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Som Tam, Pla ra, liver fluke danger


t8769

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What's the deal with Som tam and liver fluke?

Is it safe to eat if not in the North? Here in Bangkok I thought it was safe as they would use factory sauce, but the local somtam person uses home made sauce.

 

They say its safe as they use lots of salt, and its properly made, but I'm not so sure. 


I know this can be a dangerous thing causing cancer in many up North. How safe is it in Bangkok?

Is home made sauce safe?


Thanks

 

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? You use "pla ra" in the title.

"pla ra" aka. fermented fish, some would say rotten fish.

 

But your text sounds like salty fish sauce, liquid like water, which is used instead of salt in many Thai dishes?

 

Pla ra:

the fish is fermented in raw state and so certain parasites (worms) could survive.

One has to make absolutely sure that the pla ra is properly cooked/heated before eating.

If one catches pla ra with these parasites then indeed bile duct cancer can be the result.

 

Are you really one of the rare(?) species of foreigner who enjoys Lao/Isaan somtam with pla ra? BTW more northeast than north.

 

Even after many years I must not even get close to that stuff.

When passing the big jars with pla ra on the market I have to gain speed.

 

I am not aware about the risk with fish sauce.

 

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Som Tum which is papaya salad is actually really good.  However, I eat it with lime juice and not pla ra or those little field crabs.  In the North, most pla ra is cooked, so liver flukes aren't as big of a problem as in Issan in the Northeast where pla ra is often raw and uncooked. 

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2 hours ago, rwill said:

stick with plain som tum thai as it is usually called, with no pickled crab or fish, just the dried shrimp.

no dried shrimp for me, and i wish they would peel the garlic

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On ‎10‎/‎10‎/‎2018 at 3:01 PM, KhunBENQ said:

Are you really one of the rare(?) species of foreigner who enjoys Lao/Isaan somtam with pla ra? BTW more northeast than north.

Som tam without pla ra is same as pizza without tomato sauce or lambmeat without garlic. Not the real deal. 😍

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You wrote "

Is it safe to eat if not in the North? Here in Bangkok I thought it was safe as they would use factory sauce, but the local somtam person uses home made sauce.

 

They say its safe as they use lots of salt, and its properly made, but I'm not so sure. 


I know this can be a dangerous thing causing cancer in many up North. How safe is it in Bangkok?

Is home made sauce safe?"

 

It's actually a complex subject.  Throughout Thailand, Laos, Cambodia, and what the heck, let's add a dozen other countries--eating undercooked fish presents the potential for infection by liver fluke parasites.  It's love at first bite--should the organism be present and ends in about 25-30 years when the fluke or flukes die of old age.  That is assuming that there are no secondary ones incoming.

 

What makes it complex is that liver flukes are like snakes--some are fairly harmless, some are not.  Thailand is full of snakes and some you never want to go near.  Liver flukes are the same, they make poor pets at best but a certain specie called O. viverrina is more like handling a tiny cobra.  Opisthorchis viverrini (let's call it Ov) are most prevalent in the NE of Thailand as you imply.  Not only that but not too many years ago the government instituted a rather (but not completely) successful attempt to eradicate Ov.   A fellow from Isaan knew that the community sharing of food would never stop, it's tightly ingrained.  So he started a campaign to share only cooked food.  And it worked rather well (though not perfectly)

 

"From: Global health lessons from Thailand's successful liver fluke elimination campaign:


“Though agricultural intensification and climate change could pose new challenges for managing liver fluke transmission, early results in the afflicted Lawa Lake region are promising, with human infection rates in the worst-hit areas down to below 10%, fish infection rates dropping from 70% to below 1%”

 

Let me back up a bit.  I lived for a while in Chiang mai and if you don't know there Chiang mai was once totally encircled by a elephant Calvary repelling moat.  Parts of it are still there, and fun to visit.  Locals swim in the water.  I don't recommend that for the water is rife with Metacercariae of liver flukes, but I have no idea if they are Ov (I'd guess they are not) and while other flukes may be undesirable it's the nasty Ov that leads to Cholangiocarcinoma (aka cancer).  Currently CDC and other sources state that about 60 people die in Thailand from Ov related liver cancer every day.  (But only 1-5% infected develop the cancer) Some cancers are not too bad, this one, unfortunately is.  

 

So let's assume that you eat pla ra or use anything that has raw fresh-water fish from Thailand waters (since you're in Thailand we'll ignore other countries).  Now whatever you eat has been pickled, is it safe?   Answer: yes, no or maybe so?  Fermenting--proper fermenting kills the Metacercaria, but was it properly fermented?  Maybe not. (No Thai person would ever "cheat" and eat or sell it a bit too soon to be safe now, would they?)  Let's say it was fermented for a few days, no thank you.  But let's say that it was fermented then frozen at -20C for a few days then yes, it's safe (See DOI: 10.22034/APJCP.2017.18.6.1507)

 

Note: That's -4 Fahrenheit and most home refrigerators don't get that cold.  See the above reference if you want to know more.

 

So in summation, it seems that the risk has dropped quite a lot of at least getting liver cancer.  But there are other species of liver flukes which are not notorious cancer causes and if ingested you are likely to be ill for a week or so, but probably not get cancer.  For me, I'll try to avoid any fermented fresh fish products when in Thailand.

 

Wikipedia has a good take on it, search Opisthorchis_viverrini

 

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15 hours ago, Foexie said:

Som tam without pla ra is same as pizza without tomato sauce or lambmeat without garlic. Not the real deal. 😍

Lamb meat without garlic? surely you mean Lamb meat without mint sauce.

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Very interesting, thanks for the information, and the detailed explanation jsflynn603 .

 

But I'm still rather confused. Is there danger in eating ordinary somtam when in BKK or CM, and not in Issan?


Is the sauce they use OK? It was when I saw home made sauce in BKK recently that I had to wonder. The woman there said it was OK, no parasites, as they used a lot of salt, which wasn't so convincing.

Its a great favourite of mine, but I've never been able to clarify the level of risk for ordinary Somtam.



Thank you

 

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On ‎10‎/‎12‎/‎2018 at 7:34 AM, musicscene said:

Lamb meat without garlic? surely you mean Lamb meat without mint sauce.

Nope i ment garlic. I'm not into mint sauce . Although i like mint in dishes like laab moo or marocan mint tea.

In my country we like to eat it with garlic and rosemary like this:

 

https://goo.gl/images/5p7MGs

 

slowly cooked in the oven. 😋

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On 10/11/2018 at 3:29 PM, connda said:

Som Tum which is papaya salad is actually really good.  However, I eat it with lime juice and not pla ra or those little field crabs.  In the North, most pla ra is cooked, so liver flukes aren't as big of a problem as in Issan in the Northeast where pla ra is often raw and uncooked. 

 

Too many Thai believe that it is cooked almost everywhere in restaurants or market, but this is BS, most plara$hit that Thai eat is raw.

 

 

 

 

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  • 9 months later...
On 10/18/2018 at 8:34 PM, jrjrjr said:

 

Too many Thai believe that it is cooked almost everywhere in restaurants or market, but this is BS, most plara$hit that Thai eat is raw.

 

 

 

 

 

this is my experience also, it seems that many Thai do not even know that some plara is cooked ?!

 

 

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