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What's the different between SIBO and LIBO - and what's dysbiosis?
Dysbiosis is just an imbalance in the microbiome wherever it is, but let's breakdown SIBO and LIBO.
SIBO
Small intestinal bacterial overgrowth is defined as the presence of excessive bacteria in the small intestine. The microbiome in the small intestine and large intestine are very separate as they have quite different functions.
Symptoms of SIBO
Bloating within 90 minutes of eating, can be severe
Abdominal discomfort and distension
Constipation AND/ OR Diarrhoea
Steatorrhea (yellowing/light stools)
Flatulence
FODMAP intolerance (read more here) - onions, garlic, carbohydrates....
Brain fog
Nausea
Risks for SIBO include reduced digestive enzymes, impaired intestinal motility (constipation/ diarrhoea/ slow stomach emptying), compositional changes in gut bacteria (i.e. LIBO) and compromised integrity of intestinal mucosa - the gut wall. SIBO presentations often overlap with the several functional gastrointestinal disorders such as IBS, functional diarrhoea, functional dyspepsia and bloating. A common thread between these conditions involves disturbed intestinal barrier function, which impacts enteric nerve sensitivity (i.e. more food sensitivity).
The main red flags for SIBO I see are bloating quickly or very closely to meals, rather than a few hours after, specific foods they can identify as triggers, and chronic irregular bowel movements (BM). Clients will usually find SIBO more severe than LIBO and way more chronic in terms of symptoms, additionally it is much harder to resolve on your own.
However - you can also have two predominant types of SIBO; methane dominant or hydrogen dominant. Both gases can be present at the same time, but depending which is higher, this can change the treatment style a little and tell us more about the types of bacteria that have progressed up the digestive tract. Methane dominant generally means an overgrowth of Methanobrevibacter smithii (the Meth- name beginning was definitely on purpose) and it usually constipation predominant too. Hydrogen dominant generally involves a number of other families: Clostridium, Enterobacter, Klebsiella, Citrobacter, and Bacillus to name a few, and can be more diarrhoea predominant. There is usually no one bad guy - it's a team effort.
LIBO
Lower intestinal bacterial overgrowth (LIBO) is a swing from a balanced, mutualistic relationship, to one of dysbiosis, i.e. imbalance.
Symptoms of LIBO
Bloating hours after meals
Cramping
Irregular bowel motions
Flatulence
Food intolerances
Systemic signs of inflammation (skin, joint pain, mental health, hormones, brain fog etc)
Risk factors are quite similar, and usually this precedes SIBO in most cases. Constipation and diarrhoea will 100% contribute as this affects the pH, the removal of toxins and waste; though diet and digestion will factor largely into this, as it creates the microbiome in the first place. High stress environments will add to the picture via beginning the process of ‘leaky gut’ and I often find this or similar stressors have kick started things by disrupting the normal digestive process. Viral and bacterial infections, antibiotics and other medications, toxins, stress, inflammation, food intolerances, and imbalances in gut bacteria all have been suggested as additional causes that upset digestion or contribute to 'leaky gut'.
The reason why the 'leaky gut' or intestinal permeability is a concern, is because this can allow pathogens, bad bacteria, undigested foods and potentially waste products to enter the body rather than being dealt with by the immune system or excreted normally. Once this process begins, it can overwhelm the immune system - setting off alarm bells - and generally making a mess of your gut lining. Collateral damage occurs both from the immune system reaction, but also the LPS or toxins produced by 'bad' bacteria and this further damages the protective gut lining (including mucin layer and cell wall). Eventually you get 1. overgrowth of nasty bacteria, and 2. undergrowths of your good/beneficial bacteria. Both of which cause symptoms and contribute to building food sensitivities.
The Approach?
Depending on your symptoms you can generally pick SIBO out more than half the time. Both do require a good 6+ months of work to resolve effectively, and yet SIBO is still the most relapsed of the two. Treatment from a naturopathic perspective can be quite similar or quite different depending on your pracitioner, however the aggressiveness of the diet will differ dramatically. One thing when finding the right pracitioner - you do need to be clear on what you're treating with them and you should always know what your supplements are for.
Got a question or concern - email me!