LIBO (Large Intestinal Bacterial Overgrowth): Diagnosis and Treatment
Large Intestinal Bacterial Overgrowth (LIBO)
A comprehensive guide to diagnosis and treatment. This article explains what LIBO is, the differences from SIBO, and the methods used in diagnosing and treating this lesser-known condition.
When we think of digestive health, the spotlight often shines on IBS (Irritable Bowel Syndrome) or Small Intestinal Bacterial Overgrowth (SIBO). However, there’s another condition which we see quite a lot nowadays — Large Intestinal Bacterial Overgrowth (LIBO). If your SIBO Breath test comes back negative within the first 100 minutes, and you still experience lots of symptoms such as diahrrea, constipation, bloating and gas, it could possibly be due to LIBO.
Understanding LIBO
The term Large Intestinal Bacterial Overgrowth (LIBO) has been circulating in the scientific community and spoken about in medical conferences, although it has yet to find its place in mainstream medical literature. Does it mean it doesn’t exist?
I think it certainly does, but we have to be honest about the fact the we, as the health and medical community, still know very little about it. Often dismissed as a catchy phrase, its relevance becomes clear when we see the common dysbiosis within the colon of the general population.
LIBO involves disruptions to the gut microbiota and an unusual proliferation of opportunistic bacteria within the large intestine, also known as colon. It is different from SIBO in the fact that the colon is meant to host a vast number of microbes within its walls, however this does not mean that the balance is always maintained. Nowadays it is unfortunately very often that we see imbalances in the microbiota, namely due to poor dietary habits, liberal use of broad-spectrum antibiotics and pesticides and herbicides in our food supplies. Let’s look into these two causes.
LIBO and Dietary Influence
Researchers explored whether diet alone, not just infections, could upset the delicate balance of gut microbiota. Their study on mice revealed significant changes in body weight (gain) and inflammatory markers associated with a high-fat Western diet rich in omega-6 fatty acids. Negative changes in microbiota composition were observed, showing the potential impact of dietary choices, especially now that we are bombarded with ultra-processed convenience foods.
Antibiotics and LIBO
Another important cause: antibiotic therapy emerged as a pivotal factor in inducing dysbiosis. Broad-spectrum antibiotics, administered orally, significantly altered microbiota composition, reducing diversity and favouring certain bacterial phyla which are less optimal.
While the microbiome can usually recover post-treatment, complete restoration to pre-antibiotics levels proves challenging, hinting at the long-lasting impacts of antibiotic interventions. Research results have demonstrated that there are still persistent long term impacts on the human intestinal microbiota that remain for up to 2 years post-treatment (this is how long the study was done for, so it could actually be longer than this).
Now pesticides and herbicides present in our food do have antibiotic effects in the body, and if we are not being cautious, we are basically microdosing antibiotics everyday through our diets alone. This is why I often recommend buying organic whenever possible.
Differences Between LIBO and SIBO
There are a few subtle differences between LIBO and SIBO.
Bacterial Population Levels:
SIBO is characterized by an excess of bacteria specifically in the small intestine.
LIBO is marked by an increased bacterial presence of opportunistic bacteria in the large intestine (colon).
Symptoms:
This is where it gets harder, because the various possible symptoms are basically the same. SIBO and LIBO both exhibit symptoms such as bloating, abdominal pain, diarrhea, chronic constipation, nutrient deficiencies and malabsorption.
Underlying Causes:
SIBO: Often linked to motility issues, anatomical abnormalities, or immune system conditions.
LIBO: May result from factors like antibiotic use, dietary choices, or alterations in the large intestine's environment.
Keep in mind that SIBO and LIBO can occur simultaneously. One does not necessarily indicate the other, however they are very closely connected.
Diagnosing LIBO
Accurate diagnosis of LIBO involves a blend of clinical evaluation, symptom analysis, and microbiome stool testing, such as the GI-MAP. It can also show up on a SIBO Breath Test if there is a big spike of gas after the 120min mark. It takes a knowledgable practitioner to understand the link between the symptoms and the microbiota presentation on the test results. It is not always required to eradicate or “kill” certain strains, sometimes a milder approach focusing on building a stronger community is enough.
Treating LIBO
Addressing LIBO requires a customized approach that can involve therapeutic interventions and lifestyle adjustments aimed at restoring balance to the large intestine's bacterial environment. Each microbiome is different and what is required for one could be totally useless to another. This is why one-size-fits-all protocols don’t work. It is important to know that shifting the microbiome takes time - we’re talking months, sometimes years depending on how long the imbalances have been brewing.
Here are a few aspects to look into while addressing LIBO:
Probiotics:
Incorporate targeted probiotic strains to rebalance the large intestinal microbiota.
Dietary Adjustments:
Modify the diet to support a healthy bacterial environment, emphasizing prebiotic-rich foods and reducing saturated fats. Lowering your consumption of Omega 6’s in favor of Omega 3’s can also reduce inflammation and positively impact the microbiome over time.
Lifestyle Modifications:
Integrate stress management and vagus nerve toning techniques as well as regular physical activity to promote overall gut health.
Antibiotics or Antimicrobials (when necessary):
This is always the last resort when it comes to addressing LIBO. I do believe that the environment of the large intestine can be rebalanced with the use of appropriate dietary and probiotic interventions. If necessary, employ targeted herbals or selected antibiotic therapy to address specific pathogenic bacterial imbalances.
A note of Rixafimin: this antibiotic is commonly used in the treatment of SIBO, as it is effective in the small intestine only and is not systemic. The reason for this is that it needs bile to get activated, and it is an advantage in the case of SIBO treatment. However, since most bile acids are reabsorbed within the last part of the small intestine, it is reported to be deactivated once it reaches the colon, hence being ineffective for treating dysbiosis in the large intestine.
As LIBO's significance gains traction, recognizing its dietary influences and the aftermath of antibiotic therapy becomes paramount. These insights pave the way for non-pharmacological interventions, emphasizing the need for a holistic understanding of gut health and its complexities.
For individuals suspecting LIBO, seeking guidance from a Gut Health Practitioner ensures a personalized evaluation and a targeted roadmap towards digestive wellbeing.