New remedy

New remedy diarrhoea is one of the major killer diseases among children in poorer countries. Over three million kids die every year due to diarrhoeal diseases, many of whom can be saved. One of the simple and most effective means of preventing these deaths in children has been the oral dehydration therapy (ort), which was developed in the 1960s. Giving sick kids this fluid helped prevent between one to two million deaths every year. Not surprisingly, the prestigious British medical journal, The Lancet, hailed this simple solution of salt and water as the most significant medical discovery of this century. Despite the great strides made in combating diarrhoeal diseases, ort continues to remain the backbone of this disease control programmes.

Despite being simple to prepare and easy to use, ort has some limitations. Its usage has not spread to many poor homes where most kids fall ill with loose motions. Oral dehydration with commercial or home developed fluids such as coconut water and cooked rice water do not reduce the loss of fluid through stools. In fact, the glucose-based oral dehydration solution (ors ) recommended by who creates a more serious problem as it actually increases the outpour of fluid from the gut. This has somewhat reduced the acceptance as mothers feel that ors is ineffective. There have been attempts over the past three decades to find an equally effective and universally acceptable alternative to ors.

Now researchers from the Christian Medical College and Hospital ( cmch) in Vellore, Tamil Nadu, in collaboration with an Australian scientist have come out with a better ors . B S Ramakrishna and his team from cmch along with Henry Binder from Flinders University of South Australia, Adelaide, have developed a new glucose-based oral rehydration solution. They added amylase-resistant starch that is poorly digested in the intestine. Amylase is an enzyme that breaks down starch. "This addition of a resistant starch to oral rehydration solution reduces faecal fluid loss and shortens the duration of diarrhoea in adolescents and adults with cholera," write the authors ( The New England Journal of Medicine , Vol 342, No 5).

It has been found that short chain fatty acids can help the absorption of the fluid in the colon. If starch were mixed with the ors, some of the undigested starch would move through the small intestine, without being absorbed, and enter the colon where they would be broken down by the bacteria present to create small chain fatty acids. In the colon, the short chain fatty acids facilitate the absorption of salt and water besides providing the additional energy needed for the eventual reduction of diarrhoea. In this study, Ramakrishna's group used two sources for starch - rice flour as well as Australian maize starch.

The researchers found that ors with the added resistant starch reduced both the amount of fluid lost in diarrhoea and shortened the duration of illness in patients with cholera. Thus the overall weight of the stool as well as the mean duration of diarrhoea were almost halved in three days. What is more, this study suggests that the resistant starch therapy could be used to treat other types of diarrhoeal diseases also.
Scientists consider the new ors a significant step towards the control of diarrhoeal diseases, especially the use of starch. The significant part is the availability of this cereal in all the poor communities where cholera is rampant. In addition, the rice-based ors has an added advantage. Besides treating cholera, the added starch serves as a nutritional supplement during diarrhoea when patients become weak. But the issue of cooking of rice to prepare remains a problem. To overcome this, pre-cooked hydrolysed rice ors has been prepared. According to Binder, the starch source could also be green banana, cooked and cooled potatoes and maize.

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