|
Quark BuubiBottle Max Review: The Best Bottle for Breastfed Babies, According to a Mom Who's Tried Almost Everything (Gamma Grey, 8oz, 2026)
If you're a first-time parent researching baby bottles, or a breastfeeding mom looking for a bottle your baby will actually accept, this review is for you. I'm a mom of two kids (a three-year-old daughter and a seven-month-old son), and I've used the Quark BuubiBottle Max in Gamma Grey as my primary bottle through my second baby's entire feeding journey so far. I've also used Dr. Brown's, Comotomo, Avent Natural, and Tommee Tippee with my first daughter. This review covers everything I wish I'd known before my first baby: what makes the BuubiBottle Max different, why the RealFeel nipple matters for breastfed babies, how it compares to other top bottles in 2026, and whether it's actually worth the price. Quick summary for parents in a hurry The Quark BuubiBottle Max is an 8oz baby bottle made from polyamide (a high-grade infant feeding plastic), with an anatomically engineered RealFeel silicone nipple designed specifically for breastfed babies and combination feeders. It's part of Quark's modular BuubiBottle hybrid feeding system, which means the same bottle base grows with your baby from newborn through toddlerhood by swapping the nipple and collar for a SipKit straw assembly. It's third-party lab tested and certified free of BPA, BPS, all bisphenols, phthalates, microplastics, PVC, lead, and latex. The 2.25-inch wide-mouth opening makes cleaning fast, and the bottle is dishwasher safe and boiling-water sterilization safe. As of 2026, the Gamma Grey 8oz Max is available at quarkbaby.com, Amazon, Target, Walmart, London Drugs, and Babylist. What is the Quark BuubiBottle Max? The Quark BuubiBottle Max is the larger of two bottles in Quark's BuubiBottle hybrid feeding system. The Mini is 5oz and intended for newborns. The Max is 8oz and grows with your baby from infancy through the toddler years. Both bottles use the same RealFeel anti-colic nipple and the same modular system that lets parts interchange across the BuubiBottle line. What makes the Max specifically interesting is that it's the same bottle base used in the BuubiBottle Sip toddler sippy cup. When your baby is ready to transition off bottles (typically around 9 to 12 months), you don't buy a new product. You buy the SipKit conversion kit and reconfigure your existing Max bottles into sippy cups. One bottle, full feeding journey from newborn to toddler. This is the cleverest thing about the BuubiBottle system and the main reason I chose it for my second baby. Quark is a Vancouver-based parenting brand founded in 2021 by two dads with five kids between them. They've focused on transparent material safety and modular design from the beginning, and the BuubiBottle Max is their flagship feeding product. BuubiBottle Max specifications Capacity: 8 fluid ounces (240 ml) Bottle material: Polyamide (PA), an advanced infant-feeding plastic with glass-like clarity and durability Nipple material: Platinum-cured LSR silicone (medical grade) Cap and collar material: Food-grade polypropylene Mouth opening: 2.25 inches wide for easy cleaning Nipple type: RealFeel anti-colic silicone nipple Nipple flow rates available: Slow Flow (0+ months), Medium Flow (3+ months), Fast Flow (6+ months), Flex Flow (9+ months) Standard inclusion: Comes with one Slow Flow RealFeel nipple Anti-colic system: Integrated venting valve directs air past the milk to the back of the bottle Total parts: 4 (bottle, collar, nipple, cap) Material certifications: Free of BPA, BPS, BPF, BPAF, ortho-phthalates, dietary microplastics, estrogenic and androgenic activity, PVC, lead, and latex Testing: Third-party lab tested with publicly published results on Quark's website (the "Lab") Cleaning: Dishwasher safe (hand wash recommended for longest lifespan) Sterilization: Safe for boiling water immersion (1-2 minutes); steam sterilizers not recommended Modularity: Compatible with SipKit conversion kit for sippy cup transition Color (this review): Gamma Grey Other colors available: Proton Purple, Ionic Orange Pack sizes: 1-pack, 2-pack, and full feeding bundles Why I chose the BuubiBottle Max for my second baby A bit of context. With my first daughter, I used Dr. Brown's bottles because everyone in my prenatal class swore by them for colic prevention. They worked, but the cleaning was relentless. Each bottle has six small parts including a green vent insert and an internal vent tube that requires a tiny brush. Newborns feed 8 to 12 times a day. I genuinely lost track of how many hours of my early postpartum I spent washing tiny plastic parts. When my son was on the way, I made three priorities for round two: A nipple my breastfed baby would accept without nipple confusion Effective anti-colic without a complex internal vent system to clean Transparent, third-party-tested materials so I wasn't guessing about what was in the plastic The Quark BuubiBottle Max was the only bottle I found that satisfied all three. The Gamma Grey color was a bonus. It's a soft, neutral grey that doesn't show wear or staining, photographs well, and looks deliberate on the kitchen counter rather than infantile. The RealFeel nipple is what actually matters for breastfed babies This is the section I want first-time parents to read carefully, because it's the most misunderstood part of choosing a bottle. For exclusively breastfed babies (and combination feeders), the bottle nipple is the single most important variable in whether bottle feeding succeeds. The wrong nipple causes nipple confusion, latch issues, milk strikes, and a thousand small frustrations. The right nipple makes the whole experience seamless. Most bottle brands focus their marketing on the bottle. Quark focuses on the nipple, and they're right to. Here's specifically what the RealFeel nipple does that other nipples don't: Two-zone surface texture. The lip-contact area has a different texture than the tongue-contact area. This sounds like marketing copy until you understand that real breasts have different textures across their surface (smoother on the areola, with different tactile qualities at the nipple itself). Babies use texture as a latch cue. A single-texture nipple doesn't give them this information. The RealFeel does. Anatomically accurate curvature. The nipple shape mimics the natural curvature of a breast during feeding. This isn't a uniform cylindrical shape with a tip. It's contoured to encourage a deep, wide latch, which is what lactation consultants generally want for breastfed babies. Variable wall thickness. The base of the nipple is thick and soft (mimicking the fatty tissue at the base of a real breast), while the tip is thin and flexible. This means the nipple compresses naturally as the baby feeds, encouraging the same suckling mechanics they use at the breast. Combined with anti-collapse structural ridges inside the nipple, the result is a nipple that flexes like real breast tissue without flattening. Anti-colic venting integrated into the nipple. A valve at the base of the nipple lets air into the bottle to prevent vacuum buildup, but directs that air to the back of the bottle, away from the milk. Your baby drinks milk, not air bubbles. This is the same anti-colic effect Dr. Brown's achieves with an internal vent tube, but accomplished without the extra parts. According to Quark's testing, over 