In 1978, Lancet called oral rehydration salt/solution (ORS) “potentially the most important medical advance of this century”. Discovered by Indian scientist Hemendra Nath Chatterjee, its usage was eventually developed and used across the world. It is estimated that ORS has so far saved more than 50 million children. As part of their global diarrhoeal disease control programme, the World Health Organization and UNICEF standardised ORS in 1975 and further popularised its use.
India’s population made it a major beneficiary of ORS. However, its wide use bred a commercial version. In 2003, Bengaluru-based Jagdale Industries made a sugary drink that tasted like ORS, named it ORS-L, and marketed it as a rehydration drink for children. Sold almost like a medicine, it earned an estimated Rs100 crore annually for Jagdale and was bought for Rs750 crore by Johnson & Johnson in 2014.
The American brand sensed the business opportunity, rooted in a genuine health need. It renamed the brand ORSL and pushed it aggressively, onboarding medical stores, supermarkets, e-commerce websites and even doctors, especially paediatricians. But, one paediatrician understood the danger and took up the fight.
“In one case, the parents followed every instruction precisely—correct food, correct fluids—yet the child did not get better,” said Dr Sivaranjani Santosh. “The diarrhoea persisted and dehydration worsened. One day, one of the parents asked me if ORS and ORSL were the same. I said they could be, but also asked them to bring the tetra pack they were using. When I examined the label, it was not the WHO-recommended ORS at all.”
In paediatric medicine, few principles are as firmly established as ‘diarrhoea rarely kills, dehydration does’. If dehydration is prevented, a child usually survives. “Even glucose cannot be given directly to sick children; it needs the right amount of sodium and water,” said Sivaranjani. The balance ORS should have is measured in osmolarity (concentration of a fluid). It is key because, in the body, water always moves from a diluted fluid to a concentrated one. When ORS has the right osmolarity—about 0.245 osmoles per litre (osm/l)—it is lower than blood (0.275-0.295osm/l), and water flows from the gut to the body, improving hydration. But, when so-called ORS drinks have high osmolarity—often 0.300-0.600osm/L—water is pulled from the body to the gut, speeding up dehydration and worsening diarrhoea.
“I realised it after observing cases and eventually heard from other paediatricians of how the sugary drinks failed to provide rehydration and caused dehydration among the sick children,” said Sivaranjani. These sugary drinks are “hyperosmolar”—they are dangerously skewed in terms of composition (see table).
Around 2015, Sivaranjani realised ORS was not being diluted by medical ignorance, but by commercial confusion. The massive marketing machine continued its blitz, until, owing to increasing objections from the medical fraternity, J&J started printing the warning: “Do not give during diarrhoea”—in tiny font.
Sivaranjani intensified the awareness effort. In campaigns at schools, she warned parents about the sugary drinks. In 2017, she posted her first YouTube video on the difference between ORS and ORSL.
Meanwhile, other companies entered the space with brands like Rebalanz VITORS (launched in 2018) and ORSFIT (2019). These were sold to unsuspecting parents across the country, mostly through medical stores.
Sivaranjanai escalated the issue in 2021, writing multiple letters to the Central Drugs Standard Control Organisation. The CDSCO first asked for proof, then said that the problem did not fall under its jurisdiction as the drinks were not drugs. So, she filed a complaint with the Food Safety and Standards Association of India in February 2022. Following the efforts of Sivaranjani and other paediatricians, the FSSAI barred sugary drinks from using the term ORS on labels in April 2022.
It was a decisive win, but it did not last long. In July, the authority reversed course—allowing ORS terminology with the diarrhoea disclaimer.
The FSSAI took cover behind the Controller General of Patents, Designs and Trade Marks, Mumbai, stating it was the CGPDTM that granted trademarks such as ORSL. “This flip-flop was devastating,” Sivaranjani said. All through, she was also flagging the issue to the Union health ministry. She complained several times on the Prime Minister’s Office website, too, but there was no response.
The FSSAI and the health ministry maintained communication with Sivaranajani, but the officials were mostly asking for more proof or continued the inconsequential talk. “I could see no action; it was truly baffling,” she said. “Despite medicine, public health and ethics on our side, the government agencies refused to act.”
When contacted, neither the FSSAI nor Kenvue, which was spun off from J&J in 2023 and currently owns the rehydration product, responded. Former FSSAI CEO Pawan Agarwal said: “Though it was a drink and the issue fell under the FSSAI’s purview, ORSL was a trademark. So, at the time, the best FSSAI could do was to highlight that it was not ORS as per WHO standards. The recent decision to ban the use of ORS in trademarks was prompted by medical shops selling ORSL when the customers asked for ORS.”
In September 2022, fed up with the lack of response from the FSSAI and the health ministry, Sivaranajani filed a public interest litigation in the Telangana High Court. “As the case dragged on, I felt isolated,” she said. “I wondered why the judiciary was taking so much time on the topic that was so clear from the beginning.”
Then, before the first hearing, she posted a video on social media requesting people to wish her luck. The response was staggering. It may have started with concerned parents amplifying her message, but it was soon taken up by Anchor Ravi, a well-known TV personality in the Telugu states. Actors Samantha Ruth Prabhu and Nani took the campaign to the next level. Dozens of paediatricians and scores of social media influencers joined the movement. The campaign spread rapidly across south India. The public scrutiny shifted the balance.
Meanwhile, the Endocrine Society of India and Women Pediatricians Forum joined her case. The ESI’s petition was accepted while the WPF’s was denied.
Finally, the FSSAI banned the use of ORS in brand names on October 14, 2025. But, within two days, the Delhi High Court asked it to respond to JNTL Consumer Health (India) Pvt Ltd, a Kenvue subsidiary. JNTL had told the court that stock worth Rs180 crore was in the market and calling it back could cause reputational damage. “I could not understand how the FSSAI agreed to this,” said Sivaranjani. “This was taking the public’s health for granted and playing with the childrens’ lives.”
The response from FSSAI was slow, prompting the Delhi High Court’s Justice Sachin Datta to remark the order was intended to give the regulator two to three days to act and that he might not have granted it if he had known the FSSAI would take longer. Eventually, the FSSAI upheld its earlier ban, calling the drinks a public health hazard. Though Dr. Reddy’s, which owns Rebalanz VITORS, tried to challenge the ban, the Delhi High Court did not entertain the plea. It also reiterated that it will not interfere in the FSSAI’s ban as people could mistake the branding for ORS, leading to a public health hazard.
However, despite the ban, the drinks remain on the market. The FSSAI has conducted raids across the country and seized stock in some states. But, the issue persists. ORSL has even rebranded to ERZL (the ‘e’ designed to look similar to ‘o’ and the ‘z’ to ‘s’). Sivaranjani is reaching out to the ministry of commerce and industry and the FSSAI to not allow the rebranding.
Meanwhile, the case in the Telangana High Court is still active, with the prosecution seeking a court directive to the companies to obey the FSSAI’s ban. Sivaranjani also wants all stock recalled and distribution stopped. Amid her battles for public health, she still wonders how products endangering millions of children stayed in circulation for so long.