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  WINDY CITY TIMES

Doctor Eduardo Dolhun reinvents oral rehydration
Special to the online edition of Windy City Times
by Sarah Toce
2014-11-03

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The subject of dehydration has been one of the top issues in western medicine for about 100 years, and oral rehydration therapy has been studied for at least 50 years. New products surface rapidly in the marketplace with the ever-growing trend of athletic endurance and supplemental health "cures" and "remedies," but the art of rehydration has been very rarely understood by consumers. And it is critical especially for those with compromised immune systems.

"Our bodies are incredibly good at balancing everything out. So you can go and eat two Big Macs and a shake and top it off with some ice cream and a couple pickles, and the body amazingly will make everything work out. You wake up the next day, maybe with a little indigestion, and you're okay," said Dr. Eduardo Dolhun, founder and chief medical officer of Drip Drop. "There are college students that can get fueled by a combination even worse than that."

So, then what's the problem?

"The problem begins when you're stressed. If you're running a marathon, if you're trying to go through a desert, it's really hot outside, you have hyperemesis gravid arum, women they have the nausea from being pregnant, that first trimester nausea, you have nausea diarrhea, you're really sick with a fever … all of these things. In these situations, you become very delicate, very fragile, quickly," said Dolhun. "It's in these situations in which everything you put in your mouth becomes increasingly more important."

The art of hydration is anything but an ordinary feat for our bodies, and yet it seems so simple—until you understand how everything must work together to create the desired result.

"When you put water into your body, it goes into your small intestines and then down into your 21 feet of intestines and about six feet of colon. If you stretched out all your intestines it would cover a football field. The surface area is unbelievable," explained Dolhun. "The body has these little villi, like a rug, so the surface area explodes. Each part of your small and large bowels has a specific absorption capacity."

"Chelsea Clinton [recently] came out boldly stating that she's obsessed with diarrhea. And it's very interesting her position, because it's not a glamorous condition," said Dolhun. "Dehydration due to diarrhea affects everybody around the world and it's a normalized condition. So it's kind of like driving a car—it's actually very hazardous, it's a risky proposition, much more dangerous than flying a plane. But when a plane crashes it makes front-page news; when two people die in a car crash it doesn't. My belief is that it's normalized and so if it's happening to us how bad could it really be? And what we find now is that [dehydration] is actually really bad."

In order to understand a man's passion for his product, you must understand the man himself. The San Francisco family physician is as much emotionally involved in his patients' health as he is in their individual care.

"I see individuals of all ages. Family physicians like to say we take care of everybody from the womb to the tomb," said Dolhun. "We form deep relationships with our patients throughout the entire life cycle. We aren't organ specific like a cardiologist, a nephrologist—kidney doctor. We understand patients in their full context, in their families, their communities, and that's very important because how one behaves within the family, the belief systems you carry down from your grandmother that may have come from Russia or your father that may have come from China—all of those belief systems permeate the culture through the food we eat."

A graduate of the Mayo Medical School, Dolhun is regularly sought after by his peers and elders for his expertise and dedication to oral rehydration therapy, but he chooses instead to continue his loyal practice in the City by the Bay, with the patients he has come to know and love.

"The reason that I got involved and became passionate about finding a better rehydration solution is that oral rehydration therapy used around the world via the World Health Organization and UNICEF in the last 30 years has saved 5 million children [ages] four and under. More children were dying than AIDS and malaria and tuberculosis combined. And today it's the No. 2 leading killer of children four and under," said Dolhun.

The young doctor traveled to Guatemala as a medical student and witnessed firsthand the critical issues involved in dehydration in developing countries.

"The global awareness that I had when I went to Guatemala is the same global awareness that Chelsea had when she went to Africa. So this is what I wanted to champion and as a family physician in San Francisco being surrounded by a lot of entrepreneurs, I heard the same story. We have a problem, I thought a lot about it, I wanted to do something about it, became passionate, and then I came up with a solution. And that's the simple recipe for innovation, is somebody becoming very, very determined and persistent to come up with a solution to a very personal problem that touched all of my patients," said Dolhun. "What I found as a physician [after] 14 years in the private practice—is that the WHO solution, which has saved 50 million children in the last 30 years, tastes awful. It saves those children because when they get close to dying they'll drink it or you can put a tube in their mouth or their gut and it's life-saving. It's simpler and faster to use than an IV."

What Dolhun came up with next was an oral rehydration solution ( ORS ) called Drip Drop. Not only did it taste good, people actually wanted to drink it. Drip Drop won the 2014 Edison Award on April 30. The Edison Awards are among the most prestigious accolades honoring excellence in new product and service development, marketing, human-centered design, and innovation.

"We've come up with what's considered one of the top two medical interventions of the 20th century along with antibiotics and vaccinations. And bang for your buck, nothing else comes close. I figured everybody wants a single, simple solution that tastes good, and in my clinic in San Francisco I started formulating the same way all science is done—you just start. And over three and a half to four years we came up with a solution that I believe is groundbreaking and revolutionary," said Dolhun.

