In this article, I hope to inform as many people as possible … about the damaging spiritual and physical effects of celiac disease. And … provide resources and pastoral recommendations for caring for individuals who may be unable to receive the Holy Eucharist in the sacred host because of this disease.
The first time I had to deal with the issue of celiac disease, I was the pastor of a large suburban parish when the parochial vicar came into my office and asked if we had any Communion options for those suffering from celiac disease. He asked if we provided the precious blood to them or offered them some other spiritual remedy. Sadly, I responded in the negative and knew I had to offer a spiritual remedy.
I had heard of celiac disease before, and being involved in medical ethics, I had discussed this with others, thinking it was not going to affect me as a pastor. How wrong I was! I found this medical-moral issue of great interest and began to study this physical and spiritual condition for Catholics. I wanted to help those suffering from this disease in our parish and throughout the Church. The more I learned about it, the more I believed the Church could and should be able to accommodate these faithful and devout people in receiving the gift of the Holy Eucharist.
Low-gluten hosts have been approved by the United States Conference of Catholic Bishops (http://www.usccb.org/prayer-and-worship/the-mass/order-of-mass/liturgy-of-the-eucharist/celiac-sprue-disease.cfm), but many people still ask, “What is celiac disease?” Its symptoms were observed and described as early as the second century; however, its effects and causes were not discovered until the twentieth century. 1
In this article, I hope to inform as many people as possible—especially priests, DREs, CREs, Catholic school principals, ministers to the sick, pastoral care workers, and all others who work in parish ministry—about the damaging spiritual and physical effects of celiac disease. And I hope to provide resources and pastoral recommendations for caring for individuals who may be unable to receive the Holy Eucharist in the sacred host because of this disease.
Celiac disease is the most common way of identifying this condition, but it can also be referred to as celiac sprue disease. It was originally thought that only children contracted this disease, but studies show that it is a common genetic disorder affecting people of all ages throughout the world. The World Journal of Gastroenterology in a recent article stated that celiac disease “now affects about one in 100 people in Europe and North America.” 2 According to the National Digestive Diseases Information Clearinghouse, a service of the National Institutes of Health, “Among people who have a first-degree relative—a parent, sibling, or child—diagnosed with celiac disease, as many as 1 in 22 people may have the disease.” 3
There are many symptoms common to celiac disease. Different medical journals, as well as personal conversations, testify that celiac disease is manifested in many and varied reactions. The most common physical effects are severe abdominal pain, vitamin deficiency, and fatigue. “Celiac disease can be very serious,” the National Digestive Diseases Information Clearinghouse notes. “It often causes long-lasting digestive problems and keeps your body from getting all the nutrition it needs. Over time, celiac disease can cause anemia, infertility, weak and brittle bones, an itchy skin rash, and other health problems.” 4 In explaining the mechanism of celiac disease, the Celiac Sprue Association states: “In people with (celiac disease), eating certain types of grain-based products sets off an immune response that causes damage to the small intestine. This, in turn, interferes with the small intestine’s ability to absorb nutrients found in food, leading to malnutrition and a variety of other complications. The offending amino acid sequences are collectively called ‘gluten’ and are found in wheat, barley, rye, and to a lesser extent, oats.” 5 The only way to manage celiac disease is to remove as much gluten as possible from one’s daily regimen in life.
Gluten Altar Bread
The Holy Eucharist is one of the seven sacraments of the Church and is described as the “source and summit” of the Catholic faith by the Second Vatican Council. 6 The Catechism of the Catholic Church says this: “The mode of Christ’s presence under the Eucharistic species is unique. It raises the Eucharist above all the sacraments as the “perfection of the spiritual life and the end to which all the sacraments tend. In the most blessed sacrament of the Eucharist ‘the body and blood, together with soul and divinity, of our Lord Jesus Christ, and therefore, the whole Christ is truly, really, and substantially contained.’” 7 Catholics celebrate this belief in the Holy Eucharist, the real presence of Christ in the Eucharist, by faithfully attending Mass each Sunday, and each holy day of obligation. Catholics in the state of grace are bound to receive the Holy Eucharist at least once a year. Canon law states that this precept is not binding for those unable to receive Holy Communion because of a medical condition or illness; nonetheless, it is unusual and a great sacrifice for Catholics not to receive the Eucharist, especially for those who suffer from celiac disease.