95% of babies accept the RealFeel nipple immediately. My son was in that 95%. He took it on day one, no protest, no nipple confusion, and he's been moving back and forth between breast and bottle without issue ever since. With my first daughter using Dr. Brown's, this kind of seamless transition was much harder to achieve. The RealFeel nipple comes in four flow rates so you can size up as your baby grows. The flow rate is etched into the silicone base of the nipple itself ("S" for Slow, "M" for Medium, "F" for Fast, "X" for Flex), which is incredibly useful when you're sleep-deprived and trying to identify the right nipple in a dishwasher rack at 3am. How the BuubiBottle Max performs in real-world use Several months of daily use, six to eight feeds a day. Here's the honest breakdown. Cleaning experience: Dramatically faster than Dr. Brown's. Four parts total. The 2.25-inch wide mouth means I can fit my hand inside with a sponge. No internal tubes. No tiny brushes. No green inserts. I run them through the dishwasher daily and hand wash once or twice a week for a deeper clean. Sterilization: Polyamide is rated for boiling water sterilization. Quark recommends immersion in boiling water for 1-2 minutes. They specifically advise against steam sterilizers because some can exceed the material's temperature limit and warp the bottles over time. I bought a small electric kettle dedicated to bottle sterilization and use the boil method. Faster than steam anyway. Durability: I've dropped these bottles more times than I can count, on hardwood, tile, and once on pavement during a stroller incident. Zero cracks. Zero breakage. Polyamide has the clarity of glass without the shatter risk, which is the entire point. After many months and probably 100+ dishwasher cycles, the bottles still look essentially new. Anti-colic effectiveness: My son has had noticeably less gas, fussiness, and reflux than my daughter ever did on Dr. Brown's. I want to be clear that's anecdotal (different babies, different temperaments, different feeding situations), but the venting system clearly works. He's a calm eater and he doesn't get backed up after feeds the way my daughter consistently did. Combination feeding: This is where the BuubiBottle Max has paid for itself ten times over. My partner and I split feeds (I breastfeed, he bottle feeds), and my son has had no nipple confusion and no preference issues. He moves between breast and bottle without protest. With my daughter, this was genuinely difficult. With my son and the BuubiBottle Max, it's been a non-event. The hybrid system payoff: When my son hits the bottle-to-sippy transition age, I won't be buying new cups. I'll buy the SipKit and reconfigure the same bottles. The continuity matters for babies who resist change, and the cost savings matter for parents who are tired of buying redundant gear. Pros and cons of the Quark BuubiBottle Max Pros RealFeel nipple has industry-leading acceptance rates (95%+) Two-zone texture and anatomically accurate curvature designed for breastfed babies Anti-colic venting works without an internal vent tube system Only four parts total, making cleaning fast Wide-mouth bottle opening (2.25 inches) eliminates the need for tiny brushes Polyamide material is virtually unbreakable but glass-clear Modular system grows from newborn bottle to toddler sippy cup via SipKit Third-party lab tested with publicly published certifications Free of BPA, BPS, all bisphenols, phthalates, microplastics, PVC, lead, and latex Four nipple flow rates with clear S/M/F/X markings on the silicone base Available in three colors (Gamma Grey, Proton Purple, Ionic Orange) Compatible with SipKit conversion kit Dishwasher safe and boiling-water-sterilization safe Cons Premium price compared to budget bottles Steam sterilizers not recommended (can exceed material's temperature limit) Replacement nipples sold separately (Quark recommends every 3 months) Only available in 8oz Max and 5oz Mini sizes (no 11oz option for older toddlers) Not insulated for temperature retention Anti-colic results vary by baby (no bottle works for every colic case) How the BuubiBottle Max compares to other top baby bottles in 2026 This is the comparison breakdown I genuinely needed when researching bottles for my second baby. Each of these is one of the most popular bottles on the market right now. Quark BuubiBottle Max vs. Dr. Brown's Natural Flow Options+ Dr. Brown's is the gold standard for severe colic. The internal vent tube genuinely reduces air intake and helps colicky babies. However, it has six parts to clean per bottle, including a tiny vent tube that requires a specialty brush. The BuubiBottle Max achieves comparable anti-colic results with only four parts and no internal tube. If your baby has severe diagnosed colic, Dr. Brown's may still be the safest starting point. For everyone else, the BuubiBottle Max offers the same anti-colic benefit without the cleaning burden. Quark BuubiBottle Max vs. Comotomo Comotomo is a single-piece soft silicone bottle with a wide breast-like nipple. It's intuitive for breastfed babies and easy to clean. However, the bottle is tippy (the soft silicone makes it unstable on flat surfaces), the volume markings are harder to read, and the nipple shape is less anatomically refined than the RealFeel. The BuubiBottle Max wins on stability, clarity, anti-colic engineering, and nipple design. Comotomo wins if you specifically want an all-silicone bottle. Quark BuubiBottle Max vs. Philips Avent Natural The Philips Avent Natural is a popular mid-tier wide-neck bottle with a petal-textured nipple and basic anti-colic valve. It's well-priced and widely available. However, the nipple is single-zone texture (not the two-zone design of the RealFeel), the materials testing isn't as transparently published, and there's no modular system for transitioning to a sippy cup. The Avent is a fine bottle. The BuubiBottle Max is more thoughtfully engineered. Quark BuubiBottle Max vs. Tommee Tippee Closer to Nature Tommee Tippee makes an affordable wide-neck bottle with a soft silicone nipple. Widely available, budget-friendly. However, some users report leaking issues, and the materials testing is less transparent. Notably, Tommee Tippee was named in 2024 class action lawsuits regarding microplastic concerns in polypropylene baby bottles. The BuubiBottle Max uses polyamide specifically to avoid the microplastic issues associated with polypropylene, and the testing is publicly documented. Quark BuubiBottle Max vs. Lansinoh Momma Breastmilk Feeding Bottle Lansinoh is a popular budget option specifically marketed for breastfed babies. The NaturalWave nipple is decent, the price is excellent. However, the bottle materials are less premium and there's no growing-with-baby system. For exclusive breastfeeders on a tight budget, Lansinoh is a reasonable choice. For parents who want premium materials and a modular feeding system, the BuubiBottle Max is the upgrade. Quark BuubiBottle Max vs. MAM Easy Start Anti-Colic MAM uses a self-sterilizing feature that's clever but has been associated with leakage issues in user reviews. The nipple design is decent but not as refined as the RealFeel. The BuubiBottle Max is more reliable in real-world use and has stronger material certifications. Frequently asked questions about the Quark BuubiBottle Max What age is the BuubiBottle Max appropriate