Drip Drop. It sounds like an IV.

"I chose the name Drip Drop one day when I had a patient in the hospital on drip IV," said Dolhun. "My former girlfriend had a leaky radiator dripping and I wake up in the morning and I go, "Gosh, we haven't come up with a name for the company." Then I hear "drip … drop …" so I went on the computer."

"Drip Drop has the taste profile of a sports beverage. And it has the medical efficacy of an IV," Dolhun added.

How does Drip Drop's taste compare to competitors like Pedialyte?

"Pedialyte is still not as effective for severe dehydration as the World Health Organization mixture and is used a lot, but still has this awful taste," said Dolhun. "It has a taste that they've struggled with. It's pretty well-known, it's written about, documented. Palatability has become a big barrier."

How did they manage to break that taste barrier?

"It would be like having the best pasta sauce maker in Italy tell you how she makes it tastes good," said Dolhun.

One of Dolhun's patients, former Chicagoan LGBT activist Peggy Garner, believed in Drip Drop so much she started drinking it herself—and then invested in the company.

"I became interested because I'm a patient of Dr. Dolhun's and he talked very passionately about his issue," said Garner. "And like all of his patients, we've become very, very good friends. I've used it as different times, because I have been in the hospital and had surgeries and have gotten released and needed something to drink."

But that was just the beginning of Garner's experience with the product.

"[Drip Drop] really showed itself up even more importantly when my father-in-law was dying. He had COPD. And in the last six months of his life, he wasn't really able to ambulate. He also didn't really want to eat a lot, but he certainly didn't want to drink. And Ensure was just icky, he didn't like it. But he needed to get nutrition and he needed to make sure that he kept himself hydrated. He died eventually, at home, but for the last six months he was drinking a glass of Drip Drop a day. He would drink it because it tasted good. That's kind of a testimonial to what it's like and when you refuse all other kinds of things."

Garner became inspired and shared the drink with her friend—an HIV-Positive writer named Krandal Kraus. She believed Drip Drop would help him feel less terminal and more involved with life again. Krandal suffered from depression stemming from the complications of his HIV status. Krandal, who lives with his partner, did not believe, but decided to give it a try anyway.

"When our medication wears off around 11:30 a.m.-12 p.m. every day, I'm usually out in the yard, he's doing something either in the yard or on the computer, or with one of his many projects, and we're run down and we're hot. And before I lie down I have some Drip Drop, and by the time I wake up I'm raring to go. And he's always exhausted. He falls asleep before his head hits the pillow," said Krandal.

Krandal's partner has not touched Drip Drop, instead, saving it for Krandal's use.

"I'm going to encourage him to try it and see if it helps him feel better," said Krandal. "I've been very selfish about Drip Drop and I make no apologies for it, because I feel like Lazarus, it's just like, 'Whoa! Roll that rock away, I'm coming out.'"

"Drip Drop can help HIV patients because you have a predictable, safe, and effective means of rehydrating yourself either on a day-to-day basis or when you're acutely ill. So it's a chronic condition punctuated with episodes of acute illness: nausea, vomiting, diarrhea, bronchitis, and fevers—situations in which you can become even further depleted of water and electrolytes," said Dolhun. "Drip Drop can help in affording you a predictable level of daily hydration and something that you can use more of when you have vomiting, diarrhea, to hopefully avoid a trip to the emergency room."

Being a patient in the emergency room can prove complicated when you have HIV.

"Certainly when you have HIV you're already more at risk of getting opportunistic infections, and the last thing you want to do is go to the emergency room and be exposed to people there with the flu virus," said Dolhun. "So you go to the emergency room for simple dehydration and you walk away with the flu two days later, which puts you back in there and maybe in the ICU. By drinking Drip Drop, you avoid the whole drama, the whole fire drill of essentially getting in the car, calling 911, just to get one or two bags of seawater pumped into you. There's no more magic, that's it. It's a very costly endeavor to get a little salt into your veins, doing it through an IV in the emergency room."

Regarding athletics, is timing really everything where Drip Drop is concerned?

"People ask us all the time when they should drink Drip Drop when running or exercising? Before? During? After? And it really depends on your preference," said Office Manager Brooke Thivierge. "All of us at the office drink it every day and we have different strategies for when we drink it. But I drink half before and half during a run. Or I drink all during yoga, for example."

One of the biggest noted drawbacks for customers consuming sports drinks is the added sugar, but Dolhun insists that some sugars are actually required for appropriate rehydration.

"[There are] sugars in Drip Drop, just a lot less than in sports drinks," said Dolhun. "Sugars are an important component to driving the whole optimization of an oral rehydration solution. They're key. You actually need some sugar along with the salt to get the salts and electrolytes out of your stomach and into your bloodstream [known as the sodium glucose co-transport system], and combined in a way that makes it work. Even if it didn't taste better you'd have to do that."

Another common issue with sports drinks is sodium, which is also a necessity according to the doctor.

"Depending on how old you are and your sex, you're made up of about 85 percent water. It's almost like the ocean. We're really these water bags, if you will, with electrolytes. I always like to say that hydration has two parts—one part is water, the other part is salt," said Dolhun.

