Should SIBO be treated before Mold, Lyme, Cos?

I would address SIBO and any other gut dysbiosis first. SIBO could inhibit absorption of nutrients you need, and might limit which treatments you can tolerate. I also would not want to disrupt the gut further with pharmaceutical antibiotics until the overgrowth is corrected. Mycotoxin illness treatment often involves binders (which you might already be taking) that can be tricky with SIBO because it's important to avoid anything that reduces intentional motility. Are you thinking you'll treat with rifaximin in addition to the low-FODMAP diet?

I know it's hard to figure out which thing to do first sometimes, and I wish you luck navigating it all! Are you definitely out of mold exposure?

from my own research into SIBO and gut issues i have come to the following conclusions

gut dysbiosis will always happen to some degree with lyme

whether a person has symptoms of this or not will vary - as something like 15-20% of the general population also have SIBO confirmed by the gold standard method of aspiration - and often report no symptoms - so different people / immune system states have different tolerance for gut issues.

however with lyme - its much more likely you will have symptoms showing up - as the system as a whole is more stressed and dysregulated and less tolerant to stresses of any kind

the reason for this is that the inflammatory state that lyme generates in the body and in the digestive organs in particular - including the liver - which has to deal with the free radicals and oxidative chemicals systemic Lyme inflammation causes - and which often gets overloaded and passes these into the bile unchanged - which then flows into the gall bladder ( many with lyme have gall bladder issues) and eventually into the gut - where it continues to do harm.

this inflammatory state in the gut is then the wrong environment for the right balance of beneficial bacteria to prosper and instead favours the more pathogenic species which add to inflammation - inflame the immune system and drive leaky gut and more gut and systemic symptoms.

there is also the fact that SIBO and lyme are thought t be linked to nerve damage in the gut which hampers its ability to regulate itself - and in particular to coordinate the peristaltic action that the gut uses to clean itself and keep the fermenting bacteria in the colon where they belong. as a result with lyme SIBO is often a recurrent problem.

in function medicine circles Lyme is a known thing to look for if SIBO is repeatedly recurring after treatment.

this has happened to me - i treated with comprehensive SIBO / dysbiosis protocol for 12 weeks and just experienced herx symptoms the entire time until i eventually stopped. poss. some mild but short-lived benefits in the time between stopping and the herx subsiding - and the previous symptoms returning and no real lasting benefits

so my perspective is its very hard to treat SIBO / Dysbiosis effectivey while Lyme and in my case bart is still active - a these things will be driving things in the wrong direction.

it can be managed though.
the best thing i have found for this is
-adapting my diet to strict wholefood ketogenic approach - better than 50% symptom reduction
-HCL and pepsin capsules with every meal to aid digestion
-no snacking - i eat 3 regular spaced meals through the day - to give the gut a chance to rest and clean itself - try to make my last meal at least 3hrs before bed - but longer is better - eg 6pm till 8am gives a longer period for the gut to calm and settle

i believe Bart in particular drives this kind of gut inflammation driven symptom picture with autoimmune elements. it is known to infect both the stomach and the colon, and the endothelial cells of the entire digestive system as well as the liver and cause inflammation ( gastritis, colitis etc - and even drive primary sclerosing cholestasis - and i had gastritis and discoloured colon on endoscopy )