First of all, there is no magic right or wrong advice to staying well and how to avoid getting sick eating in Vietnam. However, if you take multiple, sensible precautions then you greatly reduce that risk. Win, win.
A nutritional therapist’s dream
So let me start with saying that by eating largely gluten & dairy-free, fresh, unprocessed foods and long-cooked broths your tummy is in for a real treat. As a nutritional therapist and foodie, this is a fabulous way of eating for your health and your tummy. That is unless you plan to tuck into the carb-and-sugar-overload international hotel breakfast which would make even the hardiest digestive tract run in the opposite direction. Or fill up on Asian junk food from the Circle K stores. However, if you plan to eat like the locals do, then you’re onto a winner. But, and this is a big but, the cleanliness and sanitation is nowhere near what you’re used to in Europe or North America. Therefore this can put you at high risk of picking up unwanted pathogens such as bacteria or parasites.
Bacterial imbalance anyone?
Mostly, the bugs work their way through with no lasting ill-effect. In milder cases you may feel ill for a few days with no serious repercussions when home. Some cases are more serious forms of gastroenteritis (food poisoning), which cause continuing issues throughout your holiday and even when back home. This is often diagnosed later on under the umbrella term IBS, or more specifically, post-infectious IBS. With a dysbiotic state (imbalance of good and bad bacteria) in your digestive system, many health issues can occur as a result of your immune system being under attack from resident pathogens that snuck in when travelling. As a nutritional therapist, I see this every day in my digestive health clinic, and whilst my intention is not to scare you, it is to encourage you to be cautious.
Be cautious without worrying
Read this blog and you’ll discover how to avoid picking up unwanted bugs. You’ll also thoroughly enjoy and come to love the wonderful vibrant food that Vietnam has to offer. I’ll show you how to embrace street food without worry. This is an essential and truly amazing part of Vietnamese culture. In fact, when I researched before I went, I found many travellers said they got sick from tourist-oriented restaurant and hotels more than eating on the street.
Here’s my 11 top tips to keep you safe:
1 Eat cooked foods
This has to be number one on my list. And very luckily, in Vietnam this is super simple as generally they eat three cooked meals per day. By cooking the foods, bacteria is less likely to be an issue. When eating pho (Vietnamese national dish – noodle soup) the broth has usually been bubbling for hours and is likely to kill any little critters hanging around. Even better is if you can see the food being cooked in front of you – a distinct advantage of eating street food. Beef pho (Pho bo) is a popular food – just make sure the beef is cooked rather than raw when added to your broth. Avoiding salads is also a good plan. Luckily, they are often accompaniments to cooked food, so you can just leave it or throw it in your broth. Raw herbs are used a lot, we just threw them in our broth for flavour, you can choose not to eat them if preferred, the taste imparted just from being in the broth is reward enough for your taste buds.
2 Keep your hands clean
This should be obvious and I’m sure you do it after going to the toilet and before bed. But what about before you eat? Or eating hand-held food? What about before you rub your eye or lick your finger to turn over a page in your guide book? What about after handling money? Transmission of bacteria and parasites are usually via the faecal-oral route. Just think of all the doorknobs, handrails, handles you’ve touched on your travels. Add to this the people who don’t wash their hands. Yuk!
- Wash your hands whenever there is hot water and soap available.
- Air dry your hands (don’t use communal towels).
- Use your elbows and feet to open toilet doors on your way OUT – think of all the people who don’t wash their hands!
- Keep your fingers out of your mouth.
- Use hand sanitiser when water and soap is not available. Now let me make it clear I am not a fan of hand sanitisers ordinarily due to the chemicals contained that can affect hormones. However on balance I decided that two weeks of exposure was preferable to getting really sick! I found one without alcohol.
- Always wash your hands or sanitise them before you eat.
- Take travel wipes to wipe surfaces (aeroplane food trays) and cutlery.
3 Follow the queues
This is a traveller’s classic. And on the whole we’ve found this work really well. Once each in Hanoi & Hoi An we ignored our own advice as we were tired and hungry, we had a very disappointing meal. We weren’t ill, but the reason the places were empty is that the food wasn’t up to scratch. If there’s not a fast turnover of food, then it may have been sitting around a bit too long which may increase your risk of getting sick.
4 Check TripAdvisor
I really wish we’d checked more reviews as back-ups close to our hotel before we travelled to Vietnam. Whether it stops you getting ill, I can’t guarantee but good reviews (and plenty of them over time) generally indicates a popular restaurant with repeat customers. Remember that many street food stalls or very small restaurants won’t be on TripAdvisor, nor will ones that are frequented mainly by locals.
5 Watch the money
One of the reasons many people fall ill around the world is because of the bacteria on bank notes. Think how often they change hands – money is the most frequently passed item in the world! Vietnam is a cash economy; you’ll be handling money a lot. Vietnamese bank notes are plastic (like the UK new £5 notes), so it’s fair to assume they may be less likely to hold bacteria. The only member of our family to have a few hours of slightly-looser-than-would-have-liked bowels was my dear husband. The only difference was that he handled all the money!
- Check on street food stalls that one person is handling the food and another the money.
- Use your hand sanitiser after handling money (after a trip to the ATM).
6 Only eat fruit you can peel
In Vietnam this doesn’t mean missing out much at all. Fruits with thick enough skins to peel include bananas, rambutans, mango, papaya, custard apple, dragon fruit & pineapple to name a few. We avoided thin-skinned apples & pears (which actually mostly hotels provided in the room) and strawberries used as decoration. This photo was fruit provided in our room (for our wedding anniversary) – we ate the dragon fruit but left the pear.
