Wellness Hydration Mix
Health agencies refer to the formula in our Wellness Hydration Mix as an “ORS,” which stands for “Oral Rehydration Solution” or “Oral Rehydration Salts.” An ORS is a drink specifically intended to rehydrate children and adults with heightened dehydration from diarrhea. Compared to common sports drinks, our Wellness Hydration Mix, which is based on recommendations developed by the World Health Organization (WHO), contains more sodium, less sugar, as well as and a small amount of zinc. Unlike the WHO formula, however, our mix also includes the use of real fruit and higher quality electrolytes for taste and function without any of the excess flavoring agents, artificial sweeteners, coloring agents, or emulsifiers found in some commercially available oral rehydration solutions. Use Wellness Hydration mix as a non-synthetic alternative to oral rehydration solutions laden with excess ingredients, to rehydrate you or your kids need to quickly replace water and electrolytes.
The Story Behind Wellness Hydration Mix
We developed our Sport Hydration Mix to rehydrate people when they’re sweating without the insult of neon colors and excess ingredients common to many sports drinks. But sweating isn’t the only way that people can suffer from heightened dehydration.
Heightened dehydration is also a huge problem when people, especially kids, are sick and experiencing diarrhea. In cases of diarrhea, large amounts of fluids and electrolytes can be lost when the intestinal wall becomes impaired due to a virus or bacteria. The result is that water and important electrolytes like sodium spill from inside the body across the intestinal wall into the gut and down the bowels where dehydration eventually announces itself in an explosive crescendo. As uncomfortable as this might be, it’s not the discomfort of diarrhea that is the issue; it’s the risk of death from dehydration and the loss of electrolytes. In fact, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) report that countries dealing with reoccurring epidemics dehydration due to diarrheal diseases is the second leading cause of death in children under five years of age – deaths that are easily preventable with the use of Oral Rehydration Salts (ORS) (1, 2, 3).
Oral Rehydration Salts (ORS) are powdered mixes containing a relatively high amount of sodium and a little bit of sugar or glucose that, as the name implies, rehydrates people by optimizing the replenishment of water and electrolytes (1). The mechanism behind an ORS is relatively simple. Not only does an ORS help replace what is lost, the addition of sodium and glucose to water actually helps improve the transport of water across the small intestine, or gut, back into the body.
The water we drink can move across the intestinal wall into the body in two ways. The simplest way is passively through a process called osmosis. Osmosis is driven by the difference in the concentration of dissolved molecules or solutes on either side of the intestinal wall. The important fact to understand is that water moves from the side with the lower solute concentration to the side with the higher solute concentration. The solute (or molecular concentration) of a solution is measured as a solution’s osmolarity (Osm/L). The osmolarity inside the body is measured as blood osmolarity, which is normally about 280 mOsm/L. Thus, if someone drinks a solution with an osmolarity lower than blood (<280 mOsm/L), water will move passively from inside the gut into the body (low to high). Likewise, if someone drinks a solution with an osmolarity greater than blood, water will move from inside the body into the gut, potentially causing bloating or diarrhea. This highlights one of they key problems with osmosis; that water movement depends on a favorable concentration gradient, which may or may not be present depending upon what someone is drinking or eating.
Fortunately, water transport into the body can also be facilitated by the active co-transport of sodium and glucose. When sodium and glucose are present, they are actively transported together across the small intestine into the body through the use of energy requiring pumps, which also opens a channel for the entry of water. Specifically, for every 2 molecules of sodium and 1 molecule of glucose that are transported into the body, 210 molecules of water are also transported (4). Thus, the addition of sodium and glucose to a solution greatly improves the movement of water back into the body – an extremely simple remedy that can literally save lives.
Because of this, the World Health Organization has provided guidelines for the production of Oral Rehydration Salts. These guidelines are part of the public domain and are used to help encourage the production of a cost effective ORS for "developing countries" and the general population (3). They call for specific amounts of sodium (1700 mg/L), potassium (784 mg/L), glucose (13.5 g/L), and zinc (10 mg/L) at an osmolarity lower than blood (245 mOsm/L). Sodium and potassium replace the two most important electrolytes lost due to diarrhea, while the addition of glucose along with sodium improves water re-absorption. Finally, zinc has been shown to help prevent diarrhea and is now considered a critical ingredient in the formulation of ORS. While the mechanism behind how zinc works is not entirely clear, it’s thought that zinc improves immune function at the intestinal wall, helping to repair the initial intestinal damage or insult causing the diarrhea (5, 9). All said, the ultimate goal is a high sodium, low sugar, low osmolarity drink that facilitates water and electrolyte replenishment and absorption by both osmosis and the active transport of sodium and glucose while also providing small amounts of zinc for improved gut health.
