Have you recently visited Vietnam? Your sage advice, please!

Your concerns about food are applicable to the entire world. And cruise ships too. I have been many places and occasionally get sick. My wife more times than me. Yet, we still go. We eat street foods. May be wise to carry pepto bismol for possible use, but not as a beforehand treatment on a regular basis.
Are you prone to sickness at home? What is your personal history on stomach issues? You have to evaluate yourself.
I have been to VN a couple times and not gotten sick.
I do not fear this as an issue for me in traveling. You don't want to have this hanging in your mind all the time. Look at the street foods before deciding to eat. That is the best advice. Restaurants, well, maybe not so apparent.
We have all our immunizations UTD in order to mitigate some of the risks. Hep A and typhoid. Others too but perhaps not as applicable to eating.
I would not hesitate to return to VN/SE Asia. To me getting sick is not a paramount influence. Try and not let it be yours.
VN food is great. A big part of a trip.

I agree with the previous poster, visiting Third World countries require being very careful what and where you eat and drink.

Only drink bottled water that you open yourself, or beverages that way as well. Brush you teeth with bottled water.
Only dine in the upper range of restaurants( restaurants in four star hotels and up or the equivalent). Never eat street food.

Been some years since I was in Vietnam/Cambodia. Stayed in nice hotels and took a river cruise. We took normal precautions, avoided iced drinks, salads, street food. Visited travel clinic before I went to update vaccinations etc. and took a course of Dukoral before leaving. None of us had any stomach issues. We used bottled water for teeth cleaning and our most popular drink was Coke Zero without ice! It was always served in its can alongside a glass. Also make sure I had Imodium and/or pepto bismal as part of my travel kit.

When I went to Nam (admittedly over a decade ago), staying in the Da Nang area, I took no precautions whatever, that I can recall. Just like going to Greece one more time. I had wonderful banana pancake, probably drank only bottled water, but brushed my teeth in tap water, and worried about nothing at all.

“Is ice served in drinks and coffees, safe?” Order them without ice (cubes), just for safety.

We followed our doctor’s advice to chew a Pepto Bismal tablet before each meal. No problems ever with diarrhea on our trips.We ate big bowls of delicious Pho daily.

I was just in Vietnam not long ago, and I totally get where you’re coming from! I had the same worries before my trip, but honestly, things turned out way better than I expected.

I ate fresh herbs with pho, had tons of iced coffee, smoothies, and even street food — and I was fine the whole time. Just try to pick places that look clean and busy. If locals are eating there too, it’s usually a good sign.

I started taking probiotics about a week before flying out, and I kept taking them during the trip. Not sure if that’s what helped, but I didn’t get sick. Some folks I met — especially on customized trips with one of those Indochina tour travel agencies — also mentioned they felt totally fine the whole way through.

Vietnam’s food is so good, it would be a shame to miss out. Just be a little careful and trust your gut. Have the best time!

I was in Vietnam and 4 other SE Asia countries over 6 weeks. I did wish I had more Pepto Bismal with me, but it was for slight upset rather than anything acute. I don't consume ice at home, so cannot comment, but this is no longer a developing country. Most places that serve traveller's know to use sterile water for their fresh food and ice. I did use fresh herbs in pho and fresh fruit and veg from hotel buffets. I consumed some fruit smoothies in Cambodia (I love a mango smoothie) but again, it isn't my 'go to'. I don't use bottled water at home or any country with drinkable tap water, but do switch to bottled in Asia...not so much for toothbrushing, however.
Much of my travel is global, so I take some precautions, pay attention to hygiene, and carry a good medicine kit (I travel solo) but don't get overly anxious about new foods.
I don't agree that one needs to only eat at 4* restaurants...unless by personal choice. There is no more guarantee that their staff washes hands as a more local locale. My India gut issues (which did require a doctor) came from a 5* tour hotel.
Also, be more religious about your own hand washing habits. Anytime you use a common serving tool, like at a buffet, wash your hands before picking up your own knife and fork, or use a tissue or napkin to pick up serving tools. You are more likely to pick up germs from dirty or share utensils that poorly prepared food. Purell is second best to water washing.

