Nourishing the Catholic Celiac: Bread from Heaven, Not of Earth
It's easier (and harder) than you think
Note: For the sake of simplicity, I use the term Celiac Disease throughout this article, but there are multiple wheat-triggered health problems that don’t fall strictly under a CD diagnosis. These non-CD conditions include allergy, sensitivity (NCGS), and other diseases (such as EoE) triggered by wheat and the gluten protein.
Standing in that uncomfortable place again…
I stood alone in the center aisle and waited for Father to look up at me. We were in a stand-off of sorts. He was holding up the Eucharistic host waiting for my “amen” and I was waiting for him to remember that he’d told me to come up last in line to receive a low-gluten host.
After seconds that felt like years, he looked up with visible irritation. Then his eyes opened wide as he remembered. I smiled weakly, trying to make it less awkward, but he was already on his way to the altar to retrieve the low-gluten host. I was embarrassed. Maybe he was, too. It was fine. Just another day in the life of being human.
It’s a small thing, really, to ask for accommodation as a celiac Catholic, but the low-confidence introvert in me prefers to abstain unless there’s a solid, uncomplicated, advance plan. The source of stress is a little ego, a little grief, a little prick of isolation, and a little bit of feeling like it shouldn’t have to be this way.
Eucharisteo! Bread of Life! Of all things. Lord, really?? I believe. Help thou my unbelief.
Publishing this article is like standing in that uncomfortable place in the center aisle, knowing that some in the pews are wondering why I don’t just simmer down and have a little more faith…
Who do you think you are? Father is busy enough. The Eucharist isn’t going to hurt you.
And yet, I have a body that is battle-weary from chronic illness and a spirit that sometimes lacks courage. I also have a daughter with celiac disease (it’s genetic) and a couple other kids with non-celiac gluten sensitivity. I’ve held sick children and dried a lot of tears. It is actually a big deal. For us. And for the Church. In fact, the presence of celiacs in the congregation can help us all to better understand our faith, the Eucharist, and how to better serve others.
THE SOLUTION
The 100% gluten free solution is simple:
Offer the Precious Blood consecrated in a separate designated chalice.
Inform parishioners and guests sometime before Communion where and when to receive. Signs, bulletins, announcements, or all of the above.
The nearly-100% gluten free solutions (low-gluten hosts or shared chalice) is also relatively simple and I’ll share them in this article along with other resources. But understand first…
The care of celiacs is not peripheral but central to pastoral care in our communities because the Eucharist is central. It is the “source and summit” of our faith. When poorly addressed, the question can become a stumbling block for the celiac and also for those worshipping with them.
The Church can use this pastoral challenge to:
Clarify the theology of Eucharistic presence
Acknowledge the increased prevalence of celiac disease and related disorders
Establish simple protocols for those who need accommodation
Remove every possible barrier to the sacraments and to Christ Himself.
WHAT’S THE BIG DEAL ABOUT GLUTEN?
When my daughter was young she was very ill. She stopped growing, forgot words to common objects, needed diapers again years after being potty trained, and had trouble making eye contact. Many of her symptoms matched regressive autism. But after two years and many alarming symptoms, we arrived at an unexpected diagnosis: Celiac Disease.
She’d been slowly starving of nutrients, and her body systems and cognitive function were shutting down. During most of history, she would have wasted away and died. Thankfully, we have many sources of nourishment today in America. The life-saving answer was simple..
Eliminate all exposure to gluten.
Simple, but not easy since gluten is in countless foods and condiments under many forms and names. When gluten was removed from her diet, she quickly began to grow, to heal, and to “wake up” to life again. Contrary to popular misconception, most who choose to be “gluten-free” are not expressing a preference, but manifesting a physiological need.
We pray for a miracle of healing from her affliction. In the meantime, the diagnosis has been like a miracle, because it brought her back to life.
Celiac Disease is an autoimmune disease in which the body’s immune system attacks the cells of the small intestine, causing damage to the villi and preventing nutrient absorption. Though it impacts the small intestine directly, it is recognized as a multi-organ condition. The trigger is the gluten protein which is present in wheat, rye, barley, oats. CD is not not an allergy or a sensitivity, though those are both legitimate reasons to abstain from gluten.