While the guidelines provided by the WHO are profound and extraordinarily important to public health, the biggest problem with ORS is the taste. Making ORS exactly to WHO specifications results in a taste profile that we can only describe as a chalky sweat with slightly bitter and metallic notes. It may be for this reason that in the United States, it's common to find that many commercially available ORS use less sodium (1000-1200 mg/L) and include artificial sweeteners, flavoring agents, chemical colors, and emulsifiers in their formula. This raises the osmotic pressure of some commercially available ORS from the osmolarity recommended by the WHO (245 mOsm/L) to values greater than blood (> 280 mOsm/L)*, which hampers functionality in an attempt to improve the look and palatability. The irony is that, we feel, these ingredients only marginally improve the taste, masking the salt and electrolytes with a synthetic and unnatural flavor by using ingredients that aren’t recognized by the body and that may contribute to additional gastrointestinal distress due to the higher osmolarity.
This problem of excess synthetic ingredients was the same problem that we at Skratch Labs experienced with sports drinks – a problem that motivated the formulation of our Sport Hydration mix. Thus, we saw an opportunity to not only improve the taste of the WHO ORS formula but to eliminate the excess chemicals used by some manufacturers of ORS. We didn’t want our kids, our loved ones, or ourselves to be drinking something when they were sick that was akin to a toxic waste dump. More importantly, we knew we could help and we wanted to help.
This hit home for us when our friend, Audie, a Peace Corp worker in Mozambique asked if we could donate some drink mix to the village she lived and worked in. What we learned from Audie was that the kids in her village wouldn’t drink the WHO formula that they were provided by relief agencies because of the taste and she needed an alternative. So when Audie’s family went to visit her in Mozambique, we sent as much high electrolyte and low sugar drink mix as they could carry for the village to try. That little trial was a huge success. Both the kids and adults loved the mix and when a number of the kids became sick with diarrhea, it proved highly effective as a remedy to treat their heightened dehydration, not just because of the high level of electrolytes but because they actually wanted to drink it.
That experience pushed us to consciously formulate a product that more closely met the guidelines set forth by the WHO. In doing so, we learned that the formula recommended by the WHO was a balance between cost and efficacy. It’s a formula that not only has clinical relevance; it’s a formula that also has to be made cheaply in any country. Not bound by cost, we decided to make a formula that met the WHO guidelines but that used more of the very expensive and preferable citrate based salts like sodium citrate and potassium citrate instead of relying on cheaper chloride based salts like sodium chloride and potassium chloride. We had previously discovered that, for some athletes, high amounts of chloride could be irritating to the gut when we used those salts to make our sports drink. We also focused on the taste of our formula using real fruit for flavor and a ratio of cane sugar and glucose that helped improve the taste and enhance the absorption of sugars (6).
The result was Wellness Hydration Mix - a formula with 1500 mg of sodium, 500 mg of potassium, 17 g of glucose (32 gram total sugar), and 10 mg of zinc per liter of water with an extremely low osmolarity of 225 mOsm/L*. By avoiding excess ingredients, we were able to make our drink slightly sweeter than the WHO formula, by using real sugar instead of artificial sweeteners, and still have a significantly lower osmolarity than either the current WHO formula or other pediatric electrolyte solutions. At the same time we kept the appropriate ratio of glucose to sodium in the mix to maximize water absorption by the co-transport of glucose and sodium (4). Finally, we lowered the overall electrolyte content slightly compared to the WHO formula to improve the taste, while still using significantly more electrolytes than similar commercially available ORS. Ultimately, by not being constrained by cost, we were able to make subtle changes that we believe improve on the WHO guidelines with respect to taste and function.
Although our Wellness Hydration Mix was specifically based on the WHO guidelines for kids and adults experiencing heightened dehydration due to diarrhea, many of our customers have found that the high sodium and lower sugar content also make it a great product for use when more dehydrated for other reasons as well. What we know is that while most sports drinks and electrolyte replacement products are not optimized for the heightened dehydration associated with diarrhea, we have found, like many of our customers, that our Wellness Hydration Mix is very effective for remedying other forms of heightened dehydration not associated with diarrhea - a fact that is often shared with us by many late night revelers.
Ultimately, our Wellness Hydration Mix with its high sodium and relatively low sugar content is designed to improve the absorption of water and electrolytes back into the body. At 1500 mg of sodium per liter, our Wellness Hydration Mix has about twice the sodium of our Sport Hydration Mix (800 mg Na+/L) and about half as much sodium as our Hyper Hydration Mix (3500 mg Na+/L). Given that sweat sodium can be highly variable (7), for those who lose more sodium than either our Sport Hydration Mix or other sports drink formulas provide, our Wellness Hydration Mix can be a great way to replace lost sodium especially after a bout of exercise that causes a large fluid and sodium loss.
