Navigating non-celiac gluten sensitivity: Using an epistemic humility approach with patients

About 10% of the population self-report sensitivity to gluten or wheat, and the number of people who avoid gluten is roughly double the number diagnosed with celiac disease or self-reported non-celiac wheat sensitivity.(1) Without reliable tests or clear clinical guidelines, managing a patient who experiences digestive symptoms after eating gluten, but does not have celiac disease or a wheat allergy, can be challenging.(1)

In the March 2025 issue of the Canadian Medical Association Journal, Dr. Megan Dean introduces a helpful guiding principle for clinicians: epistemic humility. Epistemic humility is “a commitment to make realistic assessment of what one knows and does not know, and to restrict one’s confidence and claims to knowledge only to what one actually knows about his or her specialized domain.”

Applied to clinical practice, epistemic humility encourages physicians to balance their expertise with recognition of its limits. It positions clinicians as authorities in diagnosis and treatment, while acknowledging patients as expert in their own bodily experiences.

Patients are the ones who live with their symptoms day to day. As they navigate a mix of emerging research, health information, and online mis/disinformation, health care providers have a crucial role in supporting their inquiry into non-celiac gluten sensitivity. Rather than dismissing or minimizing patient’s concerns, clinicians can validate their experiences, guide them to evidence-based health information, and facilitate dialogue that empowers patients to make well-informed, autonomous decisions.

This approach also allows providers to explain that evaluating non-celiac gluten sensitivity involves building evidence through a structured, stepwise process, which includes ruling out other conditions and carefully assessing dietary triggers.

As research evolves, a clearer diagnostic pathway for non-celiac gluten sensitivity diagnosis may be possible. In the meantime, providers can make a meaningful difference by leading with epistemic humility and supporting patients in navigating the complex and often confusing information landscape.