Bali Belly Symptoms and Treatment For Travelers

What is Bali Belly?

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Bali Belly is just a quirky name for traveler’s diarrhea and stomach pain suffered by tourists in Bali. It is technically an acute case of gastroenteritis, or gastro for short, and is almost always caused by eating contaminated food or water.

The types of intestinal pathogens or microorganisms that cause Bali Belly include:
> Bacteria – most commonly E. coli or other species like Campylobacter jejuni, Salmonella and Shigella.
> Parasites – including Giardia lamblia, Entamoeba histolytica, Cryptosporidium parvum, Dientamoeba fragilis and Blastocystis hominis.
> Viruses – norovirus and rotavirus are thought to be present in up to a third of cases.

So, you basically have a gut infection that’s causing your Bali Belly symptoms.

Bali Belly Symptoms

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The classic Bali Belly symptoms generally involve diarrhea (at least three unformed/loose/watery stools within a 24 hour period) and can also include any of the following:
> Nausea
> Abdominal bloating, cramps and pain
> Fever or mild temperature
> Headaches
> Lack of energy
> Bloody stools.

The most common version of events looks a little like this: you get four to five loose or watery stools, maybe with fever and cramping, for between two to four days during the first week of your holiday to Bali. So, I think we can agree, no one wants Bali Belly symptoms… but what about treatment?

Bonus Tip: Check out the Travel Belly Bible E-Guide

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Over 40 pages packed with everything from planning and prevention to treatment and detoxing options. Learn:

– Travel health kit essentials for any trip to a developing country or exotic destination
– 3 must have natural preventative supplements I never travel without
– Everything you need to know about food, water and sanitation to lower your risk
– A list of safe (and safer) foods for every meal to avoid getting sick
– How to treat traveller’s diarrhoea with natural supplements
– What foods to eat (and avoid) when recovering from traveller’s diarrhoea
– The top 5 mistakes to avoid if you get traveller’s diarrhoea
– The 7 day post-travel detox you can do to feel like new again, including recipes, supplements and exercise recommendations
– Symptoms to look for when you get home to know if you’ve brought a bug back with you
– Plus loads more + +

Buy it here: TRAVEL BELLY BIBLE E-GUIDE

Bali Belly Treatment

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Treating Bali Belly has two purposes. First is to ease some of your symptoms and prevent dehydration. And the second is to kill or remove the offending pathogen as fast as possible. Here’s what you need to do:

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Stay hydrated and avoid stimulants

What comes out, must go back in. I’m talking about water here, just FYI. When you suffer Bali Belly or traveler’s diarrhea, it’s mostly water you pass. Which means you have to drink lots of water to make sure you don’t get dehydrated. Here’s some suggestions:
> Water – easiest and most hydrating option. Stick with safe, clean drinking water. This means from a bottle, most of the time.
> Minerals – supercharge your water by adding salt and lemon or lime juice to boost electrolytes and minerals that you have lost.
> Coconut water – another great way to stay hydrated. It also has minerals to replace those you have lost. Just make sure it’s from a safe, clean source – packaged or from a fresh coconut.
> Avoid alcohol and caffeine – stimulants and irritants that will make you feel worse.
> Hydration sachets – like Nuun electrolytes are handy and easy to travel with as an alternative to salt and citrus juice for minerals.
> Red cordial – I haven’t actually tried this one myself but a lot of people swear by raspberry cordial for both basic prevention and treatment. And there might actually be some science to it. Try to avoid the high sugar varieties and look for a brand with at least 30% real raspberry juice.

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What to eat when you have Bali Belly (and what to avoid)

In the days straight after you get a bout of Bali Belly symptoms, the focus with diet should be less on ‘health’ and more on ‘ease of digestion’ (although there is plenty of crossover).

Avoiding sugar and spicy food is a good place to start. But it’s also a good idea to avoid dairy and raw foods like uncooked vegetables, nuts, seeds, and so on, as they place extra strain on an already inflamed digestive system.

Here is a list of foods that are hydrating and/or easily digested:
> Bone broth – if you can get your hands on it, bone broth is great for gut healing.
> Applesauce – contains pectin (a type of fiber) that helps firm up stools.
> Banana – lots of potassium, an electrolyte you lose through diarrhea. Make sure it’s not pre-peeled.
> Soups and stews – great because you get meat and vegetables that are thoroughly cooked. They also contain plenty of salt (sodium) and water for rehydrating and replenishing lost minerals.
> Rice – not the most amazing source of nutrition but super easy to digest. Rice will give your digestive system a rest while still getting easily absorbed carbs and much needed calories.
> Potato – low in fiber and very easy to digest. Another symptom-friendly source of carbs and calories that will also add firmness to your stool.

