By Dr. Jennifer L. Yocum, Licensed Acupuncturist
My path into acupuncture started with what I thought was stomach pain.
In 2005, I started hurting every time I ate. The diagnosis was gallbladder dyskinesia. The offered solution was surgery that worked about half the time and the other half the time left people with chronic diarrhea. Not odds I wanted to take. My mom talked me into trying acupuncture instead (she actually paid for the first few sessions just to get me through the door since I was a highly skeptical behavioral neuroscientist at the time). It worked, even though I didn’t believe in it. Slowly, but surely, my pain went away completely. (Read more about my story here.)
My profound healing journey inspired me to become an acupuncturist, but my gut issues didn’t stop being a part of my story. I’ve also navigated IBS and recurrent SIBO, which have taught me first-hand the importance and complexities of the gut microbiome and digestive system. Now I specialize in supporting patients with their own complicated digestive histories.
If you’re reading this with a bloated belly, sluggish or unpredictable bowels, or a diagnosis that only half makes sense: you’re not alone, you’re not broken, and you’re not imagining it.
My intent with this article is to provide a quick primer on the digestive issues that can occur after the food leaves your stomach (IBS, IBD, SIBO, and SIFO, plus how liver and gallbladder function fits into the picture), so you can better understand what’s going on and know what questions to ask next.
Your gut: more than “in, out, done”
We’re often taught that digestion is simple: food goes in, nutrients get absorbed, waste comes out. From both Western and Chinese medicine perspectives, it’s more layered than that.
Inside your digestive tract lives a dense community of bacteria, fungi, and other microbes (also known as gut flora) called the gut microbiome. These microbes help break down food, produce signaling molecules and certain enzymes necessary to synthesize vitamins, and interact with your immune system and metabolism. The gut also has a direct line to your brain through the gut-brain axis, and researchers are exploring how the gut may be involved in various mood disorders, nerve pain, and other neurological and behavioral conditions (Cleveland Clinic, 2023a).
When the ecosystem is out of balance, when the gut lining is inflamed, or when organs like the gallbladder aren’t functioning optimally, symptoms can look very similar across very different conditions. That overlap is part of what makes gut health so confusing and why a clear framework helps.
When to pay attention (and when to call)
A lot of people minimize digestive symptoms because they’ve “always been this way” or don’t know they could feel better. Common complaints across gut conditions include:
- Bloating or visible distension
- Gas and gas pain
- Abdominal discomfort or pain
- Poor digestion
- Diarrhea, constipation, or a mix of both (Cleveland Clinic, 2023a)
These are worth bringing up with a provider if they’re frequent, getting worse, or affecting your quality of life. There are also red-flag symptoms that deserve prompt medical attention:
- Blood in the stool (bright red or black and tarry)
- Unintentional weight loss
- Persistent fever, anemia, or ongoing fatigue
- Needing to get up at night to use the bathroom
- Severe or worsening abdominal pain (Miller, 2026)
It’s important you talk to your doctor to rule out inflammatory bowel disease, infections, or structural problems.
IBS: when function is off, not structure
Irritable bowel syndrome is one of the most common gut diagnoses. In IBS, the digestive tract usually looks normal on colonoscopy and imaging; it just doesn’t behave smoothly. The muscles that move food along can be too fast or too sluggish, and the nerves in the gut tend to be extra sensitive. You can have IBS-C (constipation-type), IBS-D (diarrhea-type), or IBS-M (mixed-type) (Cleveland Clinic, 2023b).
Current research describes IBS as a “disorder of gut–brain interaction”: the conversation between your brain and your belly is dysregulated. Stress, certain foods, hormone shifts, and previous infections can all be part of the picture. Typical symptoms include abdominal pain or cramping (often related to the urge to poop), bloating, gas, and diarrhea, constipation (or a swing between the two), mucus in your stools, or feeling like you’re unable to fully evacuate the bowels. Importantly, IBS does not cause visible inflammation or structural damage and does not increase colon cancer risk (Cleveland Clinic, 2023b).
IBD: when the gut is actually inflamed
Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, is a different category entirely. Here, the immune system is driving chronic inflammation in the digestive tract.
Ulcerative colitis affects the colon and rectum in a continuous pattern, primarily the inner lining. Crohn’s disease can affect any part of the digestive tract from mouth to anus, often in patchy segments that go deeper into the bowel wall.
Symptoms can overlap with IBS (abdominal pain and cramping, frequent loose stools, urgency), but IBD often adds:
- Blood in the stool
- Unintentional weight loss
- Loss of appetite
- Fatigue (Mayo Clinic, 2026)
Because the tissue itself is inflamed and sometimes ulcerated, IBD can increase the risk of strictures, fistulas, anal stenosis, perforated bowel, toxic megacolon, and colorectal cancer over time. Diagnosis requires more than a symptom list: endoscopy, imaging, and lab markers of inflammation all help clarify what’s actually going on (Cleveland Clinic, 2024).
