Bali Blog

BULE BELLY aka BALI BELLY

Bali Belly is a term adopted by visitors to Bali for Traveler's Diarrhea.  Balinese rarely get it, so it should really be called Bule (foreigner) Belly.

When visiting a foreign country, many things are foreign to you: customs, laws, weather, etc. However, as a foreigner, many things in Bali are foreign to your gut, and it can take some time to adjust.

 Here is the A-Z of types of Belly problems that you may get if you come to Bali, the why, the how and the what to do.

1. Alcohol drinkers often indulge more when on holiday. Often drinking in the heat, or after swimming in the pool, where they don't realise they are dehydrated. Even those who do not drink alcohol usually overindulge in other drinks, such as fruit juices, yummy sweet coffees, mocktails, all contributing to dehydration or sugar buildups in the gut.
2. Bacteria. There are many bacteria in your gut, but your gut is not used to the fact that people who live here can carry around good gut bacteria, some of which can be bad for others.  But then there are the bad bacteria found in water here. Some hotels have filtration systems, some areas have completely different mains water sources depending on the area you stay in, so avoid brushing your teeth in the water.
3. Consumption. There's a change in consumption habits on holidays; you spend a little more, you shop a little more, eat a little more or less, it's all a change in your normal routine.  Any change in routine, such as your eating times/what you consume, is an adjustment for your gut.
4. Dengue Fever. Now, some people have mild symptoms, and some have fatal ones.  The most important thing to do is to always use insect repellent and reapply after swimming/sweating/showering. Although Dengue has other symptoms, some people in the first 24 hours believe they have Bule Belly as their systems start with nausea and fever. It important if you have pain behind your eyes and rash on your torso to go to a hospital.
5. Eating. Your diet changes on holiday; it's foreign to your gut. It's rarely food poisoning and it's more often a change of diet.
6. Fruit: Most travelers eat a lot more fruit in Bali than they do at home. Consuming more fruit can lead to an upset stomach or diarrhea because of the high fibre and fructose content, especially if you are not used to it. You will most likely get used to it, but don't panic if you are on the toilet for hours in the first few days of your trip.  Try cutting fruit consumption out until you feel better, then try to reintroduce it slowly. Many tropical fruits are foreign to your gut.
7. Gastroenteritis can be caused by many variants, but the first course of treatment is hydration, rest, and, when feeling better, introducing bland foods. Some tourists feel like their holiday is wasted, spending days in bed, and want a Doctor after 24 hours. But really, the body is telling you what to do.
8. Heat, this one is a huge one; heat exhaustion can affect the digestive system, leading to dehydration. Dehydration alters the balance of fluids needed for healthy digestion and can lead to diarrhea.
9. Influenza, your nasal passages dry out on the flight over (and the hours waiting in airports), you are spending a lot more time in the AC, which makes you more susceptible to catching colds and the flu. Children often suffer from diarrhea and nausea when they catch the flu.
10. Juices, aren’t they yummy? Often, the morning buffet at your hotel serves quite sweet juices, or when you're out and trying to be good and not have alcohol before noon, the choice of a fresh juice may appeal.  But how often do you drink that much juice at home?  It's foreign to your gut. Juice does not contain the electrolytes; the high sugar build up can cause gut issues. Do try a young coconut, though, not the crap in the boxes, a fresh young coconut will replenish/hydrate and help your gut…great as a hangover cure.  Ask for a Kelapa Muda (young coconut), especially when at the beach, nothing better.
11. Kopi (Coffee), you are on holiday, an extra coffee or one of those lovely iced coffees is a treat. You may think you drink the same amount back home, but the milk here is different, foreign to your gut. Those Indonesian packet coffees you love are full of sugar and, of course, terrible non-dairy creamers that are banned in some countries.
12. Imodium or other diarrhea stoppers (Lodia is a local name for Loperamide). It's not a good idea to block your bowel movements when you have a bacterial infection or a change in diet. You don't want to stop going to the toilet altogether, as you need to flush all the toxins out that your body is trying to get out. Norit activated charcoal tablets are a good one to absorb the toxins and stop the trots. 
13. MSG. Now, you may consume some in your country, but it is used a lot more here, that's why everything tastes sooo good. But it could be foreign to your gut.
