Catholic Communion and Celiac Disease: the Options, by Barbara Coughlin M.D.

For the Catholic with celiac disease, the most painful aspect of living on a strict gluten free is the inability to receive the host, or bread, at Communion. Catholics believe that the bread is transformed into the Body of Christ. This transformation and the reception of the Body of Christ, called the Eucharist, takes place at Mass. It is the center around which the religious life of a Catholic revolves. To be suddenly denied this by virtue of having celiac disease is devastating to many Catholics.

Because the Catholic Church states that Communion bread must be made of only wheat and water with "sufficient gluten to attain the confection of bread," the only option for the Catholic celiac has been to receive Communion under the species of wine alone. According to Catholic doctrine, the whole of Christ is contained in the Precious Blood alone. As such, the person who receives Communion this way is still receiving the whole sacrament. Since part of the rite of the Mass includes placing a small piece of bread into the wine, the person with celiac disease needs to arrange for a separate chalice into which no bread is put. The priest is required to do this, as each Catholic in good standing has a right to receive Communion. At churches where Communion is offered to the congregation under both species, this might not be a problem, as the chalices that are brought out to the congregation generally do not have bread in them. As this is not universal, each individual should become aware of the procedures in her own parish.

Although receiving the Precious Blood alone provides a satisfactory theological answer, many Catholic celiacs still feel a deep sense of loss and isolation by being denied the ability to receive the Body of Christ in the form of bread as they have since childhood. Likewise, parents of celiac children are troubled by having their child receiving Communion differently from other children or by having their child drink wine.

Occasionally, one can find a priest who is willing to consecrate a rice host, but they are few and far between. In addition, since they are "breaking the rules," it’s best to be subtle about it and not publicize it. As such, this is not an answer for the vast majority of Catholic celiacs.

Now there is another choice. The Benedictine Sisters of Perpetual Adoration in Clyde, Missouri, have developed a Communion host that is extremely low in gluten. They have worked for ten years on this project. The host is made from gelatinized wheat starch. The hosts have been tested for the presence of gluten. According to the Sisters, they were tested to a level of 0.01% gluten. At that level, the lowest that could be tested, no gluten was detected. This means that there is less than 0.01% gluten in one of these hosts; however, it is not known how much less. The Secretariat for the Liturgy of the United States Conference of Catholic Bishops has stated that these meet the requirements of the Code of Canon Law and may be validly used at Mass with permission of the person’s pastor. They are manufactured by hand in a separate facility from the ordinary wheat hosts and are shipped separately from the wheat hosts so that there is no danger of cross contamination.

I spoke to Sister Jeanne Patricia Crowe, Pharm D, R Ph. of Immaculata College in Pennsylvania. Sister Crowe (who is in a different order from the nuns who developed the host and has no relationship with them) does not have celiac disease herself, but she has a particular interest in it and often speaks at celiac conferences. She weighed these hosts on an extremely accurate pharmaceutical scale, and then calculated how much gluten would be in one IF it actually were 0.01% gluten. The result was approximately 32 micrograms; a quarter of a host would have about 7 micrograms of gluten. For those (like me) who are little shaky on the metric system, 7 micrograms is 7/one millionths of a gram. To put this into perspective, a very small bread crumb contains about 10 milligrams, or 10/one thousandths of a gram--substantially more.

But, of course, the question in everyone’s mind is, "Is this safe?" The answer from the experts is, "Probably." Alessio Fasano MD of the Celiac Center at the University of Maryland has stated that the gluten free hosts are safe for people with celiac disease; however, he has not explained why. I have attempted to contact him, but he has not responded to me or to another person who has been researching this.

In 1993, Dr. Catassi published a study showing that the lowest level of gluten that produced a visible change in the biopsies of celiac volunteers was 100 milligrams of gliadin (equal to 200 milligrams of gluten) a day. Some experts have extrapolated from that to state that the maximum amount of gluten a celiac should ingest in a day is 10 milligrams. Clearly, the amount of gluten in one of these hosts is significantly lower than that, which suggests that it is a safe amount, However, no studies have been done on this, so it is impossible to know if there are any risks or dangers of long term exposure to this level of gluten.