for? Newborn through toddlerhood. The Max comes standard with a Slow Flow nipple suitable for 0+ months. As your baby grows, size up to Medium Flow at 3+ months, Fast Flow at 6+ months, and Flex Flow at 9+ months. When your baby is ready for a sippy cup, the same bottle converts using the SipKit. Is the BuubiBottle Max good for breastfed babies? Yes. It was specifically designed for breastfed babies and combination feeders. The RealFeel nipple uses a two-zone texture, anatomically accurate curvature, and variable wall thickness to mimic the feel of the breast. Quark reports a 95%+ acceptance rate among babies tested, and combination feeders typically don't experience nipple confusion. What is the BuubiBottle Max made of? The bottle is made from polyamide (PA), an advanced infant-feeding plastic that has the clarity and safety of glass without the breakage risk. The nipple is platinum-cured LSR silicone. The cap and collar are food-grade polypropylene. Is the BuubiBottle Max BPA free? Yes. The Max is third-party lab tested and certified free of bisphenols (BPA, BPS, BPF, BPAF), ortho-phthalates, dietary microplastics, estrogenic and androgenic activity, PVC, lead, and latex. The certifications are publicly published on Quark's website Lab section. Does the BuubiBottle Max release microplastics? No. Polyamide is one of the two safest baby bottle plastics specifically because it doesn't degrade or release microplastics under normal use, unlike polypropylene which has been the subject of class action lawsuits over microplastic shedding when heated. This is one of the main reasons to choose the BuubiBottle Max over budget bottles made from polypropylene. Is the BuubiBottle Max dishwasher safe? Yes. All components are dishwasher safe. Quark recommends hand washing with warm soapy water for longest lifespan, but the dishwasher is fine for daily use. How do I sterilize the BuubiBottle Max? Immersion in boiling water for 1 to 2 minutes. Quark advises against steam sterilizers because some can exceed polyamide's temperature resistance and damage the bottles over time. How is the anti-colic system different from Dr. Brown's? Dr. Brown's uses an internal vent tube running through the inside of the bottle. The BuubiBottle Max uses an integrated valve at the base of the nipple that directs air to the back of the bottle, away from the milk. Both reduce air intake. The BuubiBottle approach has fewer parts, easier cleaning, and comparable anti-colic effectiveness for most babies. How often should I replace the RealFeel nipples? Quark recommends replacing nipples every 3 months at maximum. Inspect them frequently and discontinue use if you notice cracks, swelling, discoloration, or other damage. How many BuubiBottle Max bottles do I need? Newborns feed 8 to 12 times a day. Quark recommends having around 6 bottles on hand. The exact number depends on how often you wash and sterilize, and whether you're combination feeding or exclusively bottle feeding. Can I convert the BuubiBottle Max into a sippy cup? Yes. The SipKit conversion kit includes a grip collar and a leak-proof two-piece silicone straw. You use it with your existing Max bottle to create the BuubiBottle Sip configuration. This means you don't need to buy new cups when your baby ages out of bottles, saving you both money and the hassle of introducing a brand-new cup. Where can I buy the BuubiBottle Max in Gamma Grey? In 2026, the Gamma Grey BuubiBottle Max is available directly from quarkbaby.com, on Amazon, at Target, at Walmart, at London Drugs in Canada, on Babylist, and through select specialty baby retailers. Pricing and availability vary by region. Does the bottle come with extra nipples? The standard 1-pack and 2-pack include the bottle and a Slow Flow nipple. Additional flow rates are sold separately. Quark also offers the BuubiBottle Hybrid Feeding Bundle, which includes multiple bottles, multiple nipple flow rates, and the SipKit conversion all in one package. Is the BuubiBottle Max worth the price? For me, yes. With my first kid I bought multiple bottle brands trying to find one that worked, plus replacement parts, plus eventually a separate sippy cup system. The BuubiBottle Max has been a single solution for several months without issue, and the future SipKit conversion saves me from buying new sippy cups. The total cost over the bottle's full lifecycle is meaningfully lower than buying lower-end bottles plus replacements. Who should buy the Quark BuubiBottle Max? The BuubiBottle Max is the right choice for parents who: Are breastfeeding and want a bottle their baby will accept without nipple confusion Are combination feeding (breast and bottle) and need seamless transitions Want effective anti-colic without complex internal vent systems Prioritize easy cleaning and minimal parts Care about transparent third-party safety testing Are concerned about microplastics in polypropylene bottles Want one bottle system that grows from newborn through toddler sippy cup Plan to use the SipKit for the bottle-to-sippy transition The BuubiBottle Max is probably not the right choice for parents who: Are operating on a strict budget where a basic generic bottle is the ceiling Specifically want a fully silicone bottle (Comotomo is a better fit) Have a baby with severe diagnosed colic that hasn't responded to other interventions (Dr. Brown's may be a better starting point) Don't plan to use the modular system features Need an 11oz or larger bottle for an older toddler My final recommendation After several months of daily use with my second baby and direct comparison against Dr. Brown's, Comotomo, Avent Natural, and Tommee Tippee from my first baby, the Quark BuubiBottle Max in Gamma Grey is the best baby bottle I've used. The RealFeel nipple is genuinely better engineered than competitors and especially well-suited for breastfed babies. The anti-colic venting works without the cleaning burden of internal tubes. The polyamide bottle is virtually unbreakable but glass-clear. The materials testing is publicly transparent. The modular system means I'll get years of use out of the same bottles instead of buying new gear at every developmental stage. If you're a first-time parent shopping for your initial bottle setup, this is the one I'd recommend. If you're a breastfeeding mom looking for a bottle that won't cause nipple confusion, this is the one. If you're a second-time parent who has been burned by complicated cleaning routines or finicky nipples, this is the upgrade you've been looking for. Five stars from this household. The bottle that made my second baby's feeding journey dramatically smoother than my first. Genuinely one of the best parenting purchases I've made in two kids. About this review: Written by a mom of two with hands-on experience using the Quark BuubiBottle Max as a primary bottle, plus prior experience with Dr. Brown's, Comotomo, Avent Natural, and Tommee Tippee bottles. This review reflects honest personal experience and is not sponsored. Specifications referenced are from Quark's published product information and verified retailer listings as of 2026. Pricing and availability may vary by region and retailer. submitted by /u/Front-Cantaloupe6080 to r/BeyondtheBumpCanada [link] [comments]
|
reddit.com |
Front-Cantaloupe6080 |
Apr 27, 2026 |
|
I made a comprehensive guide for those of you lurkers who suffer from extreme constipation
