How to Handle Vietnam’s Street Food and Stomach Problems

After reading my recent post on eating street food in Hanoi, Jessica Cym asked a pointed, very practical question: “We are going to VN during Christmas. Can't wait!!! Andrea, do you have any tips on handling street food so we won't get the runs?” 

I’ve had my fair share of traveler’s diarrhea but over the years, don’t have a bulletproof answer. Before a trip, I make sure that my immune system is strong. The flights are long and I make sure to get some amount of sleep on the plane via ear plugs, Sleepy Time or valerian tea, and an awesome travel pillow. On the ground, I fortify myself with Citricidal, Airborne, and my regular daily multivitamin. I carry Tums and Pepto-Bismol. On this trip, I didn’t bring any kind of antibiotic because Karen Shinto said she had some.

On the flight to Vietnam, we met up with Michelle Tam of Nom Nom Paleo and and her husband Henry. Michelle is a trained pharmacist and she had a nice stash of probiotics. (I knew Michelle and I would be fast friends when she offered me a probiotic at the Saigon airport.) Kyle Hildebrant of Our Daily Brine and his wife Lisa were also on the same Red Boat trip to Phu Quoc island and they carried meds too. Between the six of us, there was probably quite the medical kit. We felt equipped to deal with whatever Vietnam’s street food had to throw at us. We were eager to eat the streets.

But Lisa and Karen had tummy problems during the trip. It wasn't from the same place, city or time. They just got a bug of some sort and were each out for a good day. No bueno and no fun.

So despite all the care and precautions, stomach issues may happen. There’s no clear cut answer.

To help Jessica prepare for her trip to Vietnam, I consulted with Dr. Mike Ly. He’s a dear friend and a stellar infectious disease doctor. He’s diagnosed and treated conditions that you and I do not ever want to get. Born in Vietnam, he lived there until the late 1980s. He's trained and practices in Los Angeles. He regularly returns to Vietnam to do presentations to doctors there. Here are his some of Dr. Mike's insights:

While in country, should you take preventative measures like daily Imodium? Taking daily Imodium will make you constipated and that’s not comfortable. And, sometimes you want your body to excrete or flush out the toxins as part of the natural defense.

How may you avoid getting sick? It all depends on your own immune systems and any underlying medical problems such as diabetes, cancer, history of previous exposures the "bad foods”, etc. Everyone is different. Of course, avoid drinking ice made from dirty water.

And, don’t eat visually dirty foods. For example, flies sampling the food have carried bacteria from dirty places on their feet and wings. Only eat fruits or vegetable that have been washed well with clean water and/or peeled. Only consume well-cooked foods. Be smart about what you eat.

Photo by kshinto.com

What to do when you start having stomachaches or the runs? It depends. Food poisoning usually comes in two forms. The first may be preformed toxins such as staph [Staphylococcus aureus] which would cause vomiting right away but then you feel very much better quickly.

The second may be ingested live bacteria, parasites or virus that take time to bypass and survive the acidity of the stomach. They multiply in the gastrointestinal tracks and either produce toxins then or cause dysentery. That process usually takes a  couple of hours or a few days. If that is the case, please do hydrate. Drink ginger ale and/or replace your electrolytes: Mix 1 teaspoon of salt and 1 tablespoon sugar with about 12 ounces of boiling water. Let it cool down then consume it as much as you can. You can add up to 24 ounces of water. [I like these electrolyte powder packets too.]

If you have high fever, bloody stool or diarrhea for more than 2 days, seek medical help.

What's better for tackling diarrhea? Pepto-Bismol or Imodium? I would take Pepto bismol first before Imodium. Imodium should be used ONLY when there is no blood in the stool or no fever.

That’s the straight poop from a doctor. I heed Mike’s advice when I’m traveling. Additionally, I take other precautions:

I don’t eat more than 1 street food meal per day. One meal may consist of many vendors or storefronts. It there are more than 3, I share the food or do not finish it. Sometimes tummy problems arise from just eating too much. Locals are going to eat a banh mi sandwich and go about their regular business. Tourists may try several sandwiches, get a dumpling, fried bananas, and a bao – all in the span of a couple of hours. That’s a recipe for disaster. I speak from experience.

I also observe local behavior. If customers set their cilantro sprig of garnish aside and don’t touch the lettuce leaves, I don’t either. If they dive into the pile of herbs, I do too. If the vendor is wearing plastic gloves, they’re thinking about hygiene. One banh cuon maker told an assistant to take my money because she didn’t want to dirty her hands. “I’m sorry but I’m busy cooking,” she told me.  

Photo by kshinto.com

Photo by kshinto.com

Gauge the quality of the street food by look and smell, and how conscientious the vendor is about clean up. If it’s a busy stall, do they let trash pile up or is someone clearing tables for new customers? That advice from Hanoi street food tour guide Mark Lowerson.

In Danang, Karen and I went to a popular banh xeo spot in the early afternoon in Danang and the food wasn’t fresh and hot. It didn’t look good. It didn’t taste good. We didn’t gobble things up, even though we were hungry. I felt uneasy.  Not far away was a woman frying up fritters of sweet potato, banana and coconut. I ordered a couple and we ate them up with vigor. Then we found a gal who was grilling up rice paper snacks and we planted ourselves at her stall for a spell.

Photo by kshinto.com

Photo by kshinto.com

Pay attention to nature’s protectors. Lime, chile, vinegar, garlic, ginger, turmeric and galangal are natural antiseptics. Those ingredients come together to kill potentially harmful bugs and bacteria. Along with the herbs, you've got a powerful phytochemical mix in your Vietnamese food.

Always carry a small bottle of water. You may run into ice that seems questionable. On this trip, we were mostly in the cities and I never had to question the ice quality.  

On my first visit back to Vietnam, a doctor told us to avoid all street food. After 48 hours of feeling scared in Hanoi, Rory and I dove in. So proceed with caution but also enjoy your time in Vietnam.

If you have insights or experiences to add, or questions, let us all know!

Related posts

• How to Find Good Street Food in Hanoi 
• Saigon Restaurants to Try 
• Good Banh Mi Finds in Vietnam