Counterargument
What if dysbiosis is primary?
The Host Capacity Model treats dysbiosis as a downstream readout of host substrate state. A skeptical reader may argue dysbiosis is the primary disturbance.
Where it is valid
In post-antibiotic disturbance, structural disease, and after pathogen exposure, dysbiosis can be the primary entity to address.
What it challenges
The HCM claim that durable resolution requires restoring host bioenergetic substrate, not only modulating the microbe.
Host Capacity Model response
HCM does not deny that dysbiosis can be primary in some cases. It claims that in the recurrent / treatment-resistant subset, microbe-only strategies tend to fail durably and host substrate becomes the limiting factor.
Unresolved questions
- What clinical features best discriminate primary-microbial cases from host-capacity-mediated cases?
- Are there biomarker thresholds that predict response to microbe-only strategies?
Evidence that would resolve this
- Prospective stratified trials comparing microbe-only vs combined-substrate strategies in matched recurrent-SIBO cohorts.