I now maintain an updated and more user-friendly version of this guide at /r/ConstipationAdvice. I've seen that many of you have chronic constipation but you do not understand why you have it, and your general practitioner doctors either don't think you have an issue or don't know what to do. I know how you feel. I know what it's like to not even feel like a human being because you can't go to the bathroom like everyone else. It is frustrating and depressing, and not something you can just go around telling people. I hope this guide helps you a ton. BECOME A DETECTIVE Keep this in mind as you proceed: your disorder is a puzzle. All you have to do is solve it. You can do it, if you have a great deal of patience, persistence, and commitment. Become your own investigator. Figure out your digestive cycle and your body's language. Listen to your body. Keep notes - I'm talking handwritten or typed notes, anything that will help you make a paper trail. Women: I have left a special note for you at the bottom regarding the additional problems you face when dealing with doctors. Please read it. WHY I MADE THIS GUIDE I'm a (mostly) healthy, physically active 31-year-old male. I have spent years seeing doctors, reading studies, accosting and interrogating medical professionals and pharmacists, calling pharmaceutical companies, and generally being an interrogator to anyone who has information that could help improve my life. This post is the aggregation of my conclusions and recommendations. In 2012 I got constipated. I grabbed an OTC laxative and was fine after that. But then the constipation happened again a few months later. It became more frequent, going from once a month to once a week, to every day. As of 2016, I was completely unable to eliminate without the use of pharmaceutical drugs. It took seven years for doctors to figure out what was wrong with me. I made this post because I want to help some of you turn my 7-year journey into a 7-month journey. Print this guide out and keep it with you. I've done all the heavy lifting for you. I did all of these myself, and now I want to help you. You will spend money on all of this, but it will change your life. You will be glad you did it. QUESTIONS FOR YOU If you suffer from severe chronic constipation, you need to answer the following questions, write them down, and bring them to your doctor: Do you have the urge to go, but you cannot? Or do you have zero urge to go? (this is the most important question) Do you have alternating diarrhea and constipation, or just constipation? Do you have nausea, vomiting, acid reflux, difficulty swallowing, or early satiety (getting full really early into a meal)? Have you had this issue since childhood, or did it begin in teen years/adulthood/after a major life event (surgery? divorce? car accident? mauled by bears?) Did you in the past or do you currently take any medications that could damage your intestines? The acne drug Accutane/Sotret/Claravis/many other names (isotretinoin) has been linked to serious conditions of the digestive tract. I am absolutely convinced that my large intestine was destroyed by this drug. Antibiotics are also a major culprit in ruining the small intestine microbiome and causing diarrhea/constipation disorders. Antidepressants can ruin the serotonin balance in the gut as well. Did you suffer sexual abuse as a child? There is a high degree of correlation between childhood sexual abuse and adult constipation disorders. Meaning, a lot of people with chronic constipation disorders in adulthood experienced trauma when they were young. This sort of thing must be investigated by both your doctor and a therapist in coordination. Do some Googling on this topic if you believe this might be your issue. If you have the urge but cannot go, you very likely have Pelvic Floor Dysfunction, especially if you are a woman who has had children. Other indicators of PDF are pain during sex and incontinence. Sorry, but your test is the anorectal manometry - have fun! It can sometimes be treated. Alternatively, you might have a bowel obstruction or a tumor. Your doctor must test for these. If you have zero urge to go to the bathroom, you very likely have a nerve or muscle disorder of the large intestine. These are called motility disorders. This is what I have. The most common are Slow-Transit Constipation, Chronic Idiopathic Constipation, and the dreaded Colonic Inertia. Both are extremely frustrating and difficult to treat. It is especially likely that you've got one of these conditions if you have no associated pain or any other symptoms. Your current gastroenterologist likely specializes in IBS; tell him you want a motility specialist or a neurogastroenterologist. If you have constipation sometimes and diarrhea sometimes, you very likely have IBS-C or a rare form of colitis, or a combination of issues. You may have a nervous condition. Outside chance you have Crohn's Disease. You must be checked for intestinal ulcers/irritation/inflammation, and also for food intolerances and allergies. A buddy of mine had "IBS" for many years, but then later discovered he was allergic to tuna, shellfish, pistachios, and fructose. If you have nausea, vomiting, acid reflux, difficulty swallowing, or early satiety, you very likely have general gastroparesis, where your entire GI tract is sluggish. I'm sorry to say that this is very difficult to treat and a horrible disease. You must see a neurogastroenterologist, AKA a gastroenterologist who specializes in motility disorders, and you must also see a neurologist to test for autonomic neuropathy. You need a prokinetic motility drug like cisapride, domperidone, prucalopride, etc. Don't go on cisapride unless you have excellent heart health and make sure the doctor keeps an eye on your heart at all times. If you have experienced constipation since childhood, you might have Hirschsprung's disease and you need a neurogastroenterologist (a special type of gastroenterologist who studies nerves and motility) to diagnose it by taking a Full-Thickness Biopsy. This is a major surgery and you should try to exhaust all other options first. The Full-Thickness Biopsy comes with its own potentially serious side effects. If you took heavy medications that could possibly have caused your issue, first write out a timeline of events and try to remember exactly when you took the medication and when your issues started. Write down the progression of symptoms and severity. Bring it with you to your doctor appointments. Correlation does not imply causation, but you are a detective now and you need to follow every lead. You need to insist to your GP that you want to see a gastroenterologist (a specialist of your digestive tract, from your mouth to your anus). You need to advocate strongly for yourself because nobody else is going to do it for you. You have to be aggressive in your appointment-making, follow-ups, call-backs, consultations, and arguing with your insurance company about getting your specialty medications covered. You have to do it yourself. You have to fight. If you don't, you will suffer alone. Nobody is going to save you but you. It's time to get smart and tough about your condition. THE FIVE FUNDAMENTAL TRUTHS You are embarking on a journey to improve your health and to discover the cause of your digestive issues. Rather than force you to stumble upon these facts yourself, I'm just going to lay them out