7 Beware of the water – ice, bottled water, salads
This is probably another of the biggies. Bacteria & parasites are often water-borne and I have had many clients pick up nasty bugs white water rafting in Borneo or similar adventures. In fact just brushing your teeth in contaminated water can make you seriously ill. Without the fun of wild water rafting, damn. So what to do?
- Use sealed bottled water everywhere, even for teeth brushing.
- Ask for drinks with no ice (this is tough in 37 degree Vietnamese summer heat) but they often have refrigerated drinks anyway.
- Avoid salads that may have been washed in contaminated water.
8 Keep hydrated
Keeping well hydrated helps to keep your digestive system moving and will help to wash through any toxins. This is preferable to them taking up residence in your gut. Coconut water is an excellent drink to keep your electrolytes balanced when you are sweating lots in the humidity. In several places I ordered one, they came straight from a fridge so they were cold (without ice). I also watched one lady cutting it up after I ordered it – talk about freshly made to order! A caveat to drinking – drink mostly away from meals where you can. Fluid with meals dilutes stomach acid which is important to kill any incoming pathogens and to digest your food (particularly protein).
9 Clean your cutlery
Looking at street food stalls, you will often see hundreds of chopsticks in water that looks like it’s washed a hundred dishes with no washing up liquid! In a restaurant where you can’t see, you have no idea how clean they are. We watched one (pretty sizeable and very busy) restaurant wash up everything by hand in large un-soapy bowls, no super-hot dishwashers! Just be sensible:
- Give the chopsticks a wipe with a hand wipe.
- Take your own chopsticks as a back-up (we did but never used them).
- Then stick your chopsticks in your hot pho/broth before you eat.
10 Eat when locals do
The reason for this is that the food turnover is faster, leading to far less likelihood of food hanging around. Many street food sellers buy all their ingredients at market at 3am when markets open and keep selling food till they run out that evening. When the stalls are busy, food is never hanging around. We also found Vietnam fly-free (it may be different outside summer – we visited August). Or maybe it’s because flies only hang around rotting food?
11 Sugar feeds the bad bugs
A really simply science lesson: Sugar and refined carbohydrates feeds bad bacteria & parasites Vegetables feeds good bacteria It’s tempting on holiday, but favour real food over sugary ‘tourist’ desserts, international hotel sugar-and-carb-loaded croissants, doughnuts, breads and pastries. Feed your good bugs and not the bad ones.
Follow the 80/20 rule
Now I hear you say, that’s a faff, I’m on holiday. I don’t want to live by rules. Admittedly we didn’t always manage all of my own advice 100%. We ate salad where it was provided after a while, as it was part of the recipe we had been given (for example in Banh Xeo). We sometimes kept the ice in drinks too when we were frying from the heat. The kids had ice creams. But we kept to it the majority of the time and were always mindful. All I can advise is use your common sense, stick to the non-negotiables (handwashing, cutlery, fruit, bottled water and supplements), make an educated guess when you can take small risks and stay on track where it is possible.
What if I start to feel my tummy get upset?
Don’t panic! Often your tummy may take time to adjust to its new food sources and this is not a sign that bacteria have got in, but that it is getting used to new ingredients. Ginger tea is often enough to settle this. I always travel with Pukka Herbs Three Ginger & Three Mint teabags. As a nutritional therapist I always think prevention and use the power of natural supplements to keep me and my family protected when we’re travelling. This is one of my non-negotiables; my family just know they have to follow these rules!
What to do before you go
Start taking probiotics for one week before you leave for Vietnam. I use Optibac’s For Travelling Abroad and Allergy Research Saccharomyces Boulardii. The latter is not only researched for diarrhoea but is supportive of the immune system which helps your digestive system fight any incoming bugs that may slip in. Most folk won’t need the extra Saccharomyces Boulardii (the Optibac already has some in), but if you have a history of digestive upset and/or immune dysfunction then do consider it for additional protection.
What to pack with you
This is a key supplement; its primary job is to kill any pathogens that have snuck in to your stomach through your mouth so they can’t get through to the intestines. Stomach acid is your essential first line of defence. Take one before every meal. For children who can’t (or won’t) swallow tablets I use Nature’s Answer Bitters & ginger tincture.
These help to break your food down so that your food is digested and absorbed quickly giving YOU the benefit of the nutrients in your food and not your bad bacteria. We all have bad bacteria anyway and you certainly don’t want to feed them any more when on holiday. I travel with Just For Tummies Digestive Enzymes (which have stomach acid in too which takes care of the above).
A natural anti-microbial
This will be a godsend if you do get sick. Hopefully you won’t ever need them, but you’ll feel protected just taking them with you. I recommend garlic or oregano in supplement form. Just For Tummies do a garlic supplement.
If you do get diarrhoea, it’s wise to let it flow! Diarrhoea is your body’s way of ridding any toxins and as my dear Mum used to say “Better out than in!”. Simply take a plain, unsweetened electrolyte replacement sachet after each loose bowel movement. I use Dioralyte Natural. Avoid sport replacement drinks as these are often highly sweetened which will just feed any bad bugs you’re trying to wash out.
What to do when back home
Keep taking the probiotics for two weeks after you return. If you’ve had any upset and needed to take anti-microbials, then keep taking them and the probiotics for a month after your return.
Avoiding gluten and/or dairy?
If you’re gluten and/or dairy-free and would like advice on How To Eat Gluten And Dairy-Free in Vietnam, then read my blog here: Let me know in the comments if you’re planning a trip to Vietnam and if this blog has reassured you that’ll you have a great time.
If you find you easily get an upset tummy when at home or travelling, or think you have food intolerances, have a read of my 10 Steps To A Happy Digestion eBook and become your own digestive detective.
Jane Barrett is a registered nutritionist and expert in digestive health helping women & children with digestive issues take control of their health through food. She offers support through meal plans, online courses & personalised 1:1 programmes on Zoom.