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Natural supplements to treat Bali Belly

As you know, we like to keep things natural around here. Science-based, yes. But natural where possible. Bali Belly is a great example of where natural options are super effective, both in the short and long term.

Here’s what you need:
Saccharomyces Boulardii – a really well-researched probiotic that is effective at plugging up diarrhea and restoring levels of good bacteria in the gut. Sacc B. works by preventing bacteria from attaching to the walls of your intestine, meaning they are removed more easily.
> Available here via iHerb (Australia)
> Available here via Amazon (USA) 

Oil of Oregano – an antimicrobial that is cheap and a proven pathogen killer. Make sure you use a brand that has at least 60% carvacrol which is the active ingredient. Alternative antimicrobials that are a little more gentle include Garlic and Echinacea.
> Available here via iHerb (Australia)
> Available here via Amazon (USA)

Activated Charcoal – is used to detox the digestive tract. It binds to unwanted pathogens and toxins, allowing you to pass them via the stool. It’s cheap and available from most pharmacies in Bali.
> Available here via iHerb (Australia)
> Available here via Amazon (USA)

Ginger Root – a great natural option to reduce nausea which often comes with Bali Belly. Ginger can also be used as a digestive aid, so it ticks multiple boxes.
> Available here via iHerb (Australia)
> Available here via Amazon (USA)

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Medicines for Bali Belly

If you can’t get access to high quality natural products then there are medicines and drug options available at pharmacies (Apotik, Farmasi, etc.) or medical centres.
> Anti-diarrheal drugs – although best avoided, especially if you have a fever. Unless it really is an emergency, you don’t want to block it up. You want to get it out. Diarrhea is the body’s natural defence and detox method to excrete pathogens from your body. If you block that, it gives the pathogen a better chance to do long-term damage.
> Antibiotics – the problem with many antibiotics is that they are broad spectrum and don’t succeed against specific pathogens. Unless you have access to a skilled medical professional and lab testing to work out exactly what you have, you may be doing more harm than good in the long run. Research now shows that broad spectrum antibiotic use to treat traveler’s diarrhea increases your risk of getting antibiotic-resistant bacteria and long-term IBS symptoms.
> Anti-nausea drugs – these are things like Maxolon. They do a brilliant job at getting rid of nausea and helping with cyclical vomiting in most cases, however usually at the expense of some other symptoms. Best to choose natural options like ginger first, then if these don’t work you can hit the heavy stuff.

How long does Bali Belly last and what if it doesn’t go away?

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Bali belly can occur at any time during your trip, or even after you get home. In most cases, it is self-limiting and the acute symptoms will clear up after a few days. But if you have a nasty variety or a weakened immune system, you may find symptoms persist long after you have returned home – I’ve written a whole blog on this topic BALI BELLY AFTER RETURNING HOME.

Many cases of IBS, SIBO and other digestive disorders stem from a bout of acute gastroenteritis. It’s why there are specific conditions labelled “post-infectious IBS”. Most of the clients I see in my post-travel health consultations continue to experience worsening or cyclical symptoms for weeks to months after returning home.

If this sounds like you, then you should really seek out a functional practitioner with a focus on travel health. If you want to learn more about the services I offer, go to my The Functional Gut Health Clinic HERE.

How to avoid Bali Belly symptoms in the first place

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Education, common sense and little bit of luck can go a long way to preventing Bali Belly from wrecking your holiday.

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Water and Bali Belly

Water infected with faeces and harmful bugs is a common cause of Bali Belly and traveler’s diarrhea. Here’s a few tips to keep in mind:
> Avoid drinking tap water or brushing your teeth with it and be careful to avoid getting water in your mouth when showering.
> Safe drinks include those that have been boiled, bottled, or carbonated.
> Boiling water for at least one minute (or three minutes at altitudes above 6,500 ft / 2,000 m) will kill most bugs – that is, one minute from the time it reaches boiling point.
> Iodine liquid or tablets are an easy and effective way to purify water, although parasites in cyst form can be iodine resistant.
> Ice cubes are often overlooked, as freezing does not kill most bugs. Ask for no ice or check they use safe, clean water to create them. In Asia, the circular ice cubes with a hole through the middle are made in factories with filtered water and are a safe option.
> Carbonation kills bad bugs by reducing the pH levels, making them a safer, if not healthier, option – e.g. beer, soft-drink and soda or sparkling water.
> If drinking non-carbonated bottled water, take care to check the seals to ensure they are not waste bottles refilled with tap water. It happens.
> See above note on red cordial – again some people swear by adding it to their water and letting it sit for an hour. Same idea to iodine but a lot more variable when it comes to success stories I’d imagine.
> Purchase a water bottle filter that can remove 99.9% of the bad bugs – like the Lifestraw

