Bali Belly: What You Need to Know Before Travelling
“Bali Belly” is a colloquial term for traveller’s diarrhoea experienced by visitors to Bali. This condition is primarily caused by ingesting contaminated food or water, leading to gastrointestinal distress.
What Causes Bali Belly?
Bacterial Infections
Bali Belly is often caused by bacterial infections, with Escherichia coli (E. coli) and Shigella species being the primary culprits. These bacteria thrive in environments with poor sanitation and are commonly found in contaminated food and water. When tourists consume contaminated items, the bacteria enter the digestive system, causing symptoms like diarrhoea, nausea, and abdominal cramps. One research highlights that in regions with high tourist activity, these infections spike due to increased consumption of local foods.
Parasites and Viruses
Besides bacteria, various parasites and viruses also contribute to Bali Belly. Pathogens such as Entamoeba histolytica, which causes amoebiasis, and Norovirus, known for causing gastroenteritis, are prevalent. These pathogens can be ingested through contaminated water, undercooked food, or by touching surfaces where these organisms reside.
Studies indicate that outbreaks of these infections can be linked to water sources not treated according to global health guidelines. When these microorganisms infect the intestines, they disrupt normal digestive processes, leading to severe gastrointestinal symptoms.
Different Food Hygiene Practices
Different food hygiene practices are a significant factor in the spread of Bali Belly. Street vendors and some local eateries may not adhere to the same food safety practices tourists are used to, increasing the risk of contamination. This includes improper handling of raw ingredients, inadequate cooking temperatures, and insufficient storage conditions, which all contribute to bacterial and parasitic proliferation.
A 2019 study found that the risk of gastrointestinal infections rises in areas where food hygiene practices vary from what tourists are accustomed to. Regular inspection and improvement of food handling practices in these areas can significantly reduce the incidence of Bali Belly.
Why Locals Don’t Experience Bali Belly
Acquired Immunity
Locals have developed immunity to the pathogens due to repeated exposure over time. This adaptive immunity helps them resist infections that commonly affect tourists. Research has shown that continuous exposure to local bacteria and viruses enables the immune system to build a robust defence against these pathogens.
Essentially, locals’ immune systems are accustomed to the specific strains of bacteria and viruses found in their environment. Over time, their bodies have learned to recognise and efficiently fight off these microorganisms, which significantly reduces the likelihood of developing symptoms when exposed to them. This acquired immunity is a natural defence mechanism that develops through persistent, low-level exposure, which tourists typically lack.
Different Eating Habits
Locals tend to consume food from known, trusted sources and follow safe food handling practices more consistently than tourists. They are more familiar with which food and water sources are safe, reducing their risk of ingesting contaminated items.
Studies have found that locals’ awareness and adherence to safe food practices contribute significantly to their lower incidence of gastrointestinal infections. For instance, locals often know which street vendors maintain better hygiene or which water sources are reliably clean. Their eating habits are shaped by local knowledge and experience, which allows them to avoid high-risk foods and beverages.
Additionally, locals prepare food at home using methods that minimise the risk of contamination, further protecting them from gastrointestinal issues.
How to Avoid Bali Belly
1. Drink Bottled or Treated Water
One of the easiest ways to avoid Bali Belly is to drink bottled or treated water. Avoid tap water, ice in drinks, and even brushing your teeth with tap water. Always ensure that the seal on bottled water is intact before consumption.
2. Be Cautious with Food Choices
Choose food from reputable restaurants and avoid street food unless you are confident about the hygiene practices. Opt for hot, freshly cooked meals rather than raw or undercooked foods. Wash and peel fruits yourself, and avoid salads and unpeeled fruits that might have been washed with contaminated water.
3. Practise Good Hand Hygiene
Regularly washing your hands with soap and water, especially before eating and after using the toilet, is crucial. If soap and water are not available, use a hand sanitiser with at least 60% alcohol. This practice helps minimise the risk of ingesting harmful pathogens.
4. Use Food Safety Practices
Ensure that your food is cooked thoroughly and served hot. Avoid eating from buffets where food might have been sitting out for long periods. Be wary of dairy products that may not be pasteurised and avoid foods that are commonly associated with higher risks, such as shellfish.
Is It Possible to Build Immunity to Bali Belly?
Gradual Exposure
Building immunity to Bali Belly involves gradual exposure to local bacteria and viruses over time. This process can take months to years and is not practical for short-term tourists. Continuous low-level exposure helps the immune system recognise and fight off these pathogens more effectively.
