{"version":"v1","contradiction":{"id":"is-dysbiosis-primary-or-adaptive","question":"Is dysbiosis a primary lesion or an adaptive response to host failure?","summary":"Conventional gastroenterology often treats dysbiosis as the lesion to be corrected (kill, replace, restore). The Host Capacity Model treats most clinically relevant dysbiosis as an ecologically rational adaptation to a hospitable habitat created by host bioenergetic failure.","positions":[{"id":"dysbiosis-as-primary","label":"Dysbiosis as primary lesion","thesis":"An abnormal microbial composition is itself the disease driver; restoring composition restores function.","predicts":["Targeted antimicrobials or replacement (FMT, defined consortia) durably resolve symptoms.","Composition normalises before symptom resolution."],"supportingEvidence":["FMT efficacy in C. difficile (a true microbial lesion).","Animal models where transfer of dysbiotic microbiota transfers phenotype."],"weakeningEvidence":["High recurrence after antimicrobial or FMT therapy in functional gut disease.","Substantial overlap of 'dysbiotic' patterns in asymptomatic individuals."],"authorPosition":"treated-as-rival","evidenceLevel":"emerging"},{"id":"dysbiosis-as-adaptive","label":"Dysbiosis as habitat adaptation (HCM)","thesis":"Most clinically observed dysbiosis is an ecologically rational response to a host habitat that has lost its O₂ gradient and SCFA-driven selection.","predicts":["Restoring colonocyte bioenergetics shifts ecology back without targeted antimicrobials.","Composition normalises after, not before, host-capacity recovery."],"supportingEvidence":["Litvak/Bäumler/Byndloss work linking epithelial O₂ tension to facultative-anaerobe expansion.","Clinical pattern of antimicrobial relapse without bioenergetic intervention."],"weakeningEvidence":["Cases where composition-only interventions (e.g. specific strain replacement) durably resolve symptoms.","Lack of large prospective trials measuring epithelial bioenergetics directly."],"authorPosition":"preferred","evidenceLevel":"mechanistic-inference"}],"unresolvedQuestions":["Do humans with sustained remission show measurable changes in epithelial O₂ consumption?","Do bioenergetic markers prospectively predict relapse risk?"],"arbitratingExperiments":["Prospective cohort measuring colonic biopsy SIRT3, mucosal lactate/pyruvate, and stool SCFA before/after relapse.","Trial comparing bioenergetic restoration vs. antimicrobial-only in recurrent SIBO with bioenergetic readouts as primary endpoints."],"relatedConcepts":["host-capacity-model","dysbiosis-ecology","oxygen-gradient-failure"],"relatedArticles":["why-some-people-never-recover-from-gut-disorders-the-overloo"],"relatedClaims":["host-capacity-model-thesis","treating-bacteria-without-host-capacity-fails"],"lastReviewed":"2026-05-11"}}