Why Every Protocol Stops Working After Two Weeks: The Mechanistic Pattern Hiding in Plain Sight in Chronic SIBO, MCAS, and Long COVID — Part 5: What to Do Now

If you have read this far, and the arcs in your own history match what I have described, here is what the data is telling you. You do not need another antimicrobial course. You do not need another mast cell stabilizer at a higher dose. You do not need another diet. You do not need another vagus nerve protocol or another mitochondrial cocktail or another expensive functional test that confirms what you already know. What you need is a careful, mechanistic re-reading of your case at the layer your interventions have been bypassing. That re-reading involves several specific things. First, an honest accounting of the floor. The symptoms that no intervention has moved. The signature your data is converging on. This is the most diagnostically useful information in your entire case file, and almost no one looks at it. Second, an integrated read of the available substrate and capacity data — bile acid handling, mitochondrial cofactor status, iron-sulfur cluster substrate availability, redox balance, inflammatory tone, NAD pool dynamics if measurable, and the proxy markers for colonocyte energy state that are visible in standard stool and serum panels if you know how to read them. Third, a triage of which lesions are tractable. Some capacity-layer lesions are addressable with substrate and environmental modification. Some require pharmaceutical intervention through your medical team. So