Before I cure IBD and save the world I need to answer this one first. I've gotten a few requests in my inbox to re-explain the ORS mystery......so here we go!
Everyone knows how important keeping hydrated is, and depending on what parts of your intestine were removed….how challenging it can be for us ostomates. Even with a complete healthy bowel we don’t just drink water and have it absorbed evenly along the length of our small and large intestine (colon). Each section of our bowels absorbs something different, with some overlap along the way. That means each section can only absorb what it’s made to absorb, and everything else just flows on by unabsorbed until it gets to the appropriate section. Everything we eat or drink leaves the stomach and enters the Duodenum, then flows thru the Jejunum, Ileum and then thru our colon. Along the way our livers make bile that is stored in our gallbladder that’s then secreted by our intestines to help break down what we ate so it can be absorbed along the way. Our body then re-absorbs that bile at the end of the Ileum and recycles it. Likewise, water is the last thing to be absorbed, and that happens in the colon. I should say “mostly” happens in the colon, as some water is absorbed in the terminal ileum as part of that overlap I mentioned. But the majority of our hydration comes from what our colon absorbs. So you can see that when you have an ostomy, your ability to hydrate is a function of what parts of your intestine were removed and what’s left. Those who have had small bowel removed have issues absorbing vital nutrients (vitamins and minerals) while those whose colon is long gone have issues with hydration (water). So colostomates have it the best of all, depending if any of their colon was removed before being routed out their belly. If you’re missing significant parts of both small and large intestine like me, you’ve got the most challenges.
Now the way each section of bowel knows what it should absorb and what it should let go by to be absorbed somewhere else is in the physiology of the bowel wall. It’s not a solid wall at all, but rather a semi-permeable membrane…..think of window screen with different size and shaped holes for each bowel section. It’s more complicated than that……..but that analogy works. So only things that fit thru the size and shape of each section of screen can pass thru and be absorbed in that bowel section, and everything else is denied entry. So you can see that missing sections of bowel makes absorption of some things impossible…….or near impossible, and you have to take supplements for those things. Now the body is a wonderful biological machine in that it can adapt to overcome difficulties, but it can’t work miracles. So when a section of your bowel is removed, in many instances other sections of your bowel can adapt to absorb what the removed section absorbed. But like I said…….there’s limits. You can’t remove the whole small bowel and expect the colon to do all the work, or vice versa……..just won’t happen. But the key here is that parts of what you do have left can be tricked into absorbing water….if you know what the key is that unlocks those sections of semi-permeable membrane. Now hold that thought and we’ll come right back to it in a second.
The other way we have trouble hydrating is when our colon or large intestine is inflamed. It’s typically called diarrhea, but when inflamed the bowel walls swell and can’t absorb much. So folks in 3rd world countries that are drinking crap water have problems staying hydrated just like many ostomates. And this is where ORS comes in. The World Health Organization (WHO) developed ORS primarily to help people out who suffered from rampant diarrhea and lived in unsanitary conditions. Lucky for us………it works for ostomates who need it too.
So how does it work? Well, remember that key that unlocks the semi-permeable membrane I told you about……ORS has that key! So since the colon is either missing or inflammed……..it can’t absorb water. And the small bowel isn’t programmed to absorb water……so it won’t. But if you know what the small bowel will absorb…..you can trick it to pull in water if you mix that water with what it normally pulls in….ie, what unlocks the semi-permeable membrane lock. So what ORS does is mix together the right ratio of glucose (sugar) and sodium (from table salt) in a specific amount of water. The glucose and salt in the proper ratio diluted properly are what unlock the semi-permeable membrane, which allows the attached water molecules to slip thru the membrane……….and we get hydrated without using our colon (large intestine) at all. Pretty nifty, eh? I’m oversimplifying, as usual, but that’s the easy explanation.
Now there’s a nuance to this I might as well bring up that pertains to us short-gutted folks. That ratio of glucose and salt to water is really important for everything we drink……..and here’s why. Liquids are considered either Hypertonic, Isotonic or Hypotonic. Hyper means there’s too much sugar/salt in it, Isotonic means it’s just right and Hypo means there’s too little. If we drink Hypertonic (too much) drinks then our body actually pulls water from our body to secrete into our intestines to try to dilute what we just drank to the proper ratio for absorption. You gotta give our body kudos for trying….but that makes us even more dehydrated because there’s nothing downstream to reabsorb all that water, and instead of gaining hydration….we’re losing it faster. So sugary drinks are a no-no all the time! Conversely, if you drink straight water, or something with not enough sugar/salt (ie, Hypotonic) it flows right past the membrane and ends up in your bag. Not a biggie except it also washes out all that bile your liver made and that makes your liver work really hard to keep up. And you don’t want to stress your liver……it’s one of those things you can’t live without. So be aware of what you drink all the time, and have your liver function checked periodically.
Hopefully that explains what ORS is and why it’s really important for some folks. It’s actually very easy to make when you’re out and about once you know the ratio of salt to sugar to water. And you can use anything to make it, as long as you keep the ratio right. I will tell you that the WHO has 2 versions of ORS and if you Google them you want to start off with the “Reduced Osmolarity” version. That just means less salt, which makes a big difference in how it tastes. And if you find even that not to your liking just start with whatever amount of salt you can tolerate and slowly build up to the required amount. You’ll find your taste buds will adapt easily and eventually everything else will taste weird while ORS tastes just right. So go slow if you need to……..but do what you must to stay hydrated! Just let me know if you have any questions, can’t find the ratio or I didn’t explain something very well……..and we’ll get you straight.