BALI BELLY

Now we've all heard the term, but what is it exactly and how did Bali get lucky enough to have a tropical illness named after it?

'Bali  Belly' is not any particular illness as such. It's pretty much the blanket term used for any type of stomach upset experiened by anyone having been in Bali, with symptoms ranging from diarrhoea and abdominal cramps to vomitting and fever. This  affliction is not limited to Bali and goes by many names: Montezuma's revenge, Dehli Belly, Rangoon Runs and traveller's diarrhoea, to name a few. But what causes Bali Belly? Any number of factors can be attributed these symptoms:

Bacteria – Escherichia coli (E. coli), primarily enterotoxigenic strains (ETEC). This is one of the most common bacterial causes of traveller’s diarrhoea. Other bacterial causes of traveller’s diarrhoea include Campylobacter jejuni, Salmonella and Shigella. These infections are usually associated with severe abdominal pains and fever;

Parasites – certain parasitic infections are known to cause diarrhoea, including Giardia intestinalis, Entamoeba histolytica and Cryptosporidium parvum. In these cases, the illness lasts longer than a few days and the stools may be bloody;

Viruses – some estimates suggest that around one in three cases of traveller’s diarrhoea is caused by or associated with a viral infection, particularly norovirus and rotavirus;
 

Unknown causes – a cause can't be found in approximately one-fifth to half of all cases of traveller’s diarrhoea. It is thought that diarrhoea may be the gastrointestinal system's response to unfamiliar micro-organisms or simply a change of diet. 

A change of diet can affect the digestive system and consistency of bowel movements. Chances are you will be eating a lot of different things your not used to eating, which may include lots of fresh fruit and food that is more spicy than you are used to.

You're probably not going to want to spend your time in Bali confined to a hotel room because you have to make a mad dash to the toilet every ten minutes, so how do you prevent yourself from getting sick while you're here?

I've read many a blog and traveller info website that tell you to stay away from eating pretty much everything from raw fruits and vegetables to seafood and market stall food. Experiencing the local gastronomic delights is part of the travel experience and if you are not going to venture to try anything new for fear of getting sick, then you might as well save yourself the plane fare, stay home, order a pizza and watch Discovery Channel instead. 

There are some things, however that you can do to minimize the chance of getting sick. these are my personal tips:

1. Though it's advised to stay away from salads and strange fruits and vegetables, I say knock yourself out - just be careful not to go overboard and any one particular type of fruit or food that you're not used to eating in abundance. Papaya and young coconut water, for example are natural laxatives. Guava and not drinking enough water on the other hand, can make you constipated. Which brings us to my next tip...

2. Make sure you are drinking lots of water and make sure it's bottled water. That having been said, it would be also better for you to bring a refillable water bottle than getting a plastic bottle every time you are thirsty. A lot of places have free water refills if you bring your own bottle. Water from the tap in Bali is not treated, so you never know what's in there. There's lots of talk about not ordering ice in your drink, but if you are in even a half decent restaurant or hotel, the ice will either be made of bottled or boiled water. If you are in a more local establishment and you are unsure, ask! I have been to places where I'd talked to people who believed that simply freezing the tap water will kill bacteria. It's one of those misconceptions of some of the Balinese that has arisen due to the fact that the Balinese don't usually put ice in their drinks as it's believed that it will result in 'masuk angin'. Check out my blog musings of a balinese princess entry about 'masuk angin'.

3. Even if you are at home, you want to make sure your meat is cooked through. Sushi and steak tartare is not traditional Balinese fare, so best stick to the cooked meat. If your chicken looks a little pink, don't risk it and send it back to be cooked longer.
 

4. Ideally you are going to want to steer clear of dairy, especially things like mayonnaise. Your best bet is to be eating food that is usually eaten here. The Balinese know how to cook and keep local food properly. After all, if it makes you sick, it will make them sick, too. But where you'll run into problems is getting 'foreign' food cooked by someone who never eats it, so it may not be cooked or stored properly or may be kept past its expiry and that's when you'll run into trouble.
 

5. Market stalls and street vendors are said to be, according to all the info I've read out there, ground zero for Bali Belly. Food is really part of the experience and chances are, if you are eating in a restaurant the whole time you are in Bali, even the Balinese dishes you order are being cooked and altered to cater to western tourists, so you really are not eating real Balinese food. If you eat food in the market that is cooked in front of you, then there's less of a chance of you getting sick. However, a lot of the food in market stalls or the local 'warung' is prepared before hand and on display in the stall window for you to pick and choose. Whether or not you should venture to try it will really depend on how adventurous your normal eating habits are. Do you travel a lot and regularly eat local food in developing countries? If yes, then go for it. If not, you may want to give it a pass. Now remember, the Balinese are not immune to food poisoning, so you can be sure that you are unlikely to get that at the local vendor, but it's more of a case of exposure to micro-organisms, the effects of which the Balinese are much more resistant to from living here in conditions which are probably a bit different than where you're from. This brings us to my last tip.... 

6. Eat a handful of dirt every once in a while. One of the main reasons westerners are so quick to get an upset stomach and gastrointestinal issues, is due to living in the land of anti-bacterial and disinfectant everything, which has left the average westerner unaccustomed to any micro organism even remotely foreign. As their bodies have never been given the chance to build up an immunity, first contact has them rushing to the toilet, making up catchy names for something that they blame on Bali.  

  
Disclaimer: as you may have guessed I am no doctor, so take this info as my personal observations, opinions and suggestions based on having lived in Bali for 7 years and North Sumatera for 4 years. I now possess the stomach of steel, can eat anything, anywhere and I like my food spicy, cause that's just how I roll.