it too much then don't worry about it.....it'll sill work. If you Google ORS recipes you'll get more than you want. Just remember there are two osmolarity ratios, and I've found less is more. Let me know how you make out......and if I didn't explain anything sufficiently well just shout! Bottoms up!!