IBS - mixed. Are there medications for this?

Thank you so much for taking the time to share your experiences and suggestions with me. I can’t tell you how helpful your post has been, not only for the practical suggestions but also for the realization that I’m not the only one managing severe dietary restrictions and protocols with little professional support out there, and that there are ways to address it beyond the standard stuff my dietitian talks about.
I do think I have both emotional and food triggers, although the food triggers seem to be the most severe and rapid in terms of reaction. I’m coming off a year of primary caregiving, my beloved mother, who was my best friend and passed away in February at the age of 96 but suffered from a terrible disabling stroke last June and I spent the last months of her life really not eating well or much and running to the hospital in ambulances and navigating hospice and end of life care so there’s a part of me that realizes that the severity of the recent attacks really are psychological in nature yet at the same time I’ve had a few months now on my own, and I’ve also recently retired, so the level of stress has decreased substantially. Maybe it will just take time because the grief is still very strong. I feel like I really need to reset everything and start from scratch trying to figure out the best dietary approach because right now I’m living on so much carbohydrates that I think all the white rice, for instance, binding me up.

I’ve gotten coaching in the past from Heather who runs the website helpforibs.com and I use her Acacia fiber mixed in with my food to try to get some prebiotics in there. She also recommended the probiotics called VSL #3 . I’ve stopped taking it recently because of the flares that I was having, but I hope to get back on it soon. I would love to learn more about digestive enzymes, and I’m also wondering if some kind of bile sequestration med might help with the diarrhea, although it can also cause constipation. I think I really have IBSM although the C is more frequently a problem, whereas the D flares up unexpectedly and disables me for days and causes the weight loss to continue.
My insurance company covers the OSHI program, where you get telehealth with a nurse practitioner with expertise in G.I. as well as a dietitian and a gut therapist. They were all getting frustrated with my food restrictions and that’s why they sent me out for the CAT scans which led to the MRIs, etc.. I basically live on white rice, white chicken and turkey meat, tilapia, fish, mashed carrots mixed with the chicken and cream of rice. Also egg whites and well steamed green beans. The only thing I drink is warm water. I can no longer tolerate green tea or honey or any kind of sweetener other than maple syrup ( which thank goodness still agrees with me. )
My food choices have narrowed so much that I’m not really sure what I can add safely back, but I’m sure there must be more than just those foods. I tried to add plantains and I had an allergic reaction I used to be able to eat nut butters and almond milk but had a reaction. I have no dairy, no beef no lamb no raw fruits no raw vegetables right now no fruit at all not even cooked. It’s a really bare minimum diet. Like I said I feel like I need to start from scratch and figure out what is safe and healthy to eat.
I’m hoping to get some food allergy testing so that I know what I can actually add back in without worrying about allergic reactions because these reactions might’ve been the result of hypersensitivity because of what I was going through in my life at the time. I’m really not sure. I no longer eat out at restaurants which can contribute to social isolation. How do you deal with that? Food is such a communal experience.

I’m very interested in slippery Elm how you use it and how it helps as well as the kinds of digestive enzymes that work for you. You also mentioned got directed therapy. Was that belly breathing or did it go beyond that? The Nerva app is all about deep breathing and guided visualizations. The OSHI gut therapist I just began working with mentioned CBT. Have you had experience with that?

I will end this long post here with many thanks again for your response and best wishes for your own health!

@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.

@dm1264 Gosh,

I just wrote a detailed message and my computer froze and I lost it (darn). The tweet version:

MDs or their underlings really don't help.

Get tested for food allergies with the skin prick test. You need to confirm you just don't have a severe IBS reaction. And you should know exactly what you are allergic to.

Do CBT. It is researched and worked great for me. It allows me to turn off anxiety. Some psychologists at GI Psychology in Burke, VA can do CBT hypnosis for anxiety or perhaps even grief for out of state clients. It is a 7 week course.

Feel free to try a Zoloft bridge now (due to your grief) Try the lowest dose 25 mg tablet and cut it in half for your dose. You don't weigh much and you can taper off easily at that dose. It regularizes the gut and helps with constipation. A bridge to a better psychic place. You don't have to stay on it.

Your current diet is low residue. It is supposed to be constipating! What can they recommend for constipation?

