Dr. Amy Nett: I would not. Again, I tend to be pretty conservative in terms of treatment, and if something has not been thoroughly tested, I’m probably not going to be comfortable with it. That’s my own preference, and I’ve certainly had patients who have done the research and they’ve said, “I have SIBO, I’m still nursing, but I really want to use rifaximin. I understand that there’s less than probably 2 percent systemic absorption, very minimal risk,” and there are some patients that I think if they’ve really looked into this and they feel comfortable with that, maybe I am comfortable. I’ve had one patient where I’ve said OK. She was breastfeeding. I think the baby was about two, so on solid foods, but still getting a little bit of breastmilk. She did the research and she felt comfortable accepting the risks with rifaximin, so that’s one option, but that’s the rare case.
When someone joins the practice and they’re pregnant or nursing, I would have that conversation because some people will decide to delay working with a functional medicine practitioner or at least working with our practice until they feel that they can do more in terms of protocol.
In terms of testing, you certainly could do Cyrex Arrays 3, 4, and 10 if those are indicated. Otherwise, I agree with you that I would wait until they’re close to the point of being done with breastfeeding to run the tests. You want to have as accurate of a picture as you can once you start treatment, so you want to have tests that are fairly recent. Wait until they’re saying, “Yeah, I’m about one or two months away from weaning my child off completely,” and that’s probably the time that you want to do the testing.