In 1998-1999, the National Liturgy Office of the Canadian Conference of Catholic Bishops circulated a questionnaire to bishops and priests concerning the number of parishioners who have celiac disease. The priests were asked to distribute the questionnaire to people in their parish who are affected by the disease. One hundred and five responses were received. The questionnaire was also circulated in a newsletter published by the Canadian Celiac Association and, as a result, an additional fifty-five responses were received from individuals who saw the questionnaire in the newsletter.
One unanswered question is whether all parish priests are aware that some members of their parish have celiac disease. One priest commented that he was not aware that there was anyone in the parish who had this disease until he received the questionnaire and began to inquire among the parishioners. Many of these people have suffered for years in silence.
Although statistics are not readily available, it is estimated that one in every two thousand persons in Canada has celiac disease.
The purpose of this article is to present some of the facts concerning celiac disease and to look at the ways in which our parishes can help parishioners who have it to participate fully in our eucharistic liturgies. Although this is not a medical report, some medical information is necessary if our entire Church community is to deal compassionately with these individuals in helping them to cope with their medical condition and still participate in the fullest way at our celebration of eucharist. "The Church earnestly desires that all the faithful be led to that full, conscious, and active participation in liturgical celebrations called for by the very nature of the liturgy." (Constitution on the Sacred Liturgy, no. 14)
What is celiac disease?
Celiac disease is essentially an intolerance to gluten. Gluten is a protein found in wheat, rye, barley and oats. Although gluten sensitivity is not a food allergy, individuals with celiac disease avoid foods containing wheat, rye, barley and oats in the same way those with food allergies avoid the foods to which they are allergic. For persons with celiac disease, the toxic part of the gluten molecule is the prolamin portion: gliadin in wheat, secalin in rye, horedin in barley and evedin in oats. The gluten found in corn and rice does not contain this toxic portion.
Food is digested and absorbed in the small intestine. The small intestine is lined with microscopic finger-like projections called villi designed to provide the maximum area for nutrient absorption. These villi contain digestive enzymes.
In individuals with celiac disease, gluten ingestion results in damage to and destruction of the villi. This damage can be compared to the image of shag carpet changing into linoleum. Individuals who have this disease, consequently, cannot get any kind of nutritional benefit from any food until their damaged villi are healed.
The only way to get the damaged villi healthy and able to absorb goodness from other foods again is to completely eliminate gluten from the diet. Basically, gluten is a glue that keeps much of our food together. It is found in wheat, oats, rye, barley, wheat starch, hydrolyzed vegetable protein, hydrolyzed plant protein, and some spices. A person with celiac disease cannot ingest anything with gluten in it. All food, medications and even toothpaste must be gluten-free. A failure to follow this rule will cause damage to the villi, immense pain, and, if a great amount of gluten is taken, a comatose state and even death. Consuming even small amounts of gluten can eventually lead to cancer of the bowel.
For members of our Church (this is not just a Roman Catholic issue, but crosses ecumenical lines) the difficulty lies in what makes up our communion hosts or eucharistic bread. The problem is more complicated in the Roman Catholic Church because Canon Law requires the use of "wheat flour" for hosts and eucharistic bread and as a result people with celiac disease are unable to receive communion. Other denominations are not bound by Canon Law but most use wheat flour for their communion wafers.
Recent Ecclesial Legislation
The latest guidelines coming from the Holy See on this issue is a letter dated July 24, 2003 from the Congregation for the Doctrine of the Faith to the presidents of the episcopal conferences regarding a change in the norms regarding the use of mustum and low-gluten hosts. It reads:
The letter reaffirms the right of laypeople (and deacons) who are gluten intolerant to receive communion under the species of wine alone.
It also reaffirms that any permission granted stands as long as the condition persists.
The new norms make it easier to receive permission to use mustum and/or low-gluten communion bread. It is now within the competence of the local authority to grant all such permissions. Furthermore, under canon 137.1, he may delegate pastors to grant this permission to laypeople.
Medical certification is no longer required for the use of mustum and/or low-gluten hosts.
Presiding priests (sole celebrants and principal celebrants at a concelebration) must receive communion under both species, i.e., either regular or low-gluten communion bread and either wine or mustum.
Priests who are not able to eat even low-gluten bread or mustum may not celebrate individually, nor may they preside at a concelebration.
Pastors are encouraged to reach out to members of the faithful who might need this accommodation in order to heighten their full, conscious and active participation in the liturgy. A sample parish bulletin announcement is provided following the letter.
Pastors are advised to discuss specific needs with the individuals concerned. In some cases it might even be necessary to reserve for those who are severely gluten-intolerant a cup in which a fragment of a regular host has not been commingled.
Suggested Bulletin Notice
This notice (below) could perhaps be printed once or twice a year so that new parishioners will notice it.
Sisters of the Precious Blood
Altar Bread Department
P.O. Box 1046, LCD 1
Hamilton, Ontario L8N 3R4
Phone: (905) 527-9851
Fax: (905) 527-2888
Congregation of Benedictine Sisters of Perpetual Adoration
Altar Bread Department
31970 State Highway P
Clyde, MO 64432
Phone: 1-800-223-2772 (toll-free)
Ranelle Trading/Ojai Fresh Juice Corporation
2501 Oak Hill Circle, Suite 2032
Ft. Worth, TX 76109
Phone: 1-877-211-7690 (toll-free)
Mont La Salle Altar Wine Company
385-A La Fata St.
St. Helena, CA 94575
Phone: 1-800-447-8466 (toll-free)
A Cautionary Note
In a conversation with someone who does dietary counseling with people living with celiac disease we were advised that any gluten at all acts as a poison to someone with celiac disease. Therefore, offering low gluten communion wafers is of no value to a person who must be on a gluten-free diet. Some people may not react to low gluten, but the gluten is still damaging their small intestine. This is the reason that companies are no longer providing low gluten communion wafers. Medical data says that 1 in 133 people have celiac disease. Unfortunately, because it is so hard to diagnose many of these people are still suffering. For further information on celiac disease, see www.celiac.ca.
- Celiac Disease and Communion, in National Bulletin on Liturgy 32/159 (1999) pages 248-251;
- New Guidelines for the Use of Mustum and Low-Gluten Communion Bread, in National Bulletin on Liturgy 37/177 (2003) pages 108-111.