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I’m confused about why you’re trying to get off Miralax if it’s helping you. Is it because you want to address the “root” of what you think is the problem, the motility caused by gut dysbiosis?
If so, that’s understandable, but Miralax is safe to take long-term. Some people need to take it long-term. And taking it regularly can improve motility, thereby in time rebalancing your gut microbiome.
As you found, “natural” solutions such as probiotics aren’t without side effects. They can cause gas, constipation, or diarrhea.
There are other ways to manage constipation and motility if you want something more natural. Sunfiber (there are generic brands), psyllium fiber, or I use magnesium citrate supplements (the capsules, not the liquid). My PCP recommends at least 400 mg for constipation. Or there is a product called Natural Calm, which mixes into a drink and is magnesium citrate when mixed with water.
I saw a GI dietician to help me figure out safely what foods work best for me and expand my diet, a pelvic PT who taught me abdominal massage techniques, and a GI psychologist who taught breathing practice and does gut-directed hypnotherapy. So they all had knowledge and taught things that my gastroenterologist knew of, but fell without her specialization.
All of the above can help reset the gut microbiome in time. But If tackling your gut microbiome directly is your goal, that’s more challenging and less clear. While research is clear that the gut microbiome is important; it’s less clear how to address it. That’s probably why you’re doctor has little or nothing else to suggest if you’re asking them that question—what they do know if Miralax is safe taken regularly; what they don’t know is what’s going on with your gut microbiome and/or how to address it.
The one thing I can think of is you could ask to be tested for SIBO. But some clinics or medical centers don’t do that and have to be willing to order the test kit for you.
If you really want to take a different approach, you may want to consider getting a second opinion with a gastroenterologist at an academic medical center that would be more likely to have a team of a GI psychologist, GI dietician, and/or pelvic PT. Or you could consult any of the above on your own; I’d just suggest specifically a GI-trained dietician.
Or look for a naturopath or integrative medicine provider. I don’t have personal experience with a naturopath; it’s always made me a little uncomfortable, but that’s just me. My PCP is an integrative medicine provider though.
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Unfortunately, I moved from a very sophisticated place (Long Island) to a place where you need to do heavy research to find a real doctor, so the things you describe in terms of the treatment you received do not exist here, I can almost guaranty that. There is a teaching hospital an hour away, I have two physicians there, and the director of Gastroenterology was highly recommended. When I'm done with this horrific colonoscopy nightmare end of October, I'm going to make an appointment with him to discuss the issues. Unfortunately, winter is coming and driving an hour in each direction on the Thruway is tricky because you never know when it will snow or be icy and the Thruway is notoriously filled with lunatics, especially the truck drivers. Apparently, the career truckers are more and more difficult to find and the drivers in their place are actually homicidal maniacs. Who knew this could happen.
I don't think there' sa PCP "integrative medicine provider" within a 3 hour ride of me. Downstate, we have NY Presbyterian extension and I think NYU Langone is somewhere in Westchester now. But basically, I left a place with state of the art medicine (NYU Langone has a huge facility on Long Island now, and there's North Shore University LIJ and a couple of others) for a place with corporate "doctors" who resemble AI robots but don't know as much.
I don't have SIBO. I have none of the signs. I have a slow bowel which is most likely related to insufficient water intake as I'm totally unable to drink lots of it. And age, of course. Also, can't take any supplements with fiber. Fiber is what caused the bowel inflammation last December, I started eating peas with dinner, lots of peas. Miralax helps that along. I know at least one person who has been taking Miralax for a very long time, but she's 94. I have 20 years to go, hopefully not, since my quality of life at this point is non existent. I wish I could take your recommendations. Honestly, the Nutrition Center across the river here is still stuck in a community hospital in a quaint rural Mid Hudson Valley town, i.e., medical care stinks. I really don't trust them. I've used Calm, did nothing. The problem here is that I can't stop the Miralax to experiment with magnesium citrate because I will get constipated as a reflex to withdrawal and then the hemorrhoid and anal rim discomfort will get worse and I'm more likely to go off the Rhinecliff Bridge.
Thanks for your comments, very educated, and very good ideas, but might be impossible to achieve where I live. I'll do some research.