Use Hilma Constipation Relief to stay unconstipated. Add in Colace (brand name only) to assist in that or to solve constipation. Both are gentle. Each works a different way and can be taken together. Neither is a stimulant laxative.

Use Colace 2 in 1, a stimulant laxative, that works and is gentle if the above doesn't work for constipation. The Colace brand was recommended by a good Gastro long ago.

If you are not exploring low FODMAP foods, that is bad. Buy the Monash Food App for $9 and explore it. For example, green beans are not good for IBS. Get the app. Read up on Monash University and FODMAPs.

Try Fermenting Fairy or Align, or whatever, but get off VSL#3. IBS is solved every day. If your probiotic is not speeding up your digestion to prevent constipation, find something else. Check their website.

Try Frontier Coop Slippery Elm inner bark powder. I use 1/8 teaspoon in water before every meal or snack. Read up on it. Adds mucosa/supports mucosa.

Read up on Immuo-gG SBI. It heals gut. My brand is Biotics Research. I take one capsule with breakfast.

Breakfast and dinner: I take Intoleran brand dietary enzymes (one each of three - for carbs/sucrose, fructose, fiber) with breakfast and dinner. I also take one Pure Encapsulations Pancreatic Enzyme Formula for fats and proteins digestion.

Lunch: I take the comprehensive Pure Encapsulations Digestive Enzymes Utra for lunch and snacks.

Look into resistant starch. It heals the gut too.

I am curious -- did you get your reaction to green (unripe, hard) plantains or ripe ones?

Okay, so not a pretty, but the gist of it.

@dm1264 Gosh,

I just wrote a detailed message and my computer froze and I lost it (darn). The tweet version:

MDs or their underlings really don't help.

Get tested for food allergies with the skin prick test. You need to confirm you just don't have a severe IBS reaction. And you should know exactly what you are allergic to.

Do CBT. It is researched and worked great for me. It allows me to turn off anxiety. Some psychologists at GI Psychology in Burke, VA can do CBT hypnosis for anxiety or perhaps even grief for out of state clients. It is a 7 week course.

Feel free to try a Zoloft bridge now (due to your grief) Try the lowest dose 25 mg tablet and cut it in half for your dose. You don't weigh much and you can taper off easily at that dose. It regularizes the gut and helps with constipation. A bridge to a better psychic place. You don't have to stay on it.

Your current diet is low residue. It is supposed to be constipating! What can they recommend for constipation?

Use Hilma Constipation Relief to stay unconstipated. Add in Colace (brand name only) to assist in that or to solve constipation. Both are gentle. Each works a different way and can be taken together. Neither is a stimulant laxative.

Use Colace 2 in 1, a stimulant laxative, that works and is gentle if the above doesn't work for constipation. The Colace brand was recommended by a good Gastro long ago.

If you are not exploring low FODMAP foods, that is bad. Buy the Monash Food App for $9 and explore it. For example, green beans are not good for IBS. Get the app. Read up on Monash University and FODMAPs.

Try Fermenting Fairy or Align, or whatever, but get off VSL#3. IBS is solved every day. If your probiotic is not speeding up your digestion to prevent constipation, find something else. Check their website.

Try Frontier Coop Slippery Elm inner bark powder. I use 1/8 teaspoon in water before every meal or snack. Read up on it. Adds mucosa/supports mucosa.

Read up on Immuo-gG SBI. It heals gut. My brand is Biotics Research. I take one capsule with breakfast.

Breakfast and dinner: I take Intoleran brand dietary enzymes (one each of three - for carbs/sucrose, fructose, fiber) with breakfast and dinner. I also take one Pure Encapsulations Pancreatic Enzyme Formula for fats and proteins digestion.

Lunch: I take the comprehensive Pure Encapsulations Digestive Enzymes Utra for lunch and snacks.

Look into resistant starch. It heals the gut too.

I am curious -- did you get your reaction to green (unripe, hard) plantains or ripe ones?

Okay, so not a pretty, but the gist of it.

@researchmaven

Thank you!!! (Sorry you lost your first reply!) I’m going to print these details and look into each one.( I'm not sure VSL #3 doesn’t work because I stopped taking it during recent flare. )