14. Norovirus, you’d think people would have learnt with COVID…Wash your hands often and well, especially if using public bathrooms at the hotel lobby, hotel swimming pool, restaurants, etc. Just like COVID, the biggest prevention is washing your hands after touching anything used by others. You are not at home, you are sharing facilities with 100s of other people.
15. Oil. Have you ever wondered why you can't get your Nasi Goreng to taste the same when you get home and make it?  It's the palm oil.  Back home, you may consume various cooking oils, or salad oils, such as Olive Oil and Sunflower oil, or even canola oil.  The oils here used for cooking in local food places, where you get that yummy Nasi Goreng, are refined palm oil, and your tummy is just not used to that.  It's high in fat, often of poor quality and can cause diarrhea, stomach pain and nausea.    Even the doughnuts tourists love, the cheap packets of chips, the chocolate bars, all the cheaper, yummy snacks use palm oil. It's foreign to your gut.
16. Parasites.  Most tourists worry about water or consuming food that may contain parasites, but don’t think about other parasites, such as worms found in animals here, such as the hotel cats, the cute puppies, etc.  It's a good idea if your children love animals to give them a worming tablet before the trip, and mum and dad can have one too.
17. Queues. You are going to be in some queues, at the airport, the hotel lobby, the buffets. tourist attractions. You will be hanging out, shopping, dining, or sitting in transport with people from all over the world.  Some tourists have travelled to many places and bring all sorts of fun bugs with them that you may be more sensitive to.  So, don't be rude and not shake someone’s hand or spray a tourist with disinfectant, but carry hand sanitizer and just use it often.
18. Rupiah. The Indonesian currency.  The dirtiest item you will touch when here. The money is made from cotton fibres that love to soak up all germs.  Indonesia is a country that uses its left hand for the toilet and although they are very diligent in washing their hands before every meal, well, you get the picture.  Never give a child spending money if they are known to hold things in their mouth.
19. Swimming Pools and showers. Don’t swallow the water. Villa pools are often not maintained daily like larger hotels, so just be more conscious, just like in showers, your tummy is not used to the microbes that people who live here are. You may be fine, but if you are slightly run down or have not been drinking enough fresh water, your system may react.
20. Toilets. No matter if you avoid the squats and you can manage the hover and not sit, the virus is spread all over the toilet when people flush without putting the seat down. (It's not common to put the toilet seat down here.) So, you really need to wash your hands thoroughly after touching the flush, the stall door, the door handles, etc.
21. Unclean: Wash your hands, wash your hands, wash your hands. A local would never consider eating until they have washed their hands. Local warungs all have wash basins in the front area for this purpose. It's a pity some of the Western-owned restaurants have not adopted the local way.  You can go into the restrooms and wash your hands, but then you usually have to touch a door handle to get back out again.  And remember, if you finish your lovely meal and pay in cash, wash your hands again.  Make sure you wash your children’s hands often, especially if they are young and are in that touch-everything phase.
22. Vegetables. Many tourists avoid salads, concerned with bacteria, but will happily grab a French fry in their fingers and pop it in their mouth when they have just touched their chair, their phone, shook hands with someone etc etc. Giving up your favourite salads for 2 weeks is really going to mess up your gut. Just avoid eating the token garnish slice of cucumber and tomato on your plate at a local warung and you will be fine. There are 100’s of great places to get a nice salad in Bali, just don’t get one off a street stall.
23. Water, not enough drinking water. That is a biggie; you are sweating more than usual, eating different foods, possibly consuming more alcohol than usual, yet not drinking enough water to hydrate. Pocari Sweat. This stuff is magic, especially if you are not a big water drinker.  It replaces the lost body fluids and would be your first step before even thinking about an IV drip that many tourists fork out a lot of money for. Consider it a drinkable IV.

What’s the X, Y, & Z you should get out of this?

1. Wash hands and hydrate, repeat, and repeat. 

2. Secondly, let your body adjust to a foreign diet and overindulgence of naughty goodies and let it go through your system; if it's trying to get it out, let it out. 

3. If symptoms persist for more than 4 days, then you can see a Doctor. Oh, and make sure the Doctor does a stool test before you start taking antibiotics.  They love to hand out antibiotics and steroids here like candy.

Disclaimer. This is not medical advice; it is important if symptoms persist to discuss with a medical professional.