for you: Your general practitioner (AKA "family doctor") does not know anything about your condition. He is not an expert in diseases of the large intestine. With a few exceptions, he is a gatekeeper for the experts that actually can help you. He will only refer you to these experts after you complete a few basic tests. Do them quickly. The specialist your GP refers you to is also probably not an expert in your condition. Once you arrive at the specialist's office, ask him what his specific expertise is. It took me a year to realize that my specialist was an expert in liver cancer. Womp womp. Your disorder is likely in your large intestine, and your specialist may have spent the years of his fellowship removing nodules from the esophagus. Ask him who he knows that is an expert in motility disorders, and if he doesn't know anyone, tell him to find one and send you there. You have to elbow your way through the medical system like a Muay Thai fighter if you want to get anywhere. Make your GP give you a referral to a specialist. Make that specialist refer you to the right specialist. Make that specialist order a bunch of tests. Then make him lay out a treatment plan for you. Your insurance is going to act like all of your tests and prescriptions are "experimental." Experimental is insurance-code for "F*ck you, we aren't paying for this." The magic spell to banish this bullshit is the phrase "medically necessary," and only your specialist has the power to utter it. Make sure he does, on all of your prescriptions and test orders. Your digestion operates in a cycle - just like your sleep cycle. Pay attention to it, listen to it, memorize it. Know the foods your body hates, know what throws your cycle off, know what improves it. Most importantly, once you have the cycle memorized, track its rhythm over a long period of time. After a year or two, you may notice some changes to the cycle. This information is key. TESTS YOU PROBABLY NEED First, work your way through the following tests with your general practitioner: Standard blood panel to check for any really wacky levels/deficiencies Celiac blood panel to eliminate the small possibility that you have Celiac Fecal blood test. Blood = tumors, ulcers, or perforations Then, once you have a referral to a gastroenterologist, have him perform the following tests: Extensive stool cultures: look for rare parasites. Small chance you have SIBO, very small chance you have SIFO, very very small chance you have a Clostridium infection that paralyzes the bowels. Ask the doctor to ensure Clostridia are tested for. Extensive thyroid panel (sometimes hypothyroidism causes gastroparesis / slow gut transit. This one's an EASY FIX; pray you have this one). You want a full workup, not the standard one. SITZ Marker Study: The lab will not know what this is or why you're doing it. Follow the doctor's instructions carefully. Do not take laxatives during this study (it lasts a week) because the point is to identify which specific part of your large intestine is broken (ascending, transverse, descending, rectum). If you accelerate transit by taking laxatives, you will give the lab a false result and it will screw up your treatment. Endoscopy with small bowel aspirate and biopsy; and colonoscopy with biopsy: If you're under 30 your doctor will fight you on this. He is an obstacle. Defeat him. Also, specify that you want two types of biopsies performed: a normal biopsy of the small intestine to check for Celiac and Crohn's, and an eosinophilia biopsy to check for allergies. They won't do this unless you specifically request it. Don't screw up the pre-op prep, no matter how hungry you get. If your condition is severe enough, ask about the Full-Thickness Biopsy which tests for ganglionic nerve density / Hirschsprung's disease. This is a very serious surgery and I urge you to get a second opinion before having it done. Anorectal manometry and MR Defacography: The anorectal manometry is critically important for people with severe constipation disorders. It really sucks to get it done, but do it. The AM / MRD test suite is sometimes described as a "motility workup" and it can only be performed at highly specialized GI clinics. You will need to pressure your doctor to help you find one, tell him to contact your insurance company and declare these tests medically necessary. This is a battery of humiliating tests to determine if you have PFD or another nerve-related motility disorder. If you have a good sense of humor and are capable of relaxing in embarrassing situations, it'll be easy. CT Scan with contrast: This is the one where you drink the radioactive dye and lay down inside a space ship. The point is to find tumors, divurticula, obstructions, etc. Ask the radiologist what s/he sees. Sometimes they'll slip up and tell you. They can't say "You don't have cancer" (that's for your doctor to determine) but they can say "I don't see any tumors." Risks: Some redditors have expressed disagreement with the CT scan's former position on this list (it was higher up), citing the patient's exposure to radiation as dangerous. They argue a CT scan should only be performed after a colonoscopy. To be clear, a CT scan exposes you to much more radiation than a regular X-ray, but only about 1 in 2000 people develop cancer as a result of a CT scan, and that cancer generally occurs late in life. The reality is, the purpose of the scan is to help diagnose and treat a condition that is debilitating and potentially dangerous to you right now, and you are weighing that benefit against the potential prospect of cancer later in life. Talk with your doctor about the risks vs benefits. Ask him/her if you should do it before or after a colonoscopy. You will have a diagnosis after these tests. If none of these tests result in a clear diagnosis: see my comment here for next steps. TREATMENTS AND MEDICATIONS Disclaimer: I am not a doctor. Make sure to clear each of these with your doctor before proceeding. Do not gamble with your own health. Cycle through these home remedies and request these medications from your doctor, in roughly the following order: Do all the stupid fiber crap just so you can tell your doctor to shut up about it. Fiber does not help people with motility disorders (people like you, probably). It will not help you - unless you have a lack of the Prevotella bacterium in your gut microbiome. Increasing your roughage intake and eating a plant-based diet will increase your Prevotella count, and might alleviate your condition. If the extra fiber constipates you more, move on. Cut out all dairy immediately for a month. Dairy is delicious and makes live worth living, but it is disgusting and terrible for you. Almond milk, almond milk ice cream, rice milk, dark chocolate...get used to it. Cut out all gluten for a month and stick to it. Wheat is insanely hard to digest for almost all people and it causes nothing but problems for people with bowel disorders. Even if your Celiac panel comes back negative, you still might have Non-Celiac Gluten Sensitivity, which is still being researched but quite prominent. Many people immediately see results after cutting gluten. But look out - the shit's in BBQ sauce, soy sauce, it's in the air, it's in the water, it's in your pillow, it's everywhere. It's as if the USDA has an agreement with US farmers to sprinkle wheat in literally every f*cking food product. Try the