The range of damage to the intestines can be anywhere from low inflammation to total villous atrophy. Sometimes (as in my child’s case) they are “classic” symptoms of wasting. Very often though, modern cases present symptoms wherever the body’s essential services are compromised as a response to nutrient privation. Some examples:
Joint pain
Muscle pain and weakness
Fatigue
Migraines
Amenorrhea
IBS
Gastrointestinal
Neuropathy
Weight loss
Weight gain (a starving body craves food intensely)
Immune suppression
Cancer
Depression/Anxiety
Skin disorders
Cognitive impairment
Learning disabilities
ADHD
Multiple organ involvement
Osteoporosis
Anemia
Some celiacs have severe reactions. Some have “silent” symptoms with slower effects of nutrient malabsorption. The latter are the ones more likely to simply get in line and receive at church in spite of diagnosis. The internal and external desire and pressure are tremendous. Nobody wants to stand out, to ask for accommodations, to abstain from the Gift (and maybe scandalize others), or to take a chance by receiving. It causes conflict, guilt, and grief. In the absence of a 100% gluten free option and a way to micro-analyze the immediate response of the immune system to contact, there is always conflict.
HARMED BY THE EUCHARIST?
When I recently posted on social media asking what different parishes do to accommodate people with celiac disease, a Catholic woman asked me "Where is your faith????" Even when presented with the Church’s teachings on transubstantiation, she continued to assert that the issue is psychosomatic because no harm could come from the Eucharist. Other Catholics also challenged me:
“There’s no gluten left in the Eucharist after it becomes the Body of Christ. It won’t hurt you.”
All of these concerned people are dynamic Catholics, and have a greater-than-average knowledge of their faith. Perhaps their faith in the Eucharist is so deep and strong they haven’t had need of the theological teaching and why it matters. It happens. So here’s a clarification:
The substance changes but the accidental properties remain. It is a very personal decision for celiacs and I honor what you choose to do, but your statement is a wrong (though common) belief about transubstantiation.
“The accidents remain in their totality—for example, that which was wine and is now Christ's blood still has the smell of wine, the intoxicating power of wine.” (Sheed)
It is important that communities do not pressure celiacs into receiving, and avoid any inaccuracy about the sacrament, the disease, or wrong judgment about the faith of the person receiving.
“Christ's body remains in the communicant as long as the accidents remain themselves. Where, in the normal action of our bodily processes, they are so changed as to be no longer accidents of bread or accidents of wine, the Real Presence in us of Christ's own individual body ceases. But we live on in his Mystical Body.” (Theology for Beginners (c) 1981 by Frank J. Sheed, Chapter 18.)
SPIRITUAL ABUSE OF THE VULNERABLE
These recent interactions reminded me of a devastating experience of a young seminarian. His rector, knowing and agreeing in advance of his entrance into seminary to allow accommodation for gluten intolerance, began secretly putting wheat in his food. Father believed that any sensitivity to gluten was a mental and/or spiritual disorder, and that is was his job as spiritual formator to produce a cure.
The seminarian didn’t ask for any unreasonable accommodation when he applied to the seminary. He didn’t want to cause any inconvenience or stand out and was happy to provide his own simple food. The 18-year old had experienced a lifetime of distressing symptoms that were resolved with the elimination of wheat two years earlier. It was a great gift of healing.
The rector smiled and agreed to allow accommodation. But he lied to the family. He lied to the boy. And made a private plan to demonstrate by duplicity what he saw as a psychosomatic and spiritual problem.
He told the sister in charge of the meals to secretly include wheat in the young man’s meals. When he observed that the seminarian was not getting visibly ill after he ate the hidden wheat, he ordered him to eat everything set before him without exception at every meal (in the house, while visiting, at restaurants, everywhere) or be dismissed from seminary.
In obedience, afraid to lose his vocation, the young man ate. He told himself “I will not leave seminary over gluten.” He was encouraged to recall St. Margaret Mary who vomited cheese daily when she was ordered, under obedience, to eat it. Perhaps the rector missed the point that the saint suffered because Mother Superior was cruel and ignorant. At any rate…
The short version of the grievous story is that he did ultimately leave seminary rather than be in formation under a man who believed that an authentic medical condition was simply a mental/spiritual failing, and who used the faith to manipulate the seminarian back into illness.
The seminarian gained 30 pounds in during that semester. He lost a great deal of the excellent health he brought with him to seminary—mentally, spiritually, and physically. He was subjected to cruel tests of obedience, yelling rants, unjust accusations, physical shoves, and spiritual abuse.
So he left (for that and other reasons). The Bishop of the Diocese was informed. Sadly, that rector continues to oversee the formation of young men, even at this writing.
“WHERE IS YOUR FAITH?”
“Where is your faith?” the ignorant and (some) bullies demand. The question opens a deep wound created by an oddly common failure of charity, and it echoes the cruelty of those who should know better. We answer:
My faith is in Jesus Christ, the Son of the Living God. It is in our Eucharistic Lord, who allows sickness and health in His time, His purpose, His glory.
