My experience travelling South East Asia with IBS
People often make light of having stomach problems whilst travelling. Bali belly, Tokyo trots, the list goes on. Getting a bit of an upset stomach is almost accepted as part of travel. It is understandable, even if it isn’t a specific ‘bad’ bit of food; the complete change in diet and lifestyle can be enough to upset the natural environment in the stomach. For me, this was something I was pretty anxious about before we headed away.
Bowel habits are always a bit of a taboo topic. Everyone (kinda) knows what’s happening, it’s just rarely talked about. Over the last 18months I have realised IBS is a lot more common than I originally thought. Irritable bowel syndrome (IBS) is a broad term used to describe a dysfunctional gastrointestinal system. It varies in severity and affects everyone differently. For the year prior to our travels I struggled with IBS and a possible diagnosis of Coeliac Disease (which is an allergy to gluten). I’m sure I am not alone when the thought of having an exacerbation of my IBS whilst backpacking gives me the chills. The specialist had even warned me that South East Asia is the most difficult place in the world to travel with IBS. Great! With this in mind, I embarked on the trip of a lifetime and have managed pretty well over the past four months.
After some quick research it became evident people are (understandably) reluctant to share their experiences. I decided to write this blog in the hope it might help calm some nerves and help those who are in a similar position I was in before I left. While I have done some personal research, I am by no means an expert and what I have written is based on my personal experiences.
Firstly, I consider a trigger something that flares up your symptoms. Chances are if you have IBS you will have heard of the FODMAP diet and are aware of your biggest triggers. If you haven’t, FODMAP is an acronym for several food groups that typically cause exacerbations of IBS symptoms. The FODMAP diet is a highly restrictive diet that eliminates those groups until symptoms settle, before gradually reintroducing foods. Often, one food group is responsible for the IBS exacerbations and once eliminated symptoms usual settle. For me, gluten is my biggest trigger (I will complete testing for Coeliac Disease when I get home) but I still follow the full FODMAP diet as closely as possible.
Knowing what triggers your symptoms before you leave is a massive advantage. With this said, if you are still working through your triggers don’t be put off travelling. There will always be something you can eat, even if it is only steamed rice or something equally simple. Sometimes the break from everyday life can make the biggest difference. As stress is known to exacerbate symptoms, a holiday and break can really help. I know this has been a big factor for me and reducing my stress has really helped me manage my symptoms better. If you are still struggling with your triggers, I would highly recommend seeking advice from a dietitian who specialises in IBS (if you haven’t already). The dietitian I was referred to was incredible and her advice was excellent.
Once you have figured out what your trigger is, the trick is to then know the foods that contain the trigger. For example, I know gluten is in yellow noodles, egg noodles and instant noodles but not rice noodles. These are the four main noodles used in southeast Asia and I only order a noodle dish if I know for sure I will get rice noodles. That part is easy. The harder part is the sauces, there is no way you can avoid soy sauce, for example, which also contains gluten. Essentially I have tried to balance this, if I have something that I know has soy in it for lunch, I avoid it for dinner. If I feel a bit crook, I’ll opt for ‘safe foods’ until I feel better (I’ll write more about ‘safe foods’ below).
Unfortunately, garlic and onion can be near impossible to avoid. Onion is often served as a staple vegetable in some stir-fries, something that is disappointing for most and devastating if oligo-saccharides are a big trigger for you. In this case my advice would be to try and avoid the huge chunks of both onion and garlic, before enjoying something safe at the next mealtime.
At home I love cooking and I’ve really missed being in the kitchen since we have been travelling. This worked in my favour when I was put on the FODMAP diet as I relished in the challenge to cook tasty meals on such a strict diet. Fortunately, this also means I have a basic understanding on the main ingredients in most Asian dishes.
For me, picking ‘safe foods’ means carefully selecting a dish that I know won’t flare up my symptoms. While I eat a variety of curries, stir-fries, and fried noodles (the list could go on but I’ll stop there), it is inevitable some will be easier on the stomach than others. After the meals that didn’t sit as well, I opt for ‘safe foods’ until I feel better. The best one for me is ginger chicken (or any other meat) and steamed rice. It is pretty easy to find in most countries in Southeast Asia. Not only is it a pretty plain meal, ginger supposedly helps settle an upset stomach and I happily take all the help I can get. Another good option has been basil chicken (or some stir fried variation with basil and meat as the main ingredients) with steamed rice. Worst case scenario I head straight for plain steamed rice, which has happened, but thankfully not often.
If you’re not familiar Asian foods or are a bit worried about what might be in the meals, scope out a menu first before googling a few recipes to get a general idea of the ingredients. The complicating factor is each person has their own signature way of preparing the meal so they always come out differently. My advice is to stick with what you know will be safe and then become more adventurous as you build your confidence with the cuisine.