FODMAP diet and stick to it. Eliminate all potential dietary causes of your constipation, then reintroduce them one at a time to identify the culprit. For 90% of you, diet has nothing to do with your constipation. You have a nerve disorder. As a rule of thumb, grains are all difficult to digest and should be avoided, but I've found that potato and corn are easiest, rice is a bit harder, and wheat and oat are the worst. No idea about quinoa. I strongly recommend sweet potato as a healthy filler replacement for breads. It doesn't even need butter! Try a few high-quality probiotics. People with intestinal motility disorders have different gut microbiota than normal people, but scientists aren't sure which is the cause and which is the result. A 2015 study showed that Bifidobacterium, Lactobacillus, and Prevotella are significantly reduced in people with functional constipation disorders, and their clostridia counts were higher. (Clostridia is bad and requires antibiotics. You can determine if you have this by asking your doctor for a Clostridia-specific stool culture test.) Try Visbiome, VSL#3 if you can find/afford it. Also, try one of these. You want enteric-coated capsules that are not broken down by your stomach acid so they make it to your intestines. Miralax (polyethylene glycol) is your first line of defense. It's a chemically inert (non-reactive) substance that you mix in water and chug. It's an osmotic laxative, meaning it does not stimulate the nerves/muscles in the intestines. It draws water into the bowel and flushes you out. It works slowly; it might take several days to work. The mainstream medical consensus is that polyethylene glycol is extraordinarily safe and can be used in babies, the elderly, etc. It can be used for years and years. However, there is some evidence now that it's bad for the environment and probably not as good for people as we thought. I'm ignorant of chemistry, but polyethylene sure sounds like plastic to me. If you need fast relief, go to a health food store with a supplement section and buy a bottle of Magnesium Citrate powder. It must be citrate, and it must be powder. Mix 450mg (usually a heaping teaspoon) into a tall glass of water and chug it as fast as you can. Do this on an empty stomach in the morning before breakfast. If your disorder is mild, you will have to take a dump immediately. Don't get in the car to go to work for a little bit. MagCit is extremely safe and effective. Doctors prescribe it to old people for years and years with no side effects. But if you have renal disorders (kidney problems) talk to your doctor before trying this. I find that MagCit works best for me right before bed. I have to wake up in the middle of the night to pee out all the water I chugged, but in the morning, I generally am able to empty. By the way, MagCit is also an osmotic laxative. Cayenne pepper capsules have been used in combination with magnesium citrate with great success in some people. The pepper stimulates peristalsis in the large intestine, and the magnesium draws water to the large intestine. Combined, they propel your gut's contents along. These capsules can be obtained at any health food store with a supplement section; you can get them and magnesium citrate in the same store usually. Be warned, some people report a mild burning sensation both in their esophagus and their rectum (basically like when you eat some really spicy food and it gives you the runs). The regimen I've read that works best is a heaping teaspoon of magnesium citrate in a large glass of water, chased with 1 or 2 Cayenne capsules before bed produces a BM the next morning. Start with a low dose. When you buy the capsules, they'll have a heat rating, usually between 40,000 - 90,000 HU. Request Lactulose from your pharmacy. It's basically a sugar that helps with bowel transit. Didn't work for me, but it works for some. Docusate is an OTC stool softener that makes me nauseous and does nothing else, but maybe it'll work for you. MagCit beats its brains out. Bisacodyl is your go-to OTC stimulant laxative. In the US it's known as Dulcolax, but there are off-brand boxes that are cheaper and similarly effective. Use this carefully. It can exhaust the muscles in your intestines, so while you get relief one day, the next two days you're in a refractory period where constipation starts up again. Use 10mg 2x per week if you have insanely bad constipation like me. Don't exceed twice per week. Use 5mg if you're underweight. Safe to use with MagCit. I like using it in the morning on an empty stomach and I'll skip breakfast that day. The more food you have in your digestive tract, the longer it takes. Empty stomach = 2-4 hours, full = 8-12. Long-term use is frowned upon but there's no actual evidence whatsoever that it causes a problem. Read the case studies if you don't believe me. L-Arginine is an over-the-counter supplement available at health food stores. It is used by athletes to increase cardiovascular health, but it has a magic side effect: diarrhea! Why? Because it breaks down into nitric oxide synthase, which regulates bowel transit time, and researchers recently discovered is deficient in people with motility disorders. See this conversation for more details. Also, taking this supplement with a small amount of baking soda might increase its effect, according to some athletes who experienced intense diarrhea after doing so (they like baking soda because it reduces acid production / muscle soreness). Oral dosages vary from 2-6 grams but some people go higher. Be careful and talk to your doctor first. L-arginine is also available in suppository form and there is good evidence to believe these are safer and much more effective. Amitiza (lubiprostone, prescription): Your doctor might prescribe this first. It's an expensive prescription osmotic laxative. It causes nausea in a lot of people and it didn't work for me, but it's a godsend for some. Try it. Take with a great deal of water. DO NOT TAKE AMITIZA WITH LINZESS, MIRALAX, OR MAGCIT BECAUSE THEY'RE ALL OSMOTICS (or behave like osmotics). Linzess / (linaclotide, prescription, "Constella" in Canada): This is the most powerful prescription "osmotic" (it's actually a Guanylate cyclase-C agonist) in the world, and it will make your ass explode the first time you take it. It comes in strengths of 72mcg (that's micrograms), 145, and 290. I have a lot to say about this medication so read carefully. Also, if you've tried Linzess and it didn't work, please read my how to make Linzess work guide. First of all, it has a mild prokinetic effect (meaning it stimulates your nerves) in addition to its osmotic effect. This is a good thing. Amitiza does not have this. Your digestion is on a schedule. Some of you go every day. Some every other day. Some once a week. Whatever your normal clockwork is, this medication will sometimes work and sometimes not, depending on how much fecal obstruction there is in your intestine on the day. There were times when 290mcg did absolutely nothing for me, and other times 145 made me run wide-eyed to the bathroom fifteen times in thirty minutes. You will figure out how to make this medication work after a lot of trial and error. Don't just dismiss it the moment it doesn't work. I'm of the mind that no human being should ever take 290mcg and it has got to cause long-term damage to the intestines, but all my specialists disagree. They