Navigating SIBO During Lactation

Disclaimer: The information provided in this blog post is for general informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.

SIBO, or small intestinal bacterial overgrowth, is a condition where bacteria colonize the small intestine in numbers larger than optimal, causing digestive discomfort.

It is estimated that that roughly 13-15% of the adult US population has SIBO, though estimates vary based on diagnostic test used. (1)

Common signs and symptoms of SIBO include:

abdominal distension (bloating)
flatulence (gas or burping)
abdominal pain
food sensitivities
diarrhea
constipation
nutrient deficiencies
nausea
poor appetite
weight loss or gain
fatigue
heartburn
reflux

While SIBO has traditionally been diagnosed by breath test, many gut health experts argue that it is not reliable and leads to both false positive and false negative results. Using symptoms as your north star for seeking treatment will be most helpful regardless of what test results may show.

What Causes SIBO?

SIBO has numerous root causes, the most common of which I see in my practice among postpartum moms is slowed motility.

What can cause small intestinal bacterial overgrowth (SIBO)?

Slowed / impaired motility (due to hypothyroidism, diabetes, or other primary factors)
Hypochlorhydria (low stomach acid)
Structural issues in the abdomen (such as hernia, adhesion, valve malfunction, etc)
Nervous system dysfunction (poor vagus nerve signaling and/or stress both impact digestive function)
Infections such as food poisoning, gastroenteritis, or H Pylori
Medications including, but not limited to proton pump inhibitors (PPIs), antibiotics, hormonal birth control, and chronic NSAID use

If a client is experiencing any of the symptoms noted above, I recommend seeing a functional medicine practitioner and requesting a comprehensive lab panel. It should include all eight thyroid markers, fasting gastrin, fasting insulin, micronutrient levels (Vitamin B12, Vitamin D, zinc, copper, ceruloplasmin, magnesium), and all four iron markers. This can help identify sources of the most common etiology (impaired motility) and a skilled practitioner can offer functional treatment options.

SIBO is most commonly treated using conventional antibiotics (such as Rifaximin) or herbal compounds with potent antibacterial properties, but this aggressive “killing” approach is questioned by many gut health specialists, especially when not paired with a root cause approach to healing the underlying motility or structural issue. Below, I’ll discuss why this conventional treatment approach is not recommended in postpartum and especially not while breastfeeding.

SIBO in Postpartum

While there isn’t data that supports my hypothesis that SIBO is more common in the postpartum period, we do know that postpartum women are at increased risk for thyroid issues and autoimmunity.

C-section birth and IV antibiotic administration for Group B strep are also common occurrences (roughly 32% and 20% respectively, sometimes overlapping) that disrupt the maternal gut going into postpartum. It follows that this would also increase the risk for digestive disorders such as SIBO.

Anecdotally, I do see a high rate of IBS/SIBO amongst postpartum clients in my practice. Many other postpartum providers report the same.

Treating SIBO During Lactation

Clients with SIBO or IBS often ask me about their treatment options for their gut dysbiosis during lactation. While I am not licensed to prescribe treatments, it is within my scope of practice and my responsibility as an IBCLC to provide education on medications, herbal compounds, and other therapies when my clients inquire. Here’s what we know:

Conventional Antibiotic Therapy: Not Recommended

While antibiotics on the whole are generally considered safe for lactation, we do not have any data specifically on Xifaxan (Rifaximin), the most commonly used antibiotic for SIBO.

However, the risk of harm to the entire gut ecosystem – and baby’s gut by association – from a potent antibiotic like Xifaxan must be considered. We know that broad-spectrum antibiotics used for SIBO do more than just target pathogenic bacteria in the small intestine – they also eradicate beneficial bacteria throughout the entire digestive system. Studies widely demonstrate that maternal antibiotic usage impacts the infant microbiome. (6, 7)

Furthermore, the purported efficacy of Xifaxan was determined based on its impact on breath test results, which we established above are not reliable. It is not uncommon for patients with SIBO to experience a relapse after antibiotic treatment, and to have an additional dose prescribed.

For most cases of SIBO, pharmaceutical antibiotics alone are not likely to yield lasting improvement in symptoms, and may negatively impact both the maternal and infant microbiome.

Herbal Antimicrobial Therapy: Not Recommended

Since many of my clients prefer holistic therapies, I am frequently asked if antimicrobial herbs are a preferred option for SIBO treatment over antibiotics during lactation.

The reality is that herbal antimicrobials are often just as or more potent as pharmaceuticals, and should be approached with equal caution.

Antimicrobial herbs commonly used for SIBO include berberine, oregano, allicin (garlic), goldenseal, neem, black walnut, and wormwood. These are contraindicated for lactation due to their impact on the gut (similar to conventional antibiotic therapy) and lack of established safety for breastfeeding infants.

Supporting Motility: Several Safe Options

Since a primary root cause driving SIBO is slowed or impaired motility, it is paramount to run labs and assess any physiological factors (insulin resistance, thyroid dysfunction, zinc/copper imbalance, nutrient deficiencies) that may be at play. However, in the meantime, there are some herbs and supplements that can support digestive system function that are safe for lactation.

As long as an individual is not having regular (daily) bowel movements, SIBO will persist. Treating the underlying cause of slow motility is essential for easing SIBO symptoms and clearing bacterial overgrowth.