The one caveat is that our Wellness Hydration Mix contains 45% of the USRDA for zinc (5 mg per 500 ml serving & 10 mg per liter). While a number of papers have shown that zinc can be important to immune function when sick or for general health (8, 9), it’s important to realize that drinking too much of our Wellness Hydration Mix when not sick may lead to consuming an inappropriate amount of zinc. Chronic (60-450 mg per day) or acute over-ingestion (>450 mg) of zinc can result in nausea, vomiting, a loss of appetite, abdominal cramps, diarrhea, and headaches (10, 11). The Food and Nutrition Board (FNB), lists the upper daily limit of zinc in infants to young adults at a range from 5 to 34 mg (7-12 mo = 5 mg, 1-3 yrs = 7 mg, 4-8 yrs = 12 mg, 9-13 yrs = 23 mg, 14-18 yrs =34 mg) and adults at 40 mg (10). For an adult, to reach this upper daily limit, one would need to drink 4 liters or 8 x 16.9 ounce servings of our Wellness Hydration Mix in one day. For that reason, we don’t recommend that anyone drink more than 8 servings of Wellness Hydration Mix per day. Simply put, it is not an alternative to our Sport Hydration Mix or Hyper Hydration Mix when high volumes of fluid are required during activity.
In summary, we designed our Wellness Hydration Mix to help kids and adults who are struggling from heightened dehydration due to diarrhea. We developed our mix when we realized the importance of ORS to public health, especially in countries with reoccurring epidemics such as cholera and saw room to improve the taste of the WHO formula while eliminating the excess ingredients common to a number of commercially available formulas. The net result is an ORS that we believe tastes better and that does not contain excess ingredients like emulsifiers, coloring agents, flavoring agents or artificial sweeteners, giving it an extremely low osmolarity. That low osmolarity combined with the addition of sodium and glucose ensures the rapid absorption of water by both passive (osmosis) and active mechanisms (facilitated transport). Because other drink mix formulas are not designed specifically to deal with dehydration associated with diarrhea in either kids or adults, our Wellness Hydration Mix fills a very unique market and need. That said, our Wellness Hydration Mix can also be used in any situation that involves heightened dehydration. But since our Wellness Hydration Mix contains zinc, which has been shown to be important to the cessation of diarrhea by enhancing immune function in the gut, no more than 8 servings of our Wellness Hydration Mix is recommended per day. Like our other drink mixes, this product fits our mission to provide people with products that help them take care of themselves and their families. While we started Skratch Labs because we care about sport and performance, the reality is we care a lot more about people and their health.
1. End preventable deaths: Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea. World Health Organization / The United Nations Children’s Fund (UNICEF), 2013.
2. Diarrhoea: Why Children are still dying and what can be done. World Health Organization / The United Nations Children’s Fund (UNICEF), 2009.
3. Oral Rehydration Salts: Production of the new ORS. World Health Organization / The United Nations Children’s Fund (UNICEF), 2006.
4. Glucose, sodium, and water transport references:
a) Erokhova, L., Horner, A., Ollinger, N., Siligan, C., & Pohl, P. (2016). The Sodium Glucose Cotransporter SGLT1 Is an Extremely Efficient Facilitator of Passive Water Transport. The Journal of Biological Chemistry, 291(18), 9712–9720.
b) Loo, D. D., Zeuthen, T., Chandy, G., & Wright, E. M. (1996). Cotransport of water by the Na+/glucose cotransporter. Proceedings of the National Academy of Sciences, 93(23), 13367–13370
c) Wright, E. M., & Loo, D. D. F. (2000). Coupling between Na+, Sugar, and Water Transport across the Intestine. Annals of the New York Academy of Sciences,915(1), 54–66.
d) Meinild, A. K., Klaerke, D. A., Loo, D. D. F., Wright, E. M., & Zeuthen, T. (1998). The human Na+–glucose cotransporter is a molecular water pump. The Journal of Physiology, 508(1), 15–21.
5. M Imran Qadir, A Arshad, B. Ahmad. Zinc: Role in the management of diarrhea and cholera. World J Clin Cases. 2013 July 16; 1(4):140-142.
6. Jeukendrup, A. E., & Moseley, L. (2010). Multiple transportable carbohydrates enhance gastric emptying and fluid delivery. … Journal of Medicine & Science in Sports. 20(1), 112–121.
7. Sweat Sodium Variability References:
a) Eichner, E. R. (2008). Genetic and other Determinants of Sweat Sodium. Current Sports Medicine Reports, 7 (Suppl. 1), S36–S40.
b) Amano, T., Hirose, M., Konishi, K., Gerrett, N., Ueda, H., Kondo, N., & Inoue, Y. (2017). Maximum rate of sweat ions reabsorption during exercise with regional differences, sex, and exercise training. European Journal of Applied Physiology, 30(5), 708–11. http://doi.org/10.1007/s00421-017-3619-8
8. Zinc and immune function review references:
a) Dardenne, M. (2002). Zinc and immune function. European Journal of Clinical Nutrition, 56, S20–S23.
b) Haase, H. (2017). Zinc Signals and Immune Function. In Molecular, Genetic, and Nutritional Aspects of Major and Trace Minerals (pp. 261–271). Elsevier.
c) Ripa, S., & Ripa, R. (1995). Zinc and immune function. Minerva Medica, 86(7-8), 315–31.
9. Lewis MR, Kokan L. Zinc gluconate: acute ingestion. J Toxicol Clin Toxicol 1998; 36:99-101. Side effects of Zinc.
10. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2001.