"You don't find a lot of companies that start with a philanthropic mission simultaneous to when they bring the product to market, but that is one of the things that Drip Drop has been committed to since the beginning, because the company was founded by a doctor who was in Guatemala on the ground watching what had happened; he's been to Haiti, he's been to Pakistan," said Thivierge. "Drip Drop is simultaneously building a philanthropic and humanitarian mission at the same time that we bring this product to market in the United States. And that is a huge commitment for us, but it's so important to everything that we do to make sure that we're able to ship it to people in Africa who are dying."

Thivierge noted that at the present time shipping overseas falls on the company's shoulders.

"Eventually our hope is that those distribution channels will manifest themselves, but for now we're going to do that. It's a big, important, and very exciting part of the company, and it's why I think most of us are here," she said.

The reaction to Drip Drop by the World Health Organization has been overwhelmingly encouraging.

"In the last year I've made two trips to Sweden to meet with Olivier Fontaine who has worked with the World Health Organization heading up the diarrheal disease section. He was one of the early thinkers behind oral rehydration therapy and for the last 30 years very much involved in its implementation, making it more aware and more accessible to individuals around the world," said Dolhun. "He regularly travels to Africa, volunteering his time, as well as with the World Health Organization. Both of the times we met he looked at our formulation and it's very clear that the World Health Organization contents and Drip Drop contents are very similar—we're not equal, because we are, in my opinion, the next generation of oral rehydration solution. But the main and the active ingredients are so similar that it got him excited to take Drip Drop to Dhaka, Bangladesh, which is essentially the Indy 500 of dehydration testing, because they have cholera."

Thivierge added that the Drip Drop team considers itself a medical-first company.

"We happen to be used by every day people and we happen to be used by athletes, but the focus is being able to go to Bangladesh and to help these kids with cholera or to be relevant in a hospital setting where you don't have to also intubate a child to make them drink a solution that they otherwise wouldn't drink," said Thivierge.

A growing trend in the United States is drinking coconut water, but Dolhun cautioned against being led blindly onto the bandwagon.

"Coconut water is not standardized. The level of potassium and sodium and sugars in your coconut water varies, because they're picking coconuts at various levels of maturation and it all changes. So you don't have predictable delivery of a fluid with coconut water," said Dolhun. "You can kind of ballpark it, but with Drip Drop you get a nice, precise mixture and you have precision dosing for your patient, which is great. I know that when they drink one packet of Drip Drop, the level of sodium, potassium, magnesium, citrate, and that's excellent—it allows for more sophisticated rehydration techniques."

Still, Dolhun said there is a time and a place for coconut water and other juices and liquids.

"I think you have to look at everything in context. Coconut water against sports drinks—we found out a decade ago that drinking sports drinks; they have a lot of sugar, more sugar than coconut water. Coconut water does not have nearly the amount of sodium required to rehydrate you," said Dolhun.

Is there a reason to stay away from coconut water?

"Certainly, one needs to be concerned if they have a kidney disease or a heart disease with potassium—we call them potassium-sparing medications—so people with congestive heart failure should be cautioned to run coconut water by their cardiologist or their internist because it has such high levels of potassium," said Dolhun. "But the average healthy person with a healthy heart and healthy kidneys can easily drink coconut water."

Now that Drip Drop is on store shelves, is it even affordable? The simple answer is: yes.

"It's always over-the-counter, and the cost is competitive to Pedialyte or even a sports drink," said Thivierge. "It costs $9.99 for 64 oz., which comes out to a little bit over a dollar a serving."

"Because Drip Drop packs a punch, you really have to drink a lot less. And that's really where the benefit is, it's so well-formulated that you'll achieve hydration much quicker and with less of the product. So instead of buying two or three bottles of Gatorade, you only need one little Drip Drop," said Dolhun.

Eventually, the long-term strategy is to offer Drip Drop as a reimbursable medical product through HSA accounts.

"Medicare, that's the Holy Grail for medicine. Once Medicare is involved—and you put Drip Drop against an IV to rehydrate someone, you're looking at minimally $1,500 versus $10," said Dolhun.

Currently, Walgreens and CVS carry Drip Drop for their customers and Drip Drop has been available on Amazon for more than a year. The results have been completely organic.

"There's no marketing. We have marketed zero. It's just all [based] on quality," said Dolhun.

"This is something that we feel should be in every home and in every medicine cabinet in the country," said Thivierge.

Getting Drip Drop into the hands of medical practitioners is perhaps one of the company's biggest goals.

"One of the things we're doing is a direct marketing campaign with physicians," said Dolhun. And that means simply going into a doctor's office and asking them to try the product with their patients and see the response.

Validation will be key in obtaining future funding and the wheels are already in motion.

"Mayo Clinic is running some studies. We have a research pipeline in order to get validation that Drip Drop is effective in the hospital setting," said Eduardo.

In the meantime, Drip Drop already has the World Health Organization's seal of approval and is FDA approved.

See dripdrop.com/ .


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