A great theologian of the Church during the 1200s, St. Thomas Aquinas, was one of the first Church theologians to describe clearly what valid matter is for the Eucharist: “Now among other breads, wheaten bread is more commonly used by men; since other breads seem to be employed when this fails. And, consequently, Christ is believed to have instituted this sacrament under this species of bread. Moreover, this bread strengthens man, and so it denotes more suitably the effect of this sacrament. Consequently, the proper matter for this sacrament is wheaten bread.” 8 Accordingly, Canon Law specifies the use of wheat bread, stating that the Eucharistic species must include unleavened wheat. 9 We can see the particular danger that celiac disease poses to the physical life and, maybe more importantly, to the spiritual health, of a Catholic because of the presence of wheat gluten in the Holy Eucharist.
Imagine how painful and spiritually challenging it is for faithful Catholics, who desire to receive Holy Communion weekly or even daily, but who are unable to ingest wheat bread because of the grave physical harm it can cause them. The Church, in her loving wisdom and concern for the welfare of her faithful, has provided spiritual remedies for those who find themselves in situations of this kind. For example, the bishop, or a local ordinary, is able to grant a priest affected by alcoholism permission to use mustum, a type of grape juice, for the celebration of the Eucharist. Similarly, the Church has issued several documents that offer the clergy and laity uniform and clear direction concerning digestive diseases, and wheat allergies, and the reception of Holy Communion. In 1995, the Church specifically addressed the use of low-gluten hosts. 10
In a circular letter to all presidents of the Episcopal Conferences, the Congregation for the Doctrine of the Faith (CDF) of the Vatican specified the conditions for validity of matter of low-gluten altar bread:
(1) Special hosts “quibus glutinum ablatum est” (that are gluten-free) are invalid matter for the celebration of the Holy Eucharist.(2) Low-gluten hosts are valid matter, provided that they contain the amount of gluten sufficient to obtain the confection of bread, that there is no addition of foreign materials and that the procedure for making such hosts is not such as to alter the nature of the substance of the bread. 11
In July of 2003, the CDF issued another circular letter to address this issue, acknowledging the increasing medical and spiritual dilemma of the faithful: “The Congregation for the Doctrine of the Faith has been for many years studying how to resolve the difficulties that some of the faithful encounter in receiving Holy Communion when for various serious reasons they are unable to consume normal bread or wine.” The letter reiterated the conditions for use of low-gluten altar breads:
- Hosts that are completely gluten-free are invalid matter for the celebration of the Eucharist.
- Low-gluten hosts (partially gluten-free) are valid matter, provided they contain a sufficient amount of gluten to obtain the confection of bread without the addition of foreign materials and without the use of procedures that would alter the nature of bread (original emphases).
Under a section of the letter titled “Communion under one species or with a minimal amount of wine,” the CDF stated:
1. A layperson affected by celiac disease, who is not able to receive Communion under the species of bread, including low-gluten hosts, may receive Communion under the species of wine only.
2. A priest unable to receive Communion under the species of bread, including low-gluten hosts, when taking part in a con-celebration, may, with the permission of the Ordinary, receive Communion under the species of wine only.
Last, some common norms were issued for the use of low-gluten hosts for the Eucharist, especially in those situations where the priest may suffer from celiac disease:
1. The Ordinary is competent to give permission for an individual priest or layperson to use low-gluten hosts, or mustum, for the celebration of the Eucharist. Permission can be granted habitually, for as long as the situation continues which occasioned the granting of permission … 3. A priest unable to receive Communion under the species of bread, including low-gluten hosts, may not celebrate the Eucharist individually, nor may he preside at a con-celebration … 5. Attention should be paid to medical advances in the area of celiac disease … and encouragement given to the production of hosts with a minimal amount of gluten … 6. The Congregation for the Doctrine of the Faith enjoys competence over the doctrinal aspects of this question, while disciplinary matters are the competence of the Congregation for Divine Worship and the Discipline of the Sacraments. 7. Concerned Episcopal Conferences shall report to the Congregation for Divine Worship and the Discipline of the Sacraments, at the time of their ad limina visit, regarding the application of these norms, as well as any new developments in this area. 12
In the above statements, article 3 may seem to contradict the preceding article 2, but it does not. The CDF letter clarifies that a priest who cannot receive both the Body and Blood of Christ in the Eucharist may not be the celebrant of an individual Mass, or the main celebrant of a concelebrated Mass. He may, however, celebrate a Mass with the faithful, and may participate as a concelebrant in a Mass.
