Who Is Sivaranjani Santosh & Why Is This Hyderabad Doctor Trending? Everything You Should Know About The ORS Controversy

Dr Sivaranjani Santosh is a Hyderabad-based pediatrician. (Photo Credits: Instagram)

A major regulatory shift has come for food and beverage labelling in India following years of concern over misleading claims. The Food Safety and Standards Authority of India (FSSAI) has now strictly prohibited the use of the term ‘Oral Rehydration Salts (ORS)’ on products that do not meet the standards recommended by the World Health Organisation (WHO). This move comes after persistent efforts by Hyderabad-based pediatrician Dr Sivaranjani Santosh who fought to prevent the misuse of the term on sugary drinks and beverages.

Dr Santosh’s eight-year-long campaign highlighted how several companies were marketing sugar-rich drinks as ORS that gave a false impression of health benefits. Her efforts brought attention to the potential risks of consuming such products especially for children and people with diabetes.

The FSSAI Order

On October 14, FSSAI issued a directive stating that no food brand can label its product as ‘Oral Rehydration Salts’ or ‘ORS’ unless it strictly follows WHO’s recommended formulation. The order also cancels all previous permissions granted to food businesses for using ‘ORS’ in product names. It rescinds two prior orders dated July 14, 2022, and February 2, 2024, which had allowed companies to use the term with a disclaimer: “The product is Not an ORS formula as recommended by WHO.”

Dr Santosh shared her emotional reaction in a video on Instagram. In the caption, she wrote, “WE HAVE WON IT! A CLARIFICATION WAS ISSUED TODAY! NO ONE CAN USE ORS on their label unless it is a WHO recommended formula and no one can sell it right from today! Thank you @FSSAI @jpnaddaofficial @narendramodi. 10.20 PM- Thanks to each and every parent, doctor, Paediatrician, child, teacher, journalist, Advocate, anchor, celebrity, podcaster, influencer, educator, and every one who stood by me for this cause! Special thanks to my teachers, family, staff, @endocrinesocietyindia, and @womenpediatriciansforum.”

Her post gained traction on social media with people praising her perseverance.

One user commented, “We need more people like her, we can start by questioning ourselves when we buy these things.”

Another wrote, “Thank you for the service, mam. A true hero.”

“The fruits of the efforts of the most tirelessly determined & ethically poised doctor of India!!!!! Take a bow, Maam!” someone else added.

“Been following your journey for 3 years. Today you didn’t just win a case, you won the hearts of everyone who believes in truth and ethics. You made every honest doctor proud. Respect and gratitude,” a person shared.

The Legal Battle

In 2022, Dr Santosh filed a Public Interest Litigation (PIL) in the Telangana High Court to challenge companies that marketed sweetened fruit juices as ORS without meeting WHO standards. Her petition noted that these drinks contained excessive sugar and an inconsistent electrolyte composition that posed health risks.

The case reached the attention of the then Secretary of the Ministry of Health and Family Welfare, Rajesh Bhushan which prompted judicial and regulatory scrutiny.

The court intervention initially led FSSAI to issue a directive on April 8, 2022, which restricted the use of ‘ORS’ on food labels and advertisements. But a few months later, on July 14, 2022, the regulator temporarily relaxed this rule after several companies challenged it through a writ petition. The regulator allowed the companies with registered trademarks to keep using ‘ORS’ in their product names until the Controller General of Patents, Designs and Trademarks reached a final ruling.

WHO Standards vs Commercial Drinks

The World Health Organisation recommends an ORS solution with a total osmolarity of 245 mOsm/L. It contains 2.6 grams of sodium chloride, 1.5 grams of potassium chloride, 2.9 grams of sodium citrate and 13.5 grams of dextrose anhydrous (sugar) per litre of water.

Many commercial drinks claiming to be ORS, however, deviate significantly from these standards. These beverages often have around 120 grams of sugar per litre with about 110 grams coming from added sugar. Their electrolyte levels are also inconsistent like 1.17 grams of sodium, 0.79 grams of potassium and 1.47 grams of chloride per litre which are far below the WHO-recommended amounts.