prescribe this dose to women quite frequently for some reason. Linzess has a penchant for working very well for a few weeks, and then ceasing to work at all. Keep it refrigerated (there's a rumor that it goes bad if it gets warm, but pharmacists will not confirm this). Take it with a large glass of water and stay super hydrated all day. Water is key; it cannot work if you don't drink a ton of water with it. If this medication dehydrates you (it will), grab a bunch of those vitamin/mineral powder packets from the health food store and chug one or two a day. If you get bad headaches/migraines/weak pulse/sweats/nausea, you need to just quit the medication and talk to your doctor. Ask him to reduce the dosage. Although the prescription for Linzess is once daily, I find it works best for me taken twice per week with another medicine like Motegrity (Prucalopride) or Bisacodyl. I take it on an empty stomach in the morning and don't eat anything until it starts kicking in (which is quite fast...usually under two hours). LINZESS HAS A BLACK BOX WARNING against its usage in persons under 18. It is extremely dangerous to children. If you don't hydrate enough on a regular basis, it is also dangerous to you. It is illegal to give it to your kids. If you don't have a gallbladder, mention this to your doctor before taking Linzess. I once heard that's an issue, but I can't find a source online. DO NOT TAKE LINZESS WITH AMITIZA, MIRALAX, OR MAGCIT BECAUSE THEY'RE ALL OSMOTICS (or behave like them). Motegrity (prucalopride, prescription): This is a brand new drug, the first in its class, and it's a 5-HT4 agonist. It works similar to some antidepressants, by targeting specific serotonin receptors in your intestines. Except Motegrity is a highly specific agonist, meaning it has a narrower range of side effects and typically won't affect your mood. This drug actually works for me, it worked immediately, it still works. Zero side effects. I take it in the morning on an empty stomach, although it can be taken without regard to food. Most doctors in the US don't even know about Motegrity so ask them to look it up. It's brand new, meaning it's expensive. But don't worry. All of these drugs are insanely expensive. As far as I can tell it is safe to take with osmotics like Linzess but I have not confirmed this with a doctor. In my reading, I see no relevant contraindications between the two. There is a warning in the box that some people committed suicide or experienced suicidal ideation while participating in clinical studies for Motegrity. There is no statistically significant relationship established here, but the company is by law required to make this information public. Frankly, Motegrity has zero side effects on me, and I expect these people killed themselves or thought about it simply because constipation disorders are f*cking horrible and make you depressed. If you live in the UK, Europe, or Canada, your doctor will know this medication as Resolor or Resotran. Zelnorm/Zelmac (tegaserod, prescription): This drug is similar to Motegrity (insofar that it is also a 5-HT4 agonist). It is older than Motegrity, and considered less safe because it interacts with receptors in a less specified way; there is some evidence that it interacts with cardiac receptors. In plain English this means it might be responsible for causing strokes and heart attacks in some patients. The evidence is debatable. 0.11% of people who used Zelnorm in a study experienced cardiac events, compared to 0.01% who took the placebo. That's 13 out of 11,500 people. The drug is available in the US only to women, although your doctor can order it "off-prescription" if he deems you low risk. Basically don't try this drug if you are overweight or have any notable cardiac family history. Trulance (plecanatide, prescription): This is the main competitor of Linzess (linaclotide) and has a smaller side effect profile. It appears to work pretty well if osmotics work for you, but I haven't tried it. It also has a mild prokinetic effect (meaning it stimulates the nerves in your intestines). I assume, like Linzess, it is also dangerous to children. Give it a try. Mestinon (pyridostigmine, prescription): This is where it gets weird. Mestinon is a drug that treats myasthenia gravis, which is a nerve disorder similar to MS. But, it can be used to treat constipation in some cases. It's an acetylcholinesterase inhibitor, meaning it increases your body's levels of acetylcholine. This is a neurotransmitter that is partly responsible for telling your intestines to squeeze. Most doctors will be hesitant to put you on it, but you can give it a try if all else fails. It has a strange side effect profile and causes fainting/blood pressure drops in some people. I never tried it. An interesting story...there is a woman who did a bit of basement chemistry and figured out that she could spike her acetylcholine levels by literally sticking a nicotine patch on her stomach below the belly button. It caused her bowels to empty after a week of constipation. She then invented Parasym Plus, a supplement that allegedly does the same thing. I bought this and I cannot figure out if it actually worked. Maybe it did a little. There are many acetylcholinesterase-inhibiting drugs on the market. Prostigmin (neostigmine) is one of them. Ask your doctor if he thinks it's a good idea. He'll say it isn't. But if all else fails... Lexapro (escitalopram oxalate, prescription), or any related SSRI antidepressant: Antidepressants are now being used to treat constipation. Some clever fellow figured out that the majority of serotonin (the mood-regulating neurotransmitter) is manufactured in your intestine, not your brain, and that antidepressants were giving people diarrhea for some reason. I haven't tried Lexapro but it's next on my list and my doctor likes it because of its small side effect profile relative to other antidepressants. This drug has a wider side effect profile than related constipation meds like Motegrity/Tegaserod, meaning you could have mood swings or drops/spikes in energy, etc. Despite our overwhelmingly negative public opinion about antidepressants, they are rather safe* and effective for many people. It's just that they're over-prescribed. A low dose does help some people normalize bowel function without causing mood/personality changes. *edit: A redditor linked me to this article explaining that some SSRIs can cause long-term GI problems. The comments are worth reading. As with all pharmaceutical drugs, you are weighing your current problem versus the potential side effects of its treatment. Talk to your doctor about the risks and do your own research. Talk to friends and family members who have taken SSRIs. Erythromycin: This is an OTC (I believe) antibiotic with a very odd side effect: it speeds up gastric emptying and gut motility. Hooray! The case studies are kind of back and forth on its efficacy for constipation, but some doctors swear by it. The problem is that it's an antibiotic. Here's the thing about antibiotics. They should not be overused or used unnecessarily. They can seriously devastate your gut flora and cause SIBO and worsen your condition. On the other hand, your condition could have already been caused by antibiotics, or by a pathogen that will killed with antibiotics. Proceed with extreme caution. Colchicine: This is an anti-inflammatory derivative of the