Catholic celiacs have limited options when it comes to receiving communion at Mass. In 1995, and again in the summer of 2003, the Vatican and the United States Conference of Catholic Bishops reiterated the interpretation of Canon Law (924.2), namely that “Special hosts quibus glutinum ablatum est [in which gluten has been removed] are invalid matter for the celebration of the Eucharist;” and that “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.” The May 2000 U.S. Bishops Committee on the Liturgy newsletter went on to say that “In the light of the increasing scientific evidence that even a small amount of gluten may be dangerous to sufferers of Celiac Sprue disease many would hesitate to recommend the use of "low gluten" hosts. Thus the only viable solution seems to be the offering of the Precious Blood to such persons.”

The doctrine of concomitance teaches Catholics that the whole Christ is present under the appearance of bread and also under the appearance of wine. However the traditional manner of receiving the Eucharist for the past few centuries has been for Catholics to receive communion only in the form of bread. This tradition is one that many Catholic celiacs grew up with and one that is very close to their hearts. The inability to receive communion in the traditional manner after a diagnosis of celiac disease can be a constant source of pain and spiritual isolation. Receiving both the Body and Blood of Christ at communion (receiving under both species) has become more commonplace in the U.S. since the Second Vatican Council encouraged the faithful to receive communion under both species as a more complete sign of Christ’s sacrifice. This practice can vary from parish to parish and from diocese to diocese at the discretion of the bishop.

Catholic celiacs should understand that they have the right, as a Catholic in good standing, to receive holy communion (Canon 843), and that the Precious Blood must be made available to people with celiac disease if they request it, even if it is not offered to the rest of the congregation. Moreover, Catholic celiacs have the right to request that they receive communion in a separate chalice because the Precious Blood in the celebrant’s chalice has added gluten through the fermentum which is added in the rite of fraction and commingling during the liturgy of the Eucharist.

Several articles have recently appeared in Catholic publications regarding the development of “extremely low-gluten” hosts by the Benedictine Sisters of Perpetual Adoration of Clyde, Missouri. The gluten content of these hosts is reported as 0.01%. These hosts have been approved by the Catholic church for use at Mass. Dr. Alessio Fasano from the University of Maryland Center for Celiac Research was quoted in the February 15, 2004 issue of Catholic Review as declaring these hosts “perfectly safe for celiac sufferers.”

For many years patients with celiac disease have been told by celiac disease experts that they must avoid even trace amounts of gluten. People with celiac disease were told that there was no known “safe” amount of gluten. Yet here is a well known expert declaring that these low-gluten hosts are safe. Dr. Fasano did not return any phone calls or emails aimed at establishing just how he determined that .01% gluten was safe. So Dr. Don Kasarda, an international expert on gluten and grains was contacted. When he was asked about the safety of .01% gluten he described some of the early studies done by Dr. Catassi and his group that determined that 100 mg of gliadin (or roughly 200 mg of gluten) per day produced minimal morphological changes in the intestinal histology of celiac patients. He therefore thought that it might be reasonable to assume that if a low gluten host weighed about 0.5gm, then a person receiving the low gluten host could be receiving about 0.05 mg of gluten/gliadin per incidence of receiving communion. There is no way of knowing what long term exposure to this level of gluten could do to any given individual. The recommendation for the designation “gluten-free” in the U.S., Australia, and Canada is currently <0.001% gluten, whereas the European standard for “gluten-free” is <0.03% gluten. In Australia, some patients who do not respond to the standard European gluten free diet did respond to the lower gluten Australian gluten-free diet which suggests that there are some patients who require the stricter diet. But in patients without symptoms, there is no real way of knowing if long term exposure to low levels of gluten, as in receiving communion with a low gluten host, will cause damage.

Some celiac patients have reported getting ill from gluten by receiving communion from the priest’s chalice. I asked Dr. Kasarda what he thought about the safety of receiving Communion from the priest’s chalice vs. receiving the low gluten host. He agreed that taking communion from the priest’s chalice could conceivably result in a celiac receiving the same or even more gluten than the amount contained in these low-gluten hosts, although this would depend on a number of variables including how large the crumb was, how much was consumed ,and how long the fermentum was in the wine before it was consumed. Dr. Carol Semrad, from the University of Chicago agreed with Dr. Kasarda’s assessment that celiac patients should not receive communion from the priest’s chalice because of the possibly unacceptable level of gluten.

How a Catholic celiac chooses to receive communion depends then on a number of considerations. First, the safest form of receiving communion is for a Catholic celiac to receive the Precious Blood from a separate cup. The drawbacks to this form of receiving communion include the occasional mistake by the priest — sometimes he may forget to use a separate cup or he may decide to pour some of the Precious Blood from his chalice into the separate cup (or into the other chalices designated for the community in those cases where communion is distributed under both species). Next there is the issue of sensitivity to gluten. Since nobody can really say how sensitive any particular celiac is means that this is a decision that will have to be reached between the patient and his or her doctor. Certainly receiving a portion of a normal host or receiving communion from the priest’s chalice represent an unnecessary risk to a celiac’s health. The low-gluten host presents another alternative. It would be not quite as safe as receiving the Precious Blood alone but a plausible alternative if one’s doctor agreed. Drawbacks to using the low-gluten host include the necessity of using a pyx for communion and relying on the priest to remember to distribute the pyx at the appropriate time. The long term health issues related to the consumption of the low-gluten host are not known. Catholic celiacs should consider using only a half or a quarter of the low-gluten host for communion in order to further reduce the gluten content. Parents considering using this host for their celiac child’s communion might wish to consider the mixed message using this altar bread may send to the child, namely that some gluten is sometimes “okay”. Finally the Catholic hierarchy offers this alternative to celiac disease sufferers: making a “spiritual” communion. Spiritual communion is an asking of Our Blessed Lord to enter into one’s heart since at that moment when one isn’t able to receive Him Sacramentally. The Church says that the value of this practice is that the graces received may be as great as -- or greater than -- those received by some people in the actual Sacrament.