Thanks to everyone who chimed in with their excellent advice. I do believe I (and my travel companion) followed it ALL yet, still, we both got "HO CHI MIHN REVENGE" ... simultaneous violent vomiting and diarrhea. LOL. I know I know, TMI. We were THE most "careful" of our group of 15 and STILL we were the only ones who got sick!

Go figure!?

One poster asked if I had a history of GI issues. No! Stomach strong as steel. I eat everything. Can't speak for my friend but I think she would say the same.

So, I'm leaving for safari in a month and will not be doing what we did for VN. I'll "just" use "common sense"... washing hands and sticking to busy cafes. I will pack ORSs and antibiotics in case lightening strikes again. I'll not let it stop me. Thanks again!!!

From a previous post I made that applies to these questions.

There are kinda three “levels” of dining. The lowest are random ubiquitous street vendors that set up on the sidewalk and sell noodle dishes, coffee, grilled pork, etc. These places don’t have running water so you dine at your own risk. Vietnamese folks eat at these places all the time, but their guts are used to the local microbes. The second level is a sidewalk place in front of a storefront. The garage door goes up, the little plastic stools go out and the proprietor pushed their one specialty to hungry diners. These places have running water and might be a bit safer for westerners’ stomachs. Finally, there are sit down restaurants with table service. They run the gamut in terms of expense and cuisine.<

Yes, you should eat the herbs" (see below)
*You should absolutely eat street food. Street food is for me an essential part of experiencing Vietnam.. Just choose places that are crowded and the food turns over quickly. Choose sidewalk places in that middle tier that have running water.
You should definitely say yes to ice. Iced coffee & tea drinks are ridiculously good and such a part of the Vietnamese food culture that it'd be a shame to miss out. Just choose places that are in the top 2 tiers of dining and avoid anyplace that makes their own ice from chipping off frozen blocks. Reverse osmosis filtered ice is everywhere so enjoy your Salt Coffee (amazing) with confidence.

We spent 17 days in Vietnam, eating and drinking with abandon. I was pretty convinced I was gonna get TD. I was mentally prepared for it but it never happened to either of us. We didn't drink tap water (I brushed w it), we ate mostly at the top 2 tiers and I took some additional precautions...
- Start a good probiotic the week before you leave. Having never
taken one previously, I did a bunch of research before selecting
FLORASTOR Dual Action off Amazon. Not all probiotics are created
equal. Shelf stability is a question and there can be massive
discrepancies between "dosage" that show up when products are
independently tested in the lab. I am not a doctor, but I do play one on TV

Take a Pepto chewable every day as an anaphylactic. I never
realized that they could be helpful in "prepping" the stomach ahead
of time, but you learn something new every day. Bring extra, just in
case. As MariaF mentioned, your tummy may just react to grease/spice just like at home

Get a PRN antibiotic prescription filled at home before you
leave. We each brought a 3-day course of Azithromycin but never had
to use them. Bring your scrip with you; either paper or in your
phone pictures. Vietnamese pharmacies are available to fill if you
need more than what your brought

Isabel, I love your conclusion for SA! But I am sorry you had a bout of GI stuff! That was bound to interfere with your enjoyment of your trip.

We all have only our own experience to go on - and what might work for my system might not for someone else’s. I did pretty much what Chris described - started 1 Pepto at night 2 days before I got there and continued 1 at night for maybe 5 more days before I quit. I didn’t take probiotics, though. Drank bottled water and brushed my teeth with tap water (but didn’t swallow it). Ate those lovely fresh herbs, fresh fruit at my hotel breakfasts, and had mid-level street food several times. And am grateful I had no issues!