It is important to highlight these questions and challenges because the echo the struggle that many celiac Catholics face with the decision of whether or not to receive the Eucharist.
"How can I get sick from Jesus?"
"I just have to trust more."
"I'm embarrassed to ask for accommodation."
”I’m tired of being misunderstood.”
“I don’t want to irritate Father.”
"I'm just going to offer it up."
"I'll be sick for you, Jesus."
"I have to choose between my health and Jesus."
"Maybe it isn't really Jesus after all."
The Church makes very clear that we are beloved and that it is consistent with our inherent dignity to—within reason—seek bodily health. She certainly does not condone actions whereby we intentionally cause ourselves to become acutely ill. Though many of the saints endured great suffering, they were committed to relieving the suffering of others, in whom they recognized the Imago Dei.
It is with faith and humility that we learn to carry others and, in turn, allow ourselves to be carried. So I'm grateful for the question “Where is your faith?” because I have answers. I’ll start with some practical matters and then move into FAQ and resources.
3 OPTIONS FOR CATHOLIC CELIACS
1. PRECIOUS BLOOD. The best option for celiacs when receiving the Eucharist is the Precious Blood that is not from the main chalice. This is 100% free of gluten, and therefore presents no emotional, physical, or spiritual conflict for the recipient.
2 . LOW-GLUTEN HOST. These hosts are prepared with less than 20 ppm (parts per million) which is the FDA's standard for safe levels of gluten for celiacs. This number was established by factoring in the average incidental daily exposure of a person to gluten in their environment (it's more than you'd think). By this method, they concluded that other incidental exposures plus the low gluten host don’t tend to exceed the safe amount.
However, there are many celiacs who struggle to manage their symptoms in spite of a strict gluten free diet and limiting environmental exposures. For Catholics in this position, there shouldn't have to be any emotional or physical conflict.
3 . SPIRITUAL COMMUNION. This prayer does not replace the Eucharist. It can be a consolation when the best option is abstinence. The Church recommends—but does not require—frequent reception of the Eucharist, but the law requires it only once a year. Here in America, with typically easy access to a local parish, we hope to receive at least weekly. If that is not possible, this is a beautiful prayer for growing in intimacy with Jesus.
CROSS-CONTAMINATION
”Contamination” is a rather unsavory word to use when considering the Eucharist, but it is relevant in discussions of celiac safety.
The Precious Blood distributed to the celiac faithful should not be from the main chalice. This chalice contains the frumentum, which is a bit of the Host dropped in during the Angus Dei.
Low-gluten hosts should not be stored with wheat hosts.
If gluten and low-gluten hosts are distributed alternately, fingers can collect crumbs which then contact the low-gluten hosts. This is an acceptable option for many celiacs but not for all.
A chalice that is shared with regular communicants can be a source of contamination. It is a reasonably good option but it is better to have a separate line if possible.
The perfect solution to low-gluten host and chalice contamination is a separate Communion line (or place at the altar rail) by a designated minister, or another option where a priest or minister’s hands can be free from wheat crumbs. Each community should have the discussion and consider what is reasonable related to individual needs and parish resources.
It may seem like minutiae of no importance, but the immune system is brilliantly designed to deal with every single molecule.
THE NECESSITY OF KINDNESS
For those with any form of gluten intolerance, the challenge is one meal, one snack, one beverage, one liturgy at a time. From navigating liturgy to donut Sunday, it is harder than most people might understand. It is more difficult and confusing still for children and teenagers who yearn only to seamlessly belong. Sometimes one look of irritation, one more time left standing in the center aisle, or one more parish event at which there’s not one thing they can eat, can be the catalyst for lengthy discouragement…
Lord, just let me be normal.
In spite of fervent prayer, the good Lord does not always grant that kind of miracle. So it falls to His people to be compassionate, even when they don’t understand.
COMMON QUESTIONS & ANSWERS…
(If you can’t find it here, feel free to ask. If you have resources, please share so I can add)
“I’ve always wondered if someone with celiac could receive half a host or even a quarter, or can any small amount hurt you?”
Yes, even a small amount can hurt. Your immune system responds to every molecule you consume. Though a larger amount of gluten will provoke a stronger immune response, the body’s defenses are amazing and will still attack when triggered by a minute amount.
“What about all the Catholics who just want to avoid gluten but aren’t celiac? They really shouldn’t be getting accommodation.”
There is no sin or harm in validly receiving the Eucharist one way or another if in a state of grace. No one is assigned to check mental, physical, or spiritual health before Communion, nor should they be. Err on the side of charity.