I also spoke to Michelle Melin-Rogovin from the University of Chicago’s Celiac Disease program. She told me that no one knows how much gluten is safe, and that in the Real World, we are all probably ingesting some low level of gluten. She stated that she could not say that it would be safe for someone to use these hosts, but that it might be considered an "acceptable risk" that would be a valid decision for some. She recommended taking only a quarter of a host once a week at most. She also suggested that it would be wise for someone choosing to do this to check her antibodies beforehand and then several months later. She would not recommend someone who had elevated antibodies to use these hosts.

I realize that the policy of our support group and, therefore, of this website is to advocate that a person with celiac disease should do her utmost to avoid any consumption of gluten. As such, this article may seem to be in conflict with this message. As a Catholic celiac myself, however, I understand the deep sorrow that not being able to have the Body of Christ can cause. In the past four years, I have come to accept my gluten free life; I live fully and joyfully and eat very well. But the one issue that has continued to be painful and difficult to live with has been my loss of the ability to receive the Body of Christ at Mass. I also realize that non-Catholics may find it hard to grasp how vital the sacrament is for us, and why even those of us who are scrupulous to avoid any other source of gluten may choose this as an acceptable risk, and I hope they will look at it without judgement. I felt it important to gather as much information as I could about the low gluten host so that each person can make her own decision. The latest issue of Gluten Free Living also contains an article on the low gluten hosts, with comments from experts on celiac disease regarding their safety for someone on a gluten free diet.

My mentor in college once told me, "For the rest of your life, you will be making decisions based on insufficient information." That certainly applies to life with celiac disease! Whether or not one decides to accept the use of the low gluten host or to allow one’s child to receive it is a personal decision. Having had to make it myself, I know how difficult it is. If anyone would like to speak to me personally about the low gluten host or the logistics of using it in a way that avoids cross contamination, please feel free to call or to email me.

Evening Service: Traveling with our Gluten-free Pyx

It’s Sunday morning and we just decided to go to the evening contemporary mass. Since our parish does not offer an evening service we are trying to decide whether to go to Lady of the Lake or St. Ignatius. One is a contemplative service (which mom is voting for) and the other is a Life Teen mass (which Nate and Emily vote for).

I think I am out numbered.

We’ve come a long way. Years ago, when Nate was first receiving Eucharist, his low-gluten wafer was unique. Popping in to a new parish meant showing up early or calling a day in advance to explain the situation. Now, even if we have a visiting priest, we can arrive a quarter of an hour in advance, meet with the priest, and then slip into church for a quiet meditative moment before mass.

How does this conversation usually go? Now that Nate is 12, according to him, 12 years-8 months-and 12 days, we have been encouraging him to initiate the interaction. It still takes a bit of courage, occasional role playing, and then a “you-can-do-this” speech.

“Hello, Father. My name is Nate. I am gluten intolerant and I have brought my pyx with a low gluten wafer. I was hoping to have it consecrated at mass so I can receive both the body and blood.”

Either one of two things happens at this point, either the priest responds with a story of experience with low-gluten wafers, or the priest queries as he has never experienced this situation. As the years go by, fewer priests are unaware of the low-gluten wafers most of them now want to have an address of where to locate the wafers for other parishioners.

At this point, I usually get the elbow nudge. In a whispered panicked voice, Nate will cry, “MOM!” It’s my turn to step in. It’s a slow process to coach the communicant and educate the presider. As Nate grows in confidence, I am sure he will initiate more of the information when we visit new parishes, as it is now, I want Nate to feel welcome and excited about receiving eucharist.

Our home parish priest has set up a routine with Nate. No matter where we sit, Nate gets into line for Father, and then receives his low-gluten host from our pyx. (Prior to church, we laid the low-gluten wafer loaded pyx on the side table for the alter servers to deliver to the altar at the appointed time.) Quietly, the priest snaps the pyx closed and hands it back to Nate, who then pockets it and proceeds to the line waiting for the cup. This is Nate’s preferred mode of receiving. He feels like no one know he is different. No one singles him out from the rest.

