If you have cut out dairy, skipped gluten, thrown out carbonated drinks, and still find yourself dealing with stubborn abdominal swelling, the issue might not be what you are eating, but how your body is processing it. Dr Saurabh Sethi, a US-based gastroenterologist trained at AIIMS, Harvard, and Stanford Universities, took to Instagram on July 13 to address this exact frustration.
In his post, Dr Sethi outlined ‘four things I check in my patients when bloating persists despite diet change’, highlighting underlying clinical conditions that lifestyle overhauls alone cannot fix.
1. SIBO (Small intestinal bacterial overgrowth)
When standard dietary tweaks fail, Dr Sethi noted that SIBO is often the culprit. He described the condition as ‘bacteria colonising the wrong part of your gut, fermenting food before it should be’. According to Dr Sethi, this misplacement of gut flora is highly pervasive yet rarely caught early, calling it ‘significantly underdiagnosed in patients who don’t respond to diet changes alone’.
2. Celiac disease
For some, bloating is an autoimmune response rather than simple sensitivity – Dr Sethi highlighted celiac disease, an illness where ‘gluten triggers an immune attack on your gut lining’. The path to an accurate diagnosis is notoriously long. Dr Sethi warned that ‘the average patient waits six plus years for a diagnosis while blaming stress, IBS, or the wrong foods’, leaving their digestive tracts exposed to prolonged damage.
3. Lactose intolerance
Even adults who grew up drinking milk without issue can develop a sudden intolerance later in life. Dr Sethi shared that when this happens, ‘undigested lactose ferments in the gut, producing hydrogen gas and bloating’. It is far from rare. Dr Sethi pointed out, “65 percent of adults lose the ability to digest lactose after childhood, many without knowing it.” This leads them to search for other, more complicated explanations for their discomfort, he added.
4. H pylori (helicobacter pylori)
The final common culprit hiding in plain sight is helicobacter pylori, a resilient stomach bacterium. Dr Sethi characterised it as ‘a bacterial infection that hijacks your stomach acid and wrecks digestion’. Despite its massive global presence, it rarely gets screened during routine checkups. According to him, the infection ‘affects approximately 50 percent of the world’s population, yet remains one of the most under-tested causes of chronic digestive symptoms’.
The takeaway: persistent bloating is often a biological puzzle, not a dietary failure. If you have changed your eating habits and seen zero relief, scheduling a targeted medical evaluation for these four conditions is the most effective next step.