Reminder: this guidance is educational only, not medical advice. Please run these by your healthcare provider. While they are safe for lactation, they may be contraindicated for certain individuals based on individual health history or current medications.

Lactation-Safe Motility Support:

Ginger: a gentle prokinetic that supports the migratory motor complex (MMC)
Milk thistle: supportive of liver function and motility
Magnesium citrate: helpful for acute constipation, draws water into the colon as an osmotic laxative (recommended for occasional or short-term use only)
Magnesium glycinate: supports smooth muscle function in the gut along and promotes optimal nervous system function (safe for long-term use)
Adrenal cocktails: rich in Vitamin C, sodium, and potassium, all of which facilitate enzyme production and regular bowel movements
Lemon water: stimulates bile flow and stomach acidity
Bitter foods: consuming foods such as arugula, endive, radicchio, endive, or dandelion greens help promote bile flow and promote stomach acid production

While over-the-counter laxatives and stool softeners (Miralax, Colace) are technically considered safe for lactation, I generally do not recommend them unless all other motility options have been exhausted. These products have lasting impacts on the gut microbiome and should be a last resort. If a client is reliant on them for regular bowel movements, a full lab workup should be prioritized immediately.

Easing SIBO Symptoms: Several Safe Options

For parents experiencing symptoms related to SIBO such as bloating, gas, reflux, heartburn, or food reactivity, there are quite a few options to help relieve digestive discomfort. Again, please consult with your healthcare provider, but in general, the following are safe for lactation.

Lactation-Safe Relief for Digestive Discomfort:

Digestive enzymes: Helpful for giving the body extra support for breaking down food, especially when low stomach acid is suspected. Particularly helpful for food sensitivities
Marshmallow root tea: Helpful for reflux, heartburn, or other symptoms related to irritation in the mucus membranes
Peppermint tea: Helpful for bloating and gas (may reduce milk supply in very sensitive individuals with frequent consumption)
Chamomile tea: Has antispasmodic and anti-inflammatory properties that can ease symptoms of bloating and gas
Fennel: Chewing fennel seeds or drinking fennel tea can help soothe an upset stomach and reduce gas

Again, there are some pharmaceutical options that are considered safe for lactation (antacids, PPIs, H2 blockers, etc), but these often contain ingredients that further disrupt the gut and create a vicious cycle of inflammation and dysbiosis. Continue to advocate for identifying and treating the root cause.

Dietary Changes for SIBO: Maybe

As an IBCLC, I don’t take elimination diets lightly. Most postpartum moms are already deeply depleted and undernourished, struggling to eat enough calories each day. Broad elimination diets such as Low-FODMAP or SCD (Specific Carbohydrate Diet) significantly reduce the amount of available foods for consumption and typically do not lead to resolution of SIBO. At best, they may reduce symptoms in the short-term, but can lead to the starvation of beneficial bacteria in the long-term.

I encourage clients with SIBO or IBS to keep a food & symptom log, and to identify foods that may be particularly problematic for them (or their baby, based on the infant’s symptoms). Sometimes, temporary removal of that food from the diet may be helpful to allow the gut to heal, especially in the case of highly inflammatory foods such as gluten or conventional dairy. In most cases, we explore options for improving the digestion of FODMAP foods, such as incorporating digestive enzymes, soaking/sprouting foods (legumes, grains, etc), and/or pairing them with fermented foods for better absorption.

Often, by prioritizing motility support and herbs to support the gut lining, food reactivity symptoms decrease and the list of problem foods shrinks.

In the meantime, I encourage my clients to prioritize well-tolerated, nourishing foods as much as possible: pastured animal products (meat & fish), eggs, bone broth, well-cooked vegetables, fermented foods, and mineral-rich liquids like coconut water and herbal infusions.

Bodywork: Safe & Highly Recommended

Working with a skilled bodywork practitioner can be extraordinarily helpful for digestive issues, and is safe while breastfeeding.

Pelvic floor physical therapy: Essential care for every postpartum body – pelvic floor PT helps restore optimal function that relates directly to digestion
Massage: Relaxes the body and helps shift into “rest and digest” mode, promoting better digestion
Chiropractic care: Supports optimal alignment in the cervical spine, which can impact digestive function
Craniosacral therapy: Gentle hands-on touch designed to regulate the nervous system and reduce stress, can improve gut-brain signaling
Visceral manipulation therapy: Usually performed by aa licensed massage therapist with specialized training, this is manual therapy for the abdomen, treating fascial restrictions and optimizing organ function

What About Baby?

I would be remiss if I didn’t mention that it is extremely common for a baby of a mom with SIBO to experience digestive issues, too.

Reflux, bloating, food allergies & intolerances, constipation, persistent crying, and mucus in stool are symptoms I commonly observe in infants whose parents had digestive complaints before or during pregnancy, or who experience them in postpartum.

The good news is that working to heal your own gut through supportive foods, herbs, and supplements while breastfeeding is going to positively impact your baby’s gut health – and we have some baby-specific therapies that can relieve their symptoms as well.

As a mom who struggled with SIBO for many years, you’re not alone! There is hope for healing – it just takes time and the right provider(s).

Need 1-1 support for navigating digestive issues during lactation? Book now or learn more about ILC’s offerings & insurance coverage here.

Sources:

Integrative Lactation Care