"Your labs are normal" is one of the most common — and most frustrating — things patients tell me they've been told when bloating won't quit. Often, it means the labs that were run were normal, not that every test that could shed light on the issue was run. Here are the five categories I most often suggest asking your doctor about if a standard workup hasn't turned up an answer.
1. A thyroid panel (not just TSH alone)
A standalone TSH is a common first-line thyroid test, but it doesn't always tell the full story. Ask whether a fuller panel — including free T3 and free T4 — makes sense, since thyroid function affects digestive motility and can be a contributing factor for both bloating and constipation. If constipation is the bigger issue and standard fiber/water advice hasn't helped, this often points to something beyond fiber and water.
2. Celiac antibody panel
Celiac disease can present with bloating, gas, and irregularity without the more "classic" symptoms some people expect. A celiac antibody panel (commonly including tTG-IgA) is a reasonable ask if this hasn't been screened for and gluten hasn't been ruled out as a factor.
3. A SIBO breath test
Small intestinal bacterial overgrowth (SIBO) is frequently discussed in relation to bloating that's worse after meals. A breath test is the standard non-invasive way to screen for it — worth asking about if bloating has a strong after-eating pattern.
4. H. pylori testing
H. pylori is a bacterium linked to some cases of bloating, reflux, and upper digestive discomfort. Breath, stool, or blood testing are the common options — ask which is most appropriate for your situation.
5. Inflammatory markers (CRP and/or fecal calprotectin)
General inflammatory markers like CRP, or a gut-specific marker like fecal calprotectin, which is more effective than CRP at distinguishing IBD from IBS, can help distinguish between general digestive discomfort and something that warrants a closer look — particularly important if there's any suspicion of an inflammatory condition like IBD, which needs a gastroenterologist's evaluation, not a supplement.
The one that gets missed most often
Of the five, the celiac panel is the one worth taking most seriously if it's never been run. A case-finding study of patients with presumed IBS found that 3.23% actually had celiac disease — and separate research shows the average diagnostic delay for celiac disease runs somewhere between 6 and 13 years — once a clinician settles on an IBS diagnosis, contradicting details tend to get overlooked rather than followed up on. If you've been told "it's IBS" and a celiac panel was never part of the workup, that's a reasonable, specific thing to ask for by name.
Once you have answers
Whatever your workup shows, Velisoma's four-step protocol is built around general symptom support — gas, bloating, and occasional irregularity — not as a replacement for treating an underlying condition your doctor identifies. If labs come back clear and you're still stuck on where to start, why the order you address symptoms in matters is a good next read.
Sources
- Thyroid disorders and gastrointestinal dysmotility. National Library of Medicine (PMC11129086).
- NIDDK. Symptoms & Causes of Celiac Disease.
- Mayo Clinic. Small Intestinal Bacterial Overgrowth (SIBO) — Diagnosis & Treatment.
- Mayo Clinic. H. pylori Infection — Diagnosis & Treatment.
- Diagnostic accuracy of fecal calprotectin in assessing IBD severity. National Library of Medicine (PMC5596188).
- Celiac disease in patients with presumed irritable bowel syndrome: a case-finding study. National Library of Medicine (PMC2776860).
- Delay in Celiac Disease Diagnosis Among Patients with High-Risk Screening Conditions. National Library of Medicine (PMC12470924).
Dr. Kayle Martinsen
In clinical practice since 2008, functional-medicine based, working with patients on reflux, IBS, and digestive dysfunction.