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Food and hygiene for avoiding infection

Given that poor hygiene habits of local restaurants are thought to be the largest contributor to Bali Belly, prevention is not always within your control. Which completely sucks! That said, there are a few basic tips for reducing your risk:

> Remember that much of the risk linked to unsafe food has more to do with the water it is prepared with, rather than the food itself.
> Avoid salads and raw/uncooked veggies. If you have to, make sure to ask if they use bottled water to wash the food – the nicer restaurants should.
> Stick with fresh and fully cooked meats, poultry and fish. Buffets are tricky so be VERY wary of these.
> Steer clear of food from street vendors. I know it looks and smells delish, and you may get away with it, but if you have busy travel plans, the risk of 4 days on the loo is not worth it.
> Only eat fruit you can peel yourself – don’t touch the pre-peeled options often seen on street carts.
> Avoid cold toppings and sauces, as well as bottled sauces on tables. Up to two-thirds of tabletop sauces are contaminated with things you don’t want.
> If you have time, check restaurant ratings and reviews online. If there are common reports of food poisoning, stay away!
> Wash your hands with soap or natural antibacterial liquids, especially after using the toilet, handling money and before meal times. Dry your hands well in case the water you are using to wash with is also contaminated.
> Keep your mouth closed when showering or having a bath and think twice about swimming in water that might be contaminated like rivers or lakes.
> As a side-note, always carry toilet paper with you in Bali (with or without Bali Belly). It’s really hard to find good, clean, flush toilets outside of your hotel.

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Vaccinations for traveler’s diarrhea

At present there is no vaccine that can reliably prevent Bali Belly symptoms or traveler’s diarrhea. That said, some physicians may recommend the oral cholera vaccine. It has shown some benefit by  targeting one type of bacteria that causes Bali Belly – E. Coli. But really, the best defence is prevention.

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Antibiotics for Bali Belly

Most medical experts agree that antibiotics for prevention should only be given in short courses and only under special conditions (e.g. people with compromised immune systems and those with HIV, diabetes & chronic bowel disease).

While earlier studies have shown that they were effective in preventing traveler’s diarrhea in many parts of the world, widespread resistance to the most commonly prescribed antibiotics has come about, limiting their usefulness. Antibiotics are also NOT effective against parasites or viruses, and can lead to infections with resistant strains and contribute to the global problem of bacterial resistance.

If you are going to use antibiotics at all, it’s best to use them as a last resort treatment, rather than as a prevention. If you can’t get diarrhea under control after 3-4 days of natural treatment, then antibiotics may be required after consultation with a health physician.

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Natural alternatives for preventing Bali Belly

These are my go-to natural alternatives for preventing Bali Belly – I have a more detailed blog on natural prevention options HERE. I used to get sick all the time when traveling to exotic places (including Bali) but not anymore, thanks to these awesome options:

> Saccharomyces Boulardii – as mentioned above, it’s a really well researched probiotic that works by preventing pathogens from attaching to the walls of your intestine, meaning they are pooped out and can’t hang-around. Available on Amazon (US) and iHerb (AU).

> Oil of Oregano – antimicrobial that is cheap and a proven pathogen killer. Make sure you use a brand that has at least 60% carvacrol which is the active ingredient. Alternative antimicrobials that are a little more gentle include Garlic and Echinacea. Available on Amazon (US) and iHerb (AU).

> Travelan – Travelan this natural product is basically bovine colostrum and does have some science to back up it’s effectiveness with preventing bacterial gut infections. We used it recently for a month in Bali and didn’t experience any Bali Belly symptoms. You can purchase it on their website (AU) or on Amazon (US).

> Iodine – has been shown to kill nearly all pathogens, including bacteria, yeasts, viruses and parasites with direct contact. This makes it a great water purifier if bottled water isn’t available and one that is easily available in liquid or tablet form at most pharmacies.

> Probiotics – help fight-off pathogens and re-inoculate good gut bacteria post infection. Just make sure it is a practitioner recommended brand, a big step up from Yakult. Available on Amazon (US) and iHerb (AU).

> Digestive enzymes and HCL – help kill ingested bacteria and break down foods so they are easily absorbed. You can take these together or as separate products. Enzymes available on Amazon (US) and iHerb (AU) and HCL also available on Amazon (US) and iHerb (AU).