@dmcara

We have a lot in common. Before I started getting a handle on it, I had
lost weight too, maybe 20-25 pounds, into the below a good weight category.
If my similar gut issues can be used as a guide, there are two vectors that
trigger IBS, FOR ME:

*Vector 1 EMOTION* -- happy/sad emotion, or stress, or anxiety are
collectively an independent trigger
What I did: *a.* I took a low-dose Zoloft pill daily, cutting the 25 mg in
half. Zoloft due to my IBS-C (if there are side effects with Zoloft, it is
going to be loose stools. I felt better, but I also felt "blah" and stopped.*
b.* I cut off all contact with family and friends for a month, to "still
myself," as everything was making me anxious. *c. *I took a 7-week zoom
course with a gastro psychologist and at the end of the 7 weeks, I could
relax myself at will (this is a simplification; I have more details to my
success if you are interested).
If Nerva does this for you, even if you have to keep listening, keep doing
it. *d. *I care a whole lot less about issues and outcomes now, so I don't
get worked up.

*Vector 2 FOOD*-- food is an independent trigger. Almost everything
triggers my IBS-C. What I did:
FOOD: *a)* I started with the "green light only" Monash University FODMAP
app foods and through trial and error, I eliminated those that did not work
(I already knew I was grain intolerant and lactose intolerant). My staple
non-reactive, bland foodstuffs are plantain flour, lactose-free nonfat milk
and egg whites, and some powdered chia seeds, for a loose porridge that I
eat four times a day. I could list my other non-reactive foods if you need
them (the quantity of these "other" foods matter), as well as what I avoid
and eat little of. *b)* taking digestive enzymes with each meal (I could
tell you which if you like). *c)* never going hungry (its own trigger!),
*d)* traveling with two thermos of food, and a few nuts and seeds. No
restaurant foods and almost all drinks do not work for me.

ITS FORM, as solids, or even a mash, don't work well with my severely
redundant colon unless in a liquidy/loose form. The redundant colon is just
like a longer, curved water pipe, a mash or solids can get stuck.* e) *drinking
more plain water each day. *f)* adding "slip" before a meal (Slippery elm
bark powder, inner bark), *g) *taking magnesium citrate (some with meals,
more at night, *h*) adding Colace at night when I get off-track, *i*)
taking some Fermenting Fairy brand coconut milk kefir each morning (just
drops -- I am that sensitive).

*COMMENTS ON WHAT YOU SAID*
You have lost too much weight. I wonder if it is the emotional component or
the food component. Assuming you have addressed the emotional component,
you are eating something you shouldn't be eating or something non-reactive
but in too large a quantity.

It is not likely your GI MD has anything in his toolbox for you, mine
didn't. I can't believe s/he speculated on a food disorder. You could try
changing GI doctors. Some may do 2nd opinions on Zoom. I trust (to the
extent I can trust anything), the Castle and Connolly listing of MDs. I can
tell you why if you like. You have to do trial and error at home. You could
get a referral to an IBS-proficient dietician if you want such
guidance/partnership.

I also have a weak pelvic floor. Just IBS pooing all the time, even without
straining, exacerbated this problem for me ( I use a pessary now).

You sure don't have to be celiac to have a gluten issue. Gluten intolerance
is a big deal and both can cause many of the same problems. The latest info
says that gluten intolerance can bring on a host of health issues too. All
the MDs can do is test for celiac. MDs cannot test for gluten intolerance
(it is just a diagnosis of exclusion.) Google Cleveland Clinic and Gluten
Intolerance. I also have recent studies. Intolerance is not a small thing
in terms of potential problems.

I had colic as a newborn. Unlike you, after that phase I ate everything
until my 30s when I noticed rice plugged me up. Then in my late 40s, I
became lactose intolerant and my gut health started spiraling downward.

The best I can do today, is to address the dysbiosis that is causing food
type (and food amount) intolerances ON A DAILY BASIS. That means "taking
care of it" with every meal and drink. Doing all that I do gives me a
near-normal elimination experience. I still have a limited diet.

My gut has been getting worse over time. I am hopeful with my digestive
enzymes and probiotics, I can continue to have a more normal gut and
digestion/elimination process and arrest my gut's decline, so that it is
stable.

I do not think I can fix my gut permanently, as things stand now.

My biggest problem is constipation and IBS-C symptoms, which I have a
handle on now. I can live with my limited diet.