Ors Packets

Hi Guys.......pull up a chair,

Ok, so Storm.......you need to know that most of the premade packets are a bit different in their glucose to sodium ratio. That's because some are made for kids, others for athletes, those with diarrhea, and some for people with ileostomies or that are short-gutted. Also, the "perfect" ratio doesn't exist, because each of our bodies are a little different, and it's more important you get close rather than hit it exactly. And as I'll explain in a second......anything is better than the normal hyper and hypotonic drinks when it comes to hydration.

Drinks fall into one of three classes........Hypotonic, Isotonic and Hypertonic. And it's just like the 3 bears. The one in the middle is just right, and the other two are the wrong answer but in a different direction.

What's important to know is the way we hydrate and how our bowels function. Once your stomach dumps its contents into your small bowel, each section of the small bowel absorbs something different. But only the very end of the small bowel can absorb water, and it still can't absorb water as well as your colon. Your colon acts like a trash compactor, while sucking off the water to firm up the stool and dehydrate it before you poop it out. So basically, if you have your colon........or 2/3rds of your colon.....you probably don't have to worry about using an oral rehydration solution (ORS) to keep hydrated. But if your colon is disconnected or removed......you probably do need ORS to help keep you hydrated. And.....if you have no colon AND part of your lower small bowel is missing.......you really need to use ORS. So in general, the more bowel you're missing......the more you need ORS.

So what is ORS? Well.......it's a way to cheat, or trick parts of your small bowel that don't normally absorb water......to absorb it. Like I said above each section of your small bowel absorbs something different. So the section that absorbs vitamin B-12 won't absorb fat, protein, iron, etc, etc........and also won't absorb WATER. Think of each section of your small bowel as having it's own lock that prevents it from absorbing anything....and the key is specific molecules of certain compounds that go flowing by. So the way to trick the small bowel into absorbing water is to hide the water molecules behind the molecules that are the key to unlocking that section of bowel. In the small bowel that key is a certain combination of glucose (sugar) and sodium (salt). And ORS is the right mix of glucose and sodium, mixed in water, that unlocks those bowel section locks and allows the water to sneak in on the back of the glucose/salt molecule. Simple, right?

What's really important to remember though.......is what happens in the small bowel when you drink something that doesn't unlock the bowels locks. The bowels are pro-active. Meaning they will sense what's moving thru them and because they WANT to absorb their respective compounds.......they will react to what's flowing by and try to modify it so it CAN absorb it. So your bowel wants to absorb something with a certain amount of glucose and salt, but if what's flowing by doesn't have the right ratio of glucose and salt, or isn't diluted properly.......your bowel and body will try to make it right! This is where the "hypo", "iso" and "hyper" tonic solutions come in.

At one end of the spectrum you have drinks with NO glucose or salt in them, and those are called "hypo-tonic". Like water or diet soda or sugarless iced tea. And at the other end you have drinks with too much sugar or salt in them........and those are called "hyper-tonic". Think "hyperactive", which means too much, and you'll remember it. Drinks with the right ratio and properly diluted are the "iso-tonic" solutions, or the middle bear that's just right.

So when you drink something that's "hyper-tonic", meaning it has too much sugar/salt.......your body tries to dilute it with water to get it to the right dilution. And guess where it gets the water to dilute it from? Yup.....it pulls it from your body.............and dehydrates you. So you drink something really sweet or really salty.......and your bowels start pulling water from your cells to dump into your small bowel to dilute the mixture. It does this because even if it can't pull that much water to properly dilute the mixture.......your colon will re-absorb all that water that was pulled from you and your hydration level won't suffer. But if your colon is missing.........all that water ends up in your bag! I can tell you from experience.........if I just chug a 12 oz can of Coke, or similar really sweet drink........I'll output about a liter of water/bile into my bag before it stops. So what I'm describing is real……but invisible to those with a colon that re-absorbs all that stuff.

At the other end of the spectrum........drinking "hypo-tonic" fluids that lack glucose and sodium, like water, just causes your small bowel to dump glucose and sodium into your bowel to again try to make the fluid properly balanced and diluted, and "iso-tonic". That means when you drink water, thinking you're hydrating.......your just pulling electrolytes OUT of your body and getting MORE dehydrated. But you're thirst won't subside, and if you keep drinking water.......you'll find yourself in deep shit (no pun intended) very quickly. Again, not a problem if you have a colon and you can re-absorb everything. But without one…….your just filling your bag with things you're stripping your body of……..and need.

So (obviously) the purpose of ORS is to provide your small bowel the correct mixture of glucose and salt to unlock your small bowel so it can absorb it, while it has water molecules stuck to it...........and you get hydrated! But everyone is different, which is why there's no magic exact formula for ORS. The World Health Organization (WHO) has two formulations; the original version and a new "reduced osmolality" version. They both work, but the reduced version tastes MUCH better because it uses less salt.

And speaking of taste…..I need to give you a little word of warning. If you've NEVER tasted an ORS mixture........especially one at full strength……it can be a bit...umm....shocking. Or maybe disgusting. I would equate it to accidently taking a gulp of seawater while at the beach. It tastes like that.....and why wouldn't it........it's salt and water with some sugar thrown in. So it takes some getting used to, for sure. That's why the pre-packed packets are all a bit different. Taste sells........especially when your customers are small children and people who consider it a 'nice to have' and not essential, because they can drink Gatorade instead.

But the good news is you don't have to start out with the 100 octane version....you can start with something less potent and work your way up to full strength. Because your taste buds will acclimate over time……and pretty quickly you'll think a Coke tastes disgustingly sweet and water is just plain boring…..and you'll WANT to drink your ORS. You can start with a more diluted version because as long as you're close…..your body can work with it and make it perfect. It just can't work with things that are really “Hypo” or “Hyper” in nature. But ‘close' works!

The reduced osmolality version of ORS goes a long way toward this.........so start with that formula or even less. You'll find the pre-packaged stuff also contains some other things, primarily to help those suffering from severe diarrhea, not missing bowels. Those things won't hurt you, and if you're deficient in them it's all good. But the key ingredients to ORS are the sugar (glucose) and the sodium (salt).

Remember……you can use anything to make ORS, just dilute accordingly so you have the correct amount of sugar and salt. The possibilities are endless, so get creative!! And now finally…………………

Here's the formulations (both mixed in 1 liter/quart of water);

Regular WHO ORS: 25 grams (6 teaspoons) SUGAR + 4.5 grams ( � teaspoon) TABLE SALT

Reduced WHO Version: 25 grams (6 teaspoons) SUGAR + 3 grams ( � teaspoon) TABLE SALT

You'll find the pre-packaged ORS versions have 13.5 to 25 grams of sugar and � to � teaspoon salt

Sugar packets you get at restaurants have 3.5 grams of sugar per packet, so you'll need 7 packets

Salt packets you get at restaurants have 0.75 grams of salt, so you'll need 4 packets (3 grams) or 6 packets (4.5 grams)

Now if you shovel 6 teaspoons of table sugar into a one liter bottle your brain might have a hard time accepting that's the right thing to do. So I typically use Coke or any other regular cola. A little more than half a 12oz can (7 oz) equals 25 grams of sugar....but is much easier on the brain. If you have any issues figuring out how much of something to use.......just drop me a note and I'll help you figure it out.

Any questions…………..just shout!!

;O)

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