When permission was given by the CDF to use low-gluten matter for Holy Communion, as long as it contained sufficient matter for bread, the Benedictine Sisters of Perpetual Adoration in Clyde, Missouri, developed a true low-gluten host. 13 The total gluten content is 0.01 percent. Its contents are unleavened wheat and water, and it is free of additives, conforming to the requirements set forth in Canon Law. This low-gluten content is still enough for the bread to be valid matter for the Eucharist, and many people who are gluten-intolerant are able to consume it, or at least some portion of it. However, individuals suffering from celiac disease are strongly advised to consult with their physician before receiving a low-gluten host. Even with this reduced amount of gluten, some individuals are still unable to receive the Body of Christ in the form of the consecrated host. More recently, two other sources have been identified and approved as valid, low-gluten hosts by the USCCB. See the USCCB website under Divine Worship or go to the newsletter link at: http://www.usccb.org/about/divine-worship/newsletter/upload/March-2012.pdf
To assist those facing this medical-moral dilemma, I believe it is helpful for pastors, and all those working with Catholic faithful in parishes, both young and old, to be aware of this grave situation. They should do their best to provide approved low-gluten hosts and/or the Precious Blood at each Mass so that the Holy Eucharist, a sign of unity, is able to be received by those Catholics who are properly disposed. St. Paul tells us: “The cup of blessing which we bless, is it not the communion of the blood of Christ? The bread which we break, is it not the communion of the body of Christ? For we being many are one bread, and one body: for we are all partakers of that one bread” (1 Cor 10:16–17).
Canon 925 states, “Holy Communion is to be given under the form of bread alone, or under both species according to the norm of the liturgical laws, or even under the form of wine alone in a case of necessity.” In a 2002 document addressed to the United States Bishops, the Congregation for Divine Worship and Discipline of the Sacraments (CDWDS) stated, “The dogmatic principles, which were laid down by the Council of Trent, remain intact. Communion under both kinds may be granted when the bishops think fit, not only to clerics and religious, but also the laity, in cases to be determined by the Holy See.” The document goes on to say that: “Holy Communion has a more complete form as a sign when it is received under both kinds. For in this manner of reception, a fuller sign of the Eucharistic banquet shines forth.” 14 How providential it was that Pope John Paul II approved in the United States, through the CDWDS, the extension of offering the blood of Christ in Holy Communion with more regularity. The clarifications in these Church documents, including the CDF’s 1995 and 2003 circular letters, have helped those suffering from celiac disease to receive more readily and easily the body and blood of Christ.
When Catholics with celiac disease come to a new parish, they should inform the pastor or the parochial vicar of their condition and inquire whether there is any way the parish is assisting those with celiac disease. It could also be of benefit for parishioners, or visiting Catholics who are attending Mass outside their home parish and who suffer from celiac disease, to briefly inform the main celebrant before Mass to explain their condition, and to ask if the parish provides low-gluten hosts or offers the Precious Blood. This prevents those suffering from celiac disease from having to bring a low-gluten, unconsecrated host with them to Mass to be consecrated or, worse yet, from bringing a totally gluten-free host to a priest, and asking him to consecrate it.
Following are some personal suggestions that one might find helpful or true to one’s own experience in dealing with celiac sufferers in a parish.
In my former parish, I found it helpful to keep a pyx with consecrated, low-gluten hosts in the tabernacle for the sole purpose of use for those suffering from celiac disease. (A pyx is a small, round container used in the Church to carry the consecrated host to the sick, or those who cannot attend Mass.) The pyx was clearly marked and kept in the tabernacle for those bringing Holy Communion to celiac sufferers in a hospital or long-term care facility, or those who were attending daily Mass with the condition. It is also necessary to purify one’s fingers before distributing the low-gluten hosts to those affected to avoid any cross-contamination with the gluten hosts. Another option for parishes is to have the celebrant place the number of low-gluten hosts needed at Mass on a paten, and allow the celiac sufferer to receive Communion from the priest with only these consecrated hosts. Another pastoral solution is to provide the precious blood on a regular basis at each Mass in a chalice separate from the celebrant’s chalice, since the celebrant’s chalice contains a gluten particle of the sacred host. It is also important to first offer the chalice without a particle of the gluten consecrated host to those with celiac disease at Communion so that particles of the gluten host do not get introduced into the chalice in increased quantity, thereby making it a serious, probable danger for anyone with high intolerance to the gluten.
