The Hyderabad-based paediatrician Dr Sivaranjini Santhosh — whose eight-year long fight led to the country’s apex food regulator forbidding the use of the term ORS by brands of fruit-based, non-carbonated, ready-to-drink beverages — said on Wednesday that the product relaunched by one of the companies bears so much similarity to the old one that it confuses consumers and retailers. She said that the new brand marketed as everyday hydration solution eRZL uses a four letter brand name visually similar to the previous brand name, uses similar font style, the same colour and layout, as well as the same photograph of a fruit resulting in people still confusing the two.

“The new packaging is a clear imitation of the old one and has a strong recall value. People are still being provided this drink when they ask for ORS,” she said, adding that she had filed a trademark opposition for the new brandname. She said that she filed the opposition in late February, with the Registrar of Trademarks sending a notice to the company in early March. She added that the confusion further persists because the company, which was formerly the consumer health division of Johnson and Johnson, does have a similar tetra-pack of WHO recommended ORS going by the previous brand name ORSL as well.

Dr Santhosh fought against the use of the term ORS by these beverages because they did not adhere to the salt- sugar ratios recommended by the WHO. The problem? It let to more dehydration and diarrhoea in already sick children — something that could turn fatal in the absence of timely medical care.

She said that the company has also sent her a legal notice asking her to take down her posts regarding its brand.

The oral rehydration solution — a simple glucose-electrolyte mixture — can reduce deaths and hospitalisations due to acute diarrhoeal diseases, especially in children under the age of five years in whom diarrhoea continues to be a big killer. The impact of this simple solution has been so profound that it has been hailed as “the most important medical advancements of the 20th century.

A medicinal product, the ORS — or Oral Rehydration Solution — is able to save lives by effectively replenishing the water and electrolytes lost by people due to diarrhoea. There is a fixed formula for how much glucose, sodium chloride, and potassium chloride has to be there in the ORS solution. This formula is such that the sugar and salt actually pull water with them into the body and rehydrate a person. Any excess sugar will actually pull the water back into the gut and worsen the diarrhoea.

She said that this particular brand — and several others — are excessively sweetened to make them more palatable, adding that even though the new eRZL has reduced its sugar content by 87% it still continues to be high. “While the bigger concern is children with diarrhoea getting solutions that may worsen their problems, but marketing the drink as everyday hydration has challenges of its own. There is no need for any hydration solutions every day, just water can suffice. I don’t want parents to think that this is healthy because consuming such beverages regularly will also lead to other health problems we see with overconsumption of sweet beverages. In fact, regular consumption of ORS is also not recommended,” she said.

Dr Santosh said that such hydration solutions are needed only when one does strenuous activity or has been in the sun for a long time. The company spokesperson in a statement said: “Despite being compliant and transparent, there has been continuous disparagement and dissemination of misleading and unscientific information by a certain individual…We repose our complete trust in the Legal & Regulatory system of the country however there appears to be a deliberate attempt to prejudice public perception by misquoting scientific and regulatory positions.”

She also highlighted that there are other brands such as Cipla’s Prolyte that use artificial sweeteners to sweeten the product. “The challenge with this is that these sweeteners can also draw water into the gut and worsen diarrhoea — and, of course, there is other evidence to show that long term use may result in problems such as increasing insulin insensitivity, predisposing someone to diabetes.”

She says that while it is not in contravention of the current law, the company should mention it on the packaging, allowing people to make the choice on whether or not to consume it.

Kenvue spokesperson in a statement said: “ORSL is now the exclusive brand name of our WHO ORS drug portfolio (Liquid and Powder formats) for diarrheal dehydration, whereas eRZL is our new & improved electrolyte drink portfolio (Food Product duly licensed by FSSAI) designed for everyday hydration to address exhaustion and tiredness among general consumers…. we have substantially reduced the added sugar content by 87% with 1.4X more electrolytes to address everyday hydration needs.”