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.

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.

The low gluten hosts can be purchased from:
Congregation of Benedictine Sisters of Perpetual Adoration
Altar Breads Department
31970 State Highway P
Clyde, Missouri 64432
Phone: 1-800-223-2772