“I am a celiac and I have never had a problem receiving.”
Praise God! What a great gift. Last time I received the regular host I was sick for three days. Not every encounter with gluten provokes the same obvious response. The state of the body (high or low inflammation day) also makes a difference. But at that time, I was weary of abstaining after 2020 when the Precious Blood was no longer offered and thought maybe it would be fine…just this once. After I got sick, I had to work on acceptance and surrender all over again. God allows sickness and suffering. Jesus, I trust in You.
“My parish uses a potato starch host that is completely gluten-free. Father says it’s okay for medical need. Is he right?”
No. The host must be made with wheat and water.
“How does this work in the TLM?”
Low-gluten hosts can be offered. It is also permissible to receive the Precious Blood at the altar rail.
“What about rites that receive by intinction?”
I’ve heard from those in the Melkite and Byzantine rites that their pastors offer the Precious Blood first for the gluten-intolerant. They go first because the Eucharist is dipped into the chalice for the rest of the congregation. As an example of how one parish provides accommodation, one woman writes:
“In our parish, they distribute the precious blood via a single-use spoon to the handful or so of people who need. No extra-ordinary ministers, just Father and deacon (if he’s present.). Kneeling at altar rail. Father spoons the Precious Blood into each recipient, then reaches for a new spoon for each communicant. They come up after everyone else has received hosts.”
“What are the actual ingredients in making hosts?”
Wheat and water. Redemptionis Sacramentum
“My diocese requires a physician’s letter confirming diagnosis and a permission from the bishop. We mostly don’t receive anymore because the process is too difficult at different parishes.”
A couple comments like this came from the Diocese of Portland in Maine. I confirmed the policy here. It requires:
1) Physician statement of diagnosis
2) Physician recommendation of low gluten hosts
3) Pastors request to bishop in writing for permission to use low gluten hosts
Aside from being a completely unnecessary and intrusive obstacle to the Sacrament, it directly contradicts the directives of both the USCCB (which clarifies that no proof is required) and Rome (which makes no mention of medical proof). As of May 2024, this diocese has a new bishop. Hopefully this will be corrected soon.
“I wonder if the hosts were made from organic flour, original grains, if perhaps many more people could tolerate it.”
Celiac isn’t a digestion issue. It’s an autoimmune response to the gluten protein. Though I strongly support the use of non-toxic organic grain for making the host, contaminated food should not be confused with the mechanism of celiac disease.
“My son cannot receive any host and the precious blood has too many host particles for him to safely consume. Is there a dispensation for these poor souls?”
The minimum obligation for receiving is only once per year. But if your pastor will offer it, there is the option of receiving the Precious Blood consecrated apart from the main chalice.
“What of the celiac and alcoholic? At some point, you just have to have faith that a small amount is not going to harm you because we are talking about a real miracle- Christ, true God, truly present in what appears to be bread.”
The Church responds: “Circular Letter to all Presidents of the Episcopal Conferences concerning the use of low-gluten altar breads and mustum as matter for the celebration of the Eucharist” (Ratzinger)
The Church teaches that the accidents remain even while the substance changes. Which means someone can get drunk on Communion wine and have a celiac reaction from receiving the Eucharistic bread.
“Can a man who has celiac disease be ordained?”
Yes. Though he must be able to at least receive a low-gluten host. Rome responds HERE. With the increasing number of people suffering from gluten related illness, it seems right and just that the Church would open every door possible for the admission of good men to the priesthood.
“I know someone who went for years without receiving because of it… and then one day felt called from God to do it. So she did! And she was fine!”
Beautiful miracle. Praise the Lord! It is a very personal decision. And though I absolutely believe in miracles and expect them, I would never encourage a celiac to ignore what they know about the mechanism of disease. There are safe options for receiving our blessed Lord while also praying for miracles. In the case of my family, having a diagnosis and eliminating gluten were like our own small miracle. If there is more healing this side of heaven, we will gratefully accept it. If there is not, we are simply thankful for health and life.
“Isn’t it possible that a celiac could receive the miracle of having no symptoms?”
Absolutely. The challenge is that the only way to confirm that there is no harm is to biopsy the small intestines. This is one reason why celiac disease can take difficult years to diagnose. So I’m not saying a true miracle can’t happen, but there’s no harm at all in being prudent and taking reasonable care of the gift of the body.
“If one truly thinks the tiny amount of gluten in a consecrated host is going to attack the small intestine and hurt the ability to absorb nutrients, then perhaps consider if one is placing body above the spirit?”
You are making greater physical and spiritual demands on those with celiac disease than the Church does. She both acknowledges the potential harm and provides options for celiac participation. There’s no sin in honoring God by taking care of the gift of the body.