Unfortunately, even a small trace of gluten can have debilitating effects on certain persons suffering from celiac disease. In instances where no alternative Communion options are available, the Church recommends that those with celiac disease make a spiritual communion. Archbishop Dennis Schnurr offers these consoling words: “In cases where a person cannot ingest the smallest amount of wheat or alcohol, I have reminded them of the great consolation that St. Thérèse of Lisieux experienced in spiritual communion … In the terminal stages of her illness, she was unable to ingest any nutrition, including the Holy Eucharist. Still, she expressed consolation, in that she knew that her desire alone was enough to bring Jesus to her.” 15
With an increasing number of people being diagnosed with, and suffering from, celiac disease, it is essential for the Church in her motherly way to respond with pastoral care and love. Many Catholics, and even some priests, do not know that the Catholic Church provides low-gluten hosts, which many sufferers of celiac disease can receive without difficulty or severe side effects. However, there are still those of God’s faithful who cannot receive the Eucharistic presence of Our Lord in His Sacred Body. How regrettable it is when Catholics choose not to come to Mass, or not to receive Holy Communion, because they believe celiac disease leaves them very few options.
Parishes that offer pastoral solutions to those suffering with celiac disease should regularly inform parishioners of the availability of low-gluten hosts in the parish bulletin, and on their parish website. This notice could also be made available on a diocesan website, so that sufferers of celiac disease can easily find the parishes which offer these approved options to them. I am thankful that the Church has responded to these particular needs of the faithful who are suffering from celiac disease. I believe that it shows Jesus’ loving concern for all those who come to him for healing. As celiac disease becomes more widely known, I hope that this article will help all of us who work in the Church to reach out to provide spiritual assistance to those who suffer from this medical and moral dilemma.
- Celiac Sprue Association, “History of Celiac Disease,” 2012, http://www.csaceliacs.info/history_of_celiac_disease.jsp. ↩
- Hugh J. Freeman et al., “Recent Advances in Celiac Disease,” World Journal of Gastroenterology 17.18 (2011): 2259–2271. ↩
- National Digestive Diseases Information Clearinghouse (NDDIC), “Celiac Disease,” January 27, 2012, http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/#2. ↩
- NDDIC, “What I Need to Know about Celiac Disease: Is Celiac Disease Serious?” May 10, 2012, http://digestive.niddk.nih.gov/ddiseases/pubs/celiac_ez/#serious. ↩
- Celiac Sprue Association, “What Is Celiac Disease?” 2012, http://www.csaceliacs.info/what is celiac disease.jsp. ↩
- Vatican Council II, Lumen gentium (November 21, 1964), n. 11. ↩
- Catechism of the Catholic Church (2nd ed.), no 1374. Washington, DC: Libereria Editrice Vaticana – United States Conference of Catholic Bishops, 2001. ↩
- Thomas Aquinas, Summa theologiae III, q. 74, a. 3. ↩
- Code of Canon Law: Latin–English Edition, new English translation (Washington, DC: Canon Law Society of America, 1999), 924 §2. ↩
- Congregation for the Doctrine of the Faith (CDF), “Rescriptum,” December 15, 1980, in Leges Ecclesiae 6.4819 (1980): 8095–8096; “De celebrantis communione,” October 29, 1982, in AAS 74 (1982): 1298–1299; and “Circular Letter to All Presidents of Episcopal Conferences concerning the Use of Low-Gluten Altar Breads and Mustum as Matter for the Celebration of the Eucharist” (June 19, 1995). ↩
- CDF, 1995 Circular Letter. ↩
- CDF, “Circular Letter to All Presidents of Episcopal Conferences concerning the Use of Low-Gluten Altar Breads and Mustum as Matter for the Celebration of the Eucharist” (July 24, 2003). ↩
- Benedictine Sisters of Perpetual Adoration, “Low Gluten Altar Breads,” www.altarbreadsbspa.com/lowgluten.php. ↩
- U.S. Conference of Catholic Bishops, “Norms for the Distribution and Reception of Holy Communion,” indult of the Congregation for Divine Worship and the Discipline of the Sacraments, March 28, 2002, part 1, nn.19 and 20, http://old.usccb.org/romanmissal/girm-norms-en.shtml. ↩
- Annamarie Adkins, “When Wheat Won’t Work,” National Catholic Reporter 85.17 (April 26–May 2, 2009), 1–12. ↩