Visiting a local parish when I was called to interpret for a special signed mass for the Deaf community, the priest made a big deal of walking down to Nate, giving him his host before anyone else received. All eyes were on Nate. From the front, looking down into the congregation, I saw Nate sink lower and lower into the pew. His face became a few shades redder, and his eyes darted up to mine with humility. After mass, Nate exclaimed in frustration that he was not old or invalid. He never wanted to receive eucharist that way, ever again.

When visiting a parish that the priest has experience with low-gluten hosts, we usually follow the tradition of this parish. Sometimes this means approaching the priest, receiving a blessing, circling the priest to take the pyx off the altar and proceeding to the cup. Other times, it is a matter of waiting until the very end, and going up as one of the last, so that the priest can step back to the altar and pick up the pyx for Nathan.

For either of our choices tonight, after a brief word with the priest, Nathan will be able to walk with our family, no matter where we sit, and receive Christ in the bread and the wine. It is an amazing blessing. I am thankful that we live in a time that congregations, priests, and a cloistered group of sisters understand the importance for everyone to be welcome to receive the sacrament of the Eucharist.

Bread of Life -- Thanksgiving for the Low-Gluten Wafers

Gluten-free bread has become the bread of our lives. We make it from scratch, we buy it in bulk to put in the freezer, we go out of our way to stores that carry our favorite brands, and somedays we just eat our least favorite brand to satisfy hunger.

The Eucharist is also our Bread of Life. This is an imagery that is so prevalent in our liturgy; it's in our scripture, our prayers, and in our music. Of all the music that we sing, John Foley's One Bread, One Body holds a special imagery for me.

One bread, one body, one Lord of all,

One cup of blessings which we bless.

And we, though many throughout the earth,

We are one body in this one Lord.

(John Foley, Oregon Catholic Press, Breaking Bread,

http://www.youtube.com/watch?v=EYlJC26-Ch0 )

This great table that we gather around, no matter where we live around the world; no matter what car we drive to arrive at mass, or whether we walk or bike; no matter if we are mothers, sons, fathers, or daughters; no matter if our skin is tan or beige or peach; no matter if we eat a wheat wafer or a low-gluten wafer, we are the body of Christ. We are One body.

What does that One Body look like beyond the table. There are divisions, just look in the fellowship hall; someone forgot to bring the promised gluten-free pasta for the Italian dinner, so Nate and the other celiac parishioners get salad and sauce. Gladys, with her diabetes, skips the desert, or at least only enjoys one forkful. Steve is avoiding the wine, as he has been battling with alcohol and even one glass can become addictive. The Ingalls family is vegetarian, so they bring their own veggie sauce. Baby David is not yet eating solids, so his dinner comes in the liquid form from behind a discrete blanket thrown over mom's shoulder.

Leaving the dinner, each of us goes home to find different foods in our cupboards. For some, it is rice and beans, others enjoy the meat & potatoes, and for another family, the cupboard looks bare until the food bank opens Monday evening. If we were truly One, I wonder if all of us would go to bed content.

It's a circle that we live. When we partake of the Body of Christ, we are to live more fully as the Body of Christ. As we live out that life, those around us are more fully blest, desire to find out our motivation, and seek to find Christ. They in turn, come to the table that gives life. It is simple acts that we model of Christ's that bring us closer and inspire us to return each week and live more holy lives.

Blessed Mother Teresa is quoted as to having said, that we are to find the poorest of the poor in our own communities to serve. We all don't need to leave our homes and travel to India to serve in order to live holy lives. The Body of Christ is around the world and in our own towns, and in our own parishes.

For our family this week, we will pack a bag for the food bank; packing it to provide for those that are the poorest in our own community. We will try to think of various members of the body of Christ and choose foods to support them; a bag of rice, a box of gluten-free cereal, potatoes from the garden, and something for babies that are just starting to eat.

It's bread that brings us life and energy to live. It's the Bread of Life that brings the Catholic Christian community together each week at the altar. It's the Bread of Life that moves within us to live in the example of Christ.

Each week, Nate is able to walk forward, reach out his heart to ask Jesus to lead his life, and receive in out stretched hands the body of Christ.

I am so thankful that we have low-gluten wafers that allows even more Catholics to gather around the altar. In one more way, we are all a part of the Body of Christ.