Long-Term Residency
People who live in Bali or other similar regions for extended periods tend to develop immunity to local gastrointestinal pathogens. This acquired immunity results from frequent and repeated exposure, allowing the body to adapt and create a robust defence mechanism.
Probiotics and Diet
Some studies suggest that consuming probiotics can help strengthen the gut’s defence against harmful bacteria. A balanced diet rich in local foods may also aid in adapting to local microorganisms. However, this is not a guaranteed method to prevent Bali Belly, especially for short-term visitors.
Similar Conditions in Other Countries
Delhi Belly
Delhi Belly is a similar condition experienced by travellers in India. Like Bali Belly, it is caused by bacterial infections, particularly E. coli and other enteric bacteria. Poor sanitation and varying food hygiene practices contribute to the spread of this condition among tourists.
The symptoms are akin to those of Bali Belly, including diarrhoea, abdominal pain, and nausea. Studies show that the incidence of traveller’s diarrhoea in India is significant due to the high tourist influx and the diverse food practices.
Montezuma’s Revenge
Montezuma’s Revenge refers to traveller’s diarrhoea experienced in Mexico. This condition is often caused by ingesting contaminated food or water, with E. coli being a frequent pathogen. Similar to Bali Belly, tourists are susceptible due to different hygiene standards and unfamiliar pathogens. Symptoms include diarrhoea, cramps, and sometimes fever. Research indicates that maintaining good food and water hygiene practices can reduce the risk of contracting Montezuma’s Revenge.
Pharaoh’s Revenge
Pharaoh’s Revenge describes traveller’s diarrhoea in Egypt, primarily resulting from consuming contaminated food and water. The pathogens involved are similar to those causing Bali Belly, including E. coli and other bacteria. Tourists experience gastrointestinal distress due to exposure to unfamiliar bacteria and viruses. Studies suggest that adherence to safe food and water consumption practices can mitigate the risk of developing this condition.
Understanding and Managing Bali Belly
Bali Belly is a common ailment among tourists due to exposure to unfamiliar pathogens in food and water. Understanding its causes, such as bacterial infections and different food hygiene practices, and recognising why locals rarely experience it due to acquired immunity and eating habits, are essential.
By practising good hand hygiene, being cautious with food and drink choices, and understanding the risks, tourists can significantly reduce their chances of experiencing Bali Belly. While building immunity through gradual exposure is possible, it is impractical for short-term visitors. Hence, preventive measures are crucial for a healthy and enjoyable stay in Bali.
References
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- Sriratanaban, A., & Reinprayoon, S. (1982). Vibrio Parahaemolyticus: A Major Cause of Travelers’ Diarrhea in Bangkok. the American Journal of Tropical Medicine and Hygiene, 31(1), 128–130. https://doi.org/10.4269/ajtmh.1982.31.128
- Widiarsani, N. P. S., Yanti, N. L. P. E., & Devi, N. L. P. S. (2023). Factors Related to the Incidents of Travelers’ Diarrhea in International Travelers in The Jimbaran Area, Sub-District of South Kuta, Badung Regency. Journal of a Sustainable Global South, 7(1), 5. https://doi.org/10.24843/jsgs.2023.v07.i01.p02
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- Wahyuni, N. W. M. S., Wirawan, I. M. A., & Hendrayana, M. A. (2019). Risk factors for diarrhea among travellers visiting Bali. Public Health and Preventive Medicine Archive, 7(2), 121–126. https://doi.org/10.15562/phpma.v7i2.222
- Masyeni, S., Sukmawati, H., Paramasatiari, L., Aryastuti, S. A., Somia, K. A., Kambayana, G., Astika, N., Duarsa, R., & Merati, T. P. (2017). Diarrhea Among International Travelers in BaliIndonesia: Clinical and Microbiological Finding. International Journal of Travel Medicine and Global Health, 5(3), 84–88. https://doi.org/10.15171/ijtmgh.2017.18
- Sukrama, I. D. M., Pinatih, K. J. P., Hendrayana, M. A., Rasyid, B., & Wedari, N. L. P. H. (2022b). Escherichia coli Clonal Variability Based on Genetic Diversity Pattern with Enterobacterial Repetitive Intergenic Consensus-Polymerase Chain Reaction Methods for Traveler’s Diarrhea Cases in Bali. Open Access Macedonian Journal of Medical Sciences, 10(A), 752–760. https://doi.org/10.3889/oamjms.2022.8990