The following are a set of ‘rules’ I have generally stuck with when ordering food throughout Southeast Asia. They have kept me pretty healthy and I have only had a couple of bad experiences. Honestly, I would recommend anyone travelling through Asia is wary of where and what they eat, but within reason. We have been pretty relaxed with the places we have eaten, usually opting for street food, as it is budget friendly and often tastier than restaurants. There is certainly nothing wrong with the food, in fact, I love the food in Southeast Asia and the street side environment is amazing. The experience of eating on the street is something so great it shouldn’t be missed. Check out the ‘rules’ I have listed below, hopefully they will help you on your journey.
- Always eat at places crowded with locals. If the locals frequent there, chances are they aren’t getting sick from the food.
- The busier a place, the higher the turnover of food, which means it must be fresh.
- Order food which is hot (temperature wise) because the chances of bacteria surviving the temperature used to cook the food is minimal.
- Order food commonly found in the area. That way, the cooks know what they are doing and how to do it best. From what I have heard, travellers often get sick eating western food (ironically).
- There is some evidence certain spices can inhibit the growth of some pathogens that cause food poisoning. So ordering spicy foods (if you tolerate them) can be beneficial.
- The further from the ocean you are, the further the seafood has to travel to reach you. We haven’t avoided seafood anywhere but it isn’t something we have eaten regularly while travelling (often because it was too expensive).
- We always drank bottled water to be cautious. In some places we even used bottled water to clean our teeth.
- Be cautious with drinks that have ice. This really varies place to place and is up to each individual to make the call. Often the ice used in chilly bins (eskies for Australians or a cooler) is untreated frozen river water. Be careful of water on top of cans and drinks, this can be pretty unsanitary and can make you sick.
- Canned drinks are often kept in dirty places, I would always use a straw when possible but Jimmy usually didn’t worry.
- If you are concerned your food choice has something in it that will flare up your IBS don’t eat it. The consequences probably aren’t worth it. On the other hand, push the boundaries; as much as you are comfortable with, chances are it will be worth it.
Southeast Asia food, culture and environment…
The experiences I have had travelling in Southeast Asia have definitely been positively influenced by people and their food. I love the flavours and methods of cooking that are so specific to each country. These are a few specific things I have learnt along the way that I think are worth sharing.
- The concept of food allergies isn’t understood. I did a cooking course in Ho Chi Minh City with a Vietnamese chef who had trained in the US. He told me Vietnamese people often joke about food allergies and consequently don’t take them seriously. Unless you are with people who speak English fluently, chances are slim that your allergy or food concerns have been understood. Even if the message has gotten through, it is difficult to be sure your requests will be met. This isn’t a spiteful act, just a lack of understanding. For example, it’s unlikely they know soy sauce contains gluten.
- Breakfasts will be the hardest meal of the day to find, especially if your avoiding gluten. In Malaysia and Thailand, it was difficult to find any breakfast, as most places didn’t open until mid-morning. In all of the countries, a lot of breakfast options have used bread as the bulk of the meal. The rice porridge in Laos was amazing and a great way to start the day, as was the Pho (rice noodle soup) in Vietnam. Cambodia was a lucky draw, some places had excellent options, and others took a bit of searching.
- The fruit shakes can be a good breakfast alternative. There were stalls all through Thailand and Laos that served beautiful shakes. The only thing here, I found the ice in Thailand was a bit dodgy and aggravated my symptoms a bit. As with everything, you have to weigh up the risks and rewards before ordering.
- Vietnam produces incredible volumes of rice and consequently most meals use rice in some form as the staple. I have found Vietnamese food the most enjoyable and it has been the easiest place to find tasty gluten free meals.
- People will answer ‘yes’ to your menu-related question regardless of what you are asking and what the answer is. They’re not trying to be malicious, purely pushing the sale.
- The restaurants are dirty, unless you are eating in the more expensive places (which our budget didn’t allow). My only advice is don’t think about it too much. I’m pretty open to most places but draw the line at particularly bad places. You’ll figure out pretty quickly where your line is.
- The public toilet situation is horrendous. Always carry toilet paper (pocket tissue packets are a good option too) and hand sanitiser. Closed in shoes are beneficial as the floors are always wet and it’s not because they are clean (quite the opposite in fact). In these cases the squat toilets are better (in my opinion) as the western toilets are so incredibly dirty you don’t want to go anywhere near them. Good luck!
Southeast Asia and IBS…
The food in Southeast Asia is beautiful and I have thrived off the variety of options available. I guess the main thing is making sure you have some kind of balance with your diet. I have tried to be sensible but have suffered on a couple of occasions when my desire to try something has outweighed my normally good senses. For me, that is what it is all about. Enjoying the food and culture while trying new things and maintaining good health. If you have any questions you think I might be able to help with, pop a comment below or send and email to firstname.lastname@example.org and I will do my best to help you out.