“Why are there so many modern health issues related to wheat?”
“Any chance Glyphosate, in our diets in general over time, has contributed to Celiac?”
Yes. Absolutely. Autoimmunity is often triggered by by environmental toxins that bond to proteins. The body cannot clear something like glyphosate or aluminum in the same way it can clear organic matter. So it is often stored (in the brain, thyroid, etc.) where the immune system is constantly waging a low-level battle.
At some point the body may erroneously identify the surrounding tissue as the enemy and it trigger an attack on its own cells. That’s only a rudimentary sketch of an explanation, and why you’re absolutely right in drawing the connection.
The tragedy is that once that flip is switched, the immune system will always recognize those cells as the enemy. There are ways to reduce the response, but no known cure for celiac disease.
In addition to celiac, I also have an autoimmune esophageal disease which doctors believe is triggered by gluten. Same reaction, different part of the digestive system. Celiac is specific to the small intestines, but there’s plenty of evidence that environmental toxins cause all manner of autoimmune dysfunction.
My opinion is that the Eucharistic host should not be made from non-organic wheat that is contaminated with glyphosate or other toxins. I do not know whether or not this is the case with commercial hosts.
“What is the difference between celiac, wheat allergy, and gluten sensitivity?”
CELIAC DISEASE is an autoimmune disease in which the body’s immune system attacks the cells of the small intestine, causing damage to the villi and preventing nutrient absorption. Though it impacts the small intestine directly, it is recognized as a multi-organ condition. The trigger is the gluten protein which is present in wheat, rye, barley, oats. CD is not not an allergy or a sensitivity. The body fights against gluten as if it were a virus. It effects approximately 1% of the population.
WHEAT ALLERGY is when the immune system is sensitized and overstimulated by wheat. Reactions can include eczema, runny nose, asthma, stomach upset, or even anaphylaxis in severe cases. It is most common in children.
NON-CELIAC GLUTEN SENSITIVITY ((NCGS) impacts about 6% of the population. Symptoms include (but are not limited to) IBS to headaches, depression/anxiety, inflammatory disease, and joint pain.
OTHER CONDITIONS are also related to wheat consumption. An example of this is the autoimmune condition called esophagus esophagitis (EoE) which, in some cases, is triggered by the presence of gluten and is resolved by not eating gluten.
CATHOLIC RESOURCES
CDF (Congregation for the Doctrine of the Faith):
Congregation for Divine Worship:
Redemptionis Sacramentum: On certain matters to be observed or to be avoided
regarding the Most Holy Eucharist (Arinze)USCCB:
Celiac Disease, Alcohol Intolerance, and the Church's Pastoral Response
Vatican-Approved Low Gluten Hosts
USCCB-Approved Low-Gluten Hosts
OTHER RELEVANT LINKS
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I am shocked and disgusted that anyone would question someone with celiac or other gluten intolerance. I first heard about celiac when a classmate was diagnosed shortly after we graduated (mid 70s). She was being evaluated for leukemia due to her severe symptoms. She sadly died young, probably as a result of her disease. In more recent years my fitness instructor had celiac and at the time there were few options. She spoke of going to an out of town wedding and literally not eating for two days. Some played pranks on her, such as one man who tricked her into drinking beer. She was sick for days.
I think unfortunately people who may have some slight intolerance have made it difficult for those who are really compromised. People start rolling their eyes when a guest starts taking about being dairy free, gluten free, blah blah blah.
It is not difficult to accommodate such issues. It seems receiving the Precious Blood from the cup is least likely to cause a problem. It is very difficult to prevent a low gluten host from being contaminated unless someone is extremely careful. As a Sacristan I may touch the regular hosts and were I to put a low gluten host into the separate pyx, there could be cross contamination.
You have done a great service to those who are unaware of the seriousness of celiac.
I go to a TLM parish relatively regularly, and they both offer low gluten hosts for those who desire them AND for one woman, they offer her the Precious Blood at the communion rail. I assume that if the other parishioners who take the low gluten hosts wanted to use the option of the Precious Blood, they would be permitted to do so without fanfare.
These parishioners simply join the end of the communion line and have never been refused to my knowledge.
The parish I was raised in had a new priest come during my teen years who was ordained late in life and he had previously battled alcoholism. They announced at every one of his Masses where the mustum would be in the church (which communion line) and they use pix with low gluten hosts as well. The person receives the pix from the Extraordinary Minister, opens it themselves and receives, to minimize contamination.
It literally never occurred to me that there would be parishes, priests and dioceses that would refuse accommodations.