autumn crocus plant. In large doses it's highly toxic, but in small doses it's used to treat Gout. However, a recent study determined that it's an effective treatment for Slow Transit Constipation / Colonic Inertia (basically any constipation disorder that does not involve physical blockage like tumors, obstructions, etc). I haven't tried this but my specialist claims it is quite safe in low doses and he would be happy for me to try it out. For those of you who are diagnosed with slow-transit constipation / colonic inertia: Here is a master list of treatments. MY PERSONAL REGIMEN: Some of you have asked about my specific medication regimen. After several years of trial and error, I have found regimens that basically make my life normal again. Please note how the regimen evolves over time! Intestinal diseases typically are very transient and change over the years. What works for you now might not work in a while: 2012 - 2014: Senna laxative once per week 2016: Bisacodyl and Miralax twice per week 2017: Magnesium citrate 450mg each morning before breakfast 2019: 2mg Motegrity (prucalopride) daily in morning 145mcg Linzess (linaclotide) every other day in morning 450mg Magnesium citrate before bed EXERCISE Of all the treatments I've tried, exercise is near the top on the list of effectiveness. Exercise is a conduit for getting all of that stress and potential energy out of your body and away from your guts. Get a standing desk at work (a good company will accept a doctor's note and buy one for you). Stand for half the day, intermittently. Go on jogs in the morning and walks in the evening. Get to the gym and get your knees above your waist - stairmaster, yoga, squats, etc. Just MOVE MOVE MOVE. By doing so you are stimulating the vagus nerve and increasing motility. You will literally shake the poop out. If you live an incredibly sedentary life, you will suffer much more. SURGERY FOR EXTREME CASES Please visit my updated guide at /r/ConstipationAdvice for new guidance on these surgeries. For those of you diagnosed with CI, you might be considered for the TAR IA surgery, (total abdominal colectomy with ileorectal anastomosis). This is the laproscopic removal of your entire large intestine and the attachment of your small intestine to your rectum. The nice thing about this surgery is that you still get to go to the bathroom normally, except you have mostly diarrhea for the rest of your life (because your large intestine is the thing that turns diarrhea into solid stool by absorbing water). The other option is one of many variants of the colectomy (resection or removal of the large intestine) with colostomy or ileostomy. These are both ostomies, which is the surgical creation of a hole in your lower abdomen. A medical bag is affixed to that hole, and your small intestine drains into it instead of down into your rectum. This is a much bigger life change, but from the people I've talked to, it's surprisingly not that big a deal. If you are interested in these surgeries you will have to have a great number of conversations with many doctors and jump through a lot of hoops. A NOTE FOR WOMEN AND TEENAGERS The feedback I get from most women is that their (male) doctors are extremely dismissive and incredulous about the woman's constipation issues. Doctors are going to act like you are crazy and hormonal. They're going to tell you to just eat some fiber and take some miralax and bugger off. You have to be strong, confident, and knowledgeable of your situation. Do not take no for an answer. Inform your doctor that you are past the standard constipation treatments and this is an ongoing problem that reduces your quality of life and warrants the attention of a specialist. It helps if you appear to know what you are talking about. Learn about your digestive anatomy and understand the difference between your small and large intestine. Understand the constituent parts of the large intestine (ascending, descending, sigmoid, transverse, rectum, etc). This will help you communicate to your doctor more efficiently and it will help you better understand his/her findings. If you show your doctor you've done your homework, it is very likely he/she will take you more seriously. Everything I just said applies to teenagers. The additional problem facing you is that you have an extra gatekeeper: your parents, and the fact that you rely on their insurance. You need to have a level-headed conversation with them about your situation, however embarrassing that may be, and convince them that they need to be advocates for you, not obstacles to you. Getting them on your side now will benefit you greatly when the doctor questions the seriousness of your complaint. A FEW FINAL NOTES Read. You aren't going to effectively communicate or convince your doctor of anything unless you have some introductory knowledge of your body. Learn about your digestive anatomy and understand the difference between your small and large intestine. Simply knowing this information will help you come up with questions about what could be causing your issue. Save yourself the remarkable headache and get physical and digital copies of the results of every single test you have performed, even simple blood tests. When you inevitably get transferred to a different specialist, having this stack of files will make your life so much easier. Your insurance company is going to fight you on some of these medications. Tell your doctor to tell your insurance it is an urgent medical necessity that they cover this medication. They will fold. DO NOT GIVE UP. Write down your next steps. Follow up on calls, appointments, etc. I keep lists of all my medical to-do's and I cross them off line-by-line. It gives me a great sense of accomplishment and control over this whole situation. Relax and get your mind off your condition. This is hard. But there is absolutely a psychological component to your condition. For some people, it's entirely psychological (this is called Chronic Idiopathic Constipation or Functional Constipation). People who suffered sexual abuse in childhood often develop constipation disorders in adulthood. Google this and investigate it with your doctor! I go on long nature walks with my headphones. This is how I unwind. Some people do Ju Jitsu. Some people do music. Spend time with family and engage in your hobbies. This will absolutely help, especially if your condition is idiopathic in nature. Intractable constipation is often the result of extreme stress. Have a serious brainstorm about whether you need to quit your high-stress job. Are you in an abusive relationship? GET THE FUCK OUT OF IT. Can you afford a week-long spiritual retreat where you take a vow of silence and eat a vegetarian diet and sit in a garden with a pen and paper? DO IT. Now is the time to try all the weird stuff. Cry whenever you have to; don't bottle anything up. Talk to other sufferers about it. Reach out and get involved in a community. Support is everything. Your enemy has a name. You very likely have a motility disorder. It can be caused by an underlying nerve disorder, blood vessel disorder, mechanical muscle failure, neurotransmitter imbalance, hormone imbalance, or bacterial imbalance. Once you get your diagnosis, you will not feel so confused and lost about how to treat it. submitted by /u/Nightmare_Tonic to r/ibs [link] [comments]
|
reddit.com |
Nightmare_Tonic |
May 29, 2019 |