SIBO: bacteria in the wrong neighborhood
In a healthy gut, the small intestine has relatively low bacterial counts compared to the colon. In SIBO (small intestinal bacterial overgrowth) bacteria are present in higher numbers than they should be, or the wrong species have taken up residence.
These microbes ferment carbohydrates earlier than they’re meant to, which can cause bloating (that “six months pregnant” feeling by afternoon), gas and belching, abdominal discomfort, and diarrhea or constipation (or sometimes both).
Evaluation typically involves a breath test to examine the levels of different gases (hydrogen, methane, or hydrogen sulfide) to determine which type of overgrowth you may have. Treatment can include targeted antibiotics or herbal protocols, nutrition changes, and, most critically, addressing whatever allowed the overgrowth to develop in the first place, whether that’s sluggish motility, structural issues, or something else. (Dougherty, 2025)
SIFO: when fungi join the party
SIFO (small intestinal fungal overgrowth) is similar in concept to SIBO but involves fungi (overwhelmingly the Candida species) present in excess in the small intestine. About 25% of patients with chronic previously unexplained gut symptoms have been found to have SIFO.
Commonly reported symptoms include belching, bloating, diarrhea, gas, or nausea. It can also sometimes cause weight loss, fatigue, joint pain, headaches, brain fog, skin rashes, or changes in mood (Cloyd, 2025). Some people also notice signs of fungal imbalance elsewhere, such as recurrent vaginal yeast infections, oral thrush, or rashes in skin folds, though those aren’t required for SIFO to be present (Eckelkamp, 2026).
Risk factors include being immune compromised, frequent antibiotic use, low stomach acid or acid-suppressing medications, high alcohol consumption, and impaired gut motility. Diagnosis typically relies on specialized testing, and treatment may include prescription antifungals alongside support for the underlying conditions that allowed overgrowth to develop (Eckelkamp, 2026).
A note on liver, gallbladder, and fat digestion
This piece often gets left out of gut-health conversations, and given my own history with it, I think that’s a gap worth filling.
Your liver makes bile, and your gallbladder stores and concentrates it so it can be released in a strong pulse when you eat fat. Bile doesn’t just help break down fats; it also helps keep things moving in the intestines and influences which microbes thrive there.
When that system isn’t working smoothly, whether the liver is sluggish in its bile production or the gallbladder isn’t contracting effectively (as in gallbladder dyskinesia), fat digestion suffers, and motility can stall. In real life, that shows up as feeling heavy or nauseous after richer meals, changes in stool consistency, more bloating, or a general sense that digestion isn’t moving properly.
If you’ve had gallstones or had your gallbladder removed, you may sometimes have looser stools, urgency, or new patterns of bloating because bile is dripping into the intestines continuously instead of arriving in timed pulses. If you have a history of liver or gallbladder trouble alongside ongoing digestive symptoms, make sure that history is part of the conversation with your doctor (Tallahassee Memorial HealthCare, 2025).
Where to go from here
If your digestive health has been a long-term source of confusion or frustration, I hope this gives you a starting place for a productive conversation with your doctor or other healthcare provider. Depending on what’s going on, that team might include a gastroenterologist, a registered dietitian or certified nutrition specialist, or integrative practitioners like an acupuncturist who can look at digestion through a different lens. Whatever your path, the goal is the same: turning confusion into clarity, so you can stop guessing and start actually feeling better.
References
Cleveland Clinic. (2023, August 18). Gut microbiome. https://my.clevelandclinic.org/health/body/25201-gut-microbiome
Cleveland Clinic. (2023, November 16). Irritable bowel syndrome. https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs
Cleveland Clinic. (2024, May 20). Inflammatory bowel disease (IBD). https://my.clevelandclinic.org/health/diseases/15587-inflammatory-bowel-disease
Cloyd, J. (2025, January 23). A functional medicine small intestinal fungal overgrowth (SIFO) protocol: specialized testing, therapeutic diet, and supplements. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-small-intestinal-fungal-overgrowth-sifo-protocol-specialized-testing-therapeutic-diet-and-supplements
Dougherty, A. (2025, January 28). The 3 types of SIBO (and how they’re treated). WellTheory. https://www.welltheory.com/resources/types-of-sibo
Eckelkamp, S. (2026, January 28). What is SIFO (small intestinal fungal overgrowth)? Symptoms & how it impacts gut health. Parsley Health. https://www.parsleyhealth.com/blog/sifo-small-intestinal-fungal-overgrowth/
Miller, J. (2026, February 4). Gut health red flags: when digestive symptoms are NOT “normal.” https://digestivehealthhub.com/gut-health-red-flags/
Mayo Clinic. (2026, March 19). Inflammatory bowel disease (IBD). https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/symptoms-causes/syc-20353315
Tallahassee Memorial HealthCare. (2025, April 29). What happens when your gallbladder isn’t working right? https://www.tmh.org/blogs/what-happens-when-your-gallbladder-isnt-working-right
Note: This article was originally published in a local magazine for their May 2026 issue. For citation references, please contact Dr. Yocum at https://jenyocum.com/contact/
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