Why Does SIBO Keep Coming Back After Treatment? — What this means for treatment

A treatment approach anchored in the Host Capacity Model differs substantially from standard SIBO treatment. The shape of the approach is roughly: First, identify the upstream drivers sustaining the inflammatory tone. This may be a persistent low-grade infection, an ongoing dietary trigger, environmental exposures, sleep disruption, or unaddressed metabolic dysfunction. Until these are addressed, no substrate intervention can outpace the inflammatory drive that is consuming the substrate. Second, restore the regulatory cofactor pool, particularly NAD+. This typically involves NAD+ precursor supplementation (nicotinamide riboside or NMN at clinically validated doses), attention to the methylation cofactors that support both substrate function and regulatory machinery, and removal of NAD+-consuming drivers where possible. Third, work the gut substrate directly. This involves addressing SLC5A8 silencing where present, supporting Fe-S cluster biogenesis, sequencing antimicrobial intervention into a state that can sustain the result, and supporting the recolonization of the obligate anaerobic core community. Fourth, address the autonomic layer. Vagal afferent restoration, parasympathetic support, autonomic conditioning. The cholinergic anti-inflammatory pathway is a substantial regulator of the inflammatory tone that drives the cascade. Fifth, manage downstream symptoms with contain