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As you think about returning to Mass, perhaps the thought of receiving the Eucharist makes you nervous. Certainly, there are guidelines to protect your safety, but what if the priest makes a mistake? What if something too small to see will end up making you sick? This can be a difficult decision. Should you receive anyway, and risk illness?

What amount of risk are you willing to tolerate when receiving the Eucharist, “Christ himself” (CCC 1410), is a source of anxiety for your physical wellbeing?

Many of us can relate to these concerns because of the COVID-19 pandemic. For Catholics with celiac disease, such questions are not new.

Celiac disease is an auto-immune disorder that is triggered by the consumption of more than 20 parts per million (ppm) of gluten, a protein found in wheat, barley, and rye. Gluten can show up in any number of foods you wouldn’t expect: chicken broth, soy sauce, Fudgesicles. When people with celiac disease consume gluten, they suffer from a vast array of symptoms. There is no cure or treatment for celiac disease. There is only one way to manage it: a gluten-free diet.

Celiac disease is under-diagnosed. Approximately 1% of the population has it, although most are unaware and do not know the cause of their symptoms or the long-term damage they are incurring. Based on these numbers, virtually every Catholic parish has at least one parishioner with celiac disease. Even more may suffer from gluten intolerance.

I do not have celiac disease, so I do not personally experience this anxiety before receiving the Eucharist. But one of my children has celiac disease, and she received her First Communion last year. While other children were looking forward to the occasion, our daughter was having anxious conversations with us, wondering how she could receive the Eucharist without getting sick.

My daughter was diagnosed almost five years ago. At first, I imagined her (and our family) eating gluten-free bread with a cardboard-like taste and texture and other bland health foods for the rest of her life. Fortunately, as the months progressed and we changed our diet, we learned that there is a wide variety of delicious gluten-free food. The gluten-free diet is not as hard to follow as it might seem.

The real challenge of celiac disease soon became clear: social situations, which typically include food. Restaurants can be a challenge, but events at someone’s home are especially tough. Someone with celiac disease has a few options: not to eat, bring their own food (and feel singled out), or eat only foods that they know are safe (raw fruit or vegetables, for example).

Sometimes, people will offer gluten-free food that they’ve made. This is often one of the most difficult situations for someone with celiac disease. What do you do when your host has good intentions, but likely isn’t aware of the many ways gluten can sneak into food? How do you know whether they were careful enough about cross-contamination? In these cases—when someone went out of their way to make food something gluten-free that may still, in fact, have gluten in it—you can politely decline (and potentially offend), take the food while hoping to throw it away discretely or give it to someone else, or just eat it (and risk getting very sick later). My young daughter has encountered this many times already, sometimes deciding just to eat the food. The challenge of navigating these types of situations can lead to anxiety and depression.

Catholics should be aware that the challenges above happen regularly at Mass. In many ways, the Mass is also a social situation where people with celiac disease can be nervous about potentially consuming something that will make them sick. We must ensure that our brothers and sisters with celiac disease are safe and welcomed in our parish communities, and especially at the celebration of the Mass.

How does a Catholic with celiac disease receive the Eucharist? The Church teaches that the host must be made from wheat bread in order to be valid (CCC 1412). There is no such thing as “gluten-free wheat bread.” Fortunately, most people with celiac disease can tolerate food with gluten levels below 20 ppm, which is the accepted standard for “gluten-free.” In 2004 the Benedictine Sisters of Perpetual Adoration began making valid gluten-free hosts (called low-gluten hosts) that they’ve tested to below 10 ppm, such that “someone diagnosed with Celiac Sprue Disease would have to consume 270 wafers daily in order to reach the danger point.” Now that these hosts are available, a Catholic with celiac disease can give a valid gluten-free host in a pyx to the priest or sacristan before Mass. As long as the priest never touches the host (which could cross-contaminate it with gluten), the Eucharist can be received safely.

Here is what the USCCB recommends:

For those members of the faithful with gluten intolerance, even trace amounts of gluten can be damaging. It is important, therefore, to be mindful of “cross-contamination” when using either low-gluten hosts or when offering Holy Communion to someone only under the species of wine. It might be best, for example, for the communicant to prepare a pyx with the low-gluten host before Mass, in order to avoid the situation of a sacristan who has handled the other hosts also to handle the low-gluten ones. At Communion time, then, they could approach the sanctuary together with any Extraordinary Ministers of Holy Communion and receive the pyx from the celebrant with the words “The Body of Christ” (or, if possible, they could be given the pyx within the normal Communion line, provided “contamination” from handling of the pyx is avoided). Similarly, it might be necessary for someone who has permission to receive Holy Communion under the species of wine alone to prepare before Mass a chalice, which will not be part of the commingling rite and from which either they alone will receive or from which they will be the first to receive. Such precautions are not only medically necessary, but they demonstrate compassion to avoid singling out those who want to receive Communion, but are unable to receive one or the other species.

Pictured: my daughter’s valid gluten-free host in her pyx for First Communion.

These recommendations are great in theory, but in practice it rarely goes this smoothly.

Occasionally at communion time, the priest will not have the pyx, which can lead to a “sacramental scavenger hunt.” Sometimes you will notice the pyx inexplicably lying open on top of all the glutinous hosts. Why is it open? Has the host been cross-contaminated? Sometimes the priest takes the pyx, opens it, removes the host and hands it to you, cross-contaminating the host and negating the entire point of using a pyx in the first place.

It’s hard to decide what to do at that moment. Do you explain to him what he’s done and refuse to receive it? Do you receive and risk getting sick? When it happens, what do you tell your child to do? In other social situations you can refuse, discretely dispose, or risk eating. In this situation there are only two options: refuse—to the priest in the middle of the Communion Rite—or risk consuming.

I know some Celiac Catholics prefer to receive from the cup alone (and some people with celiac disease may decide with their doctors against taking even low-gluten hosts), but my daughter does not. With all the trouble we have had with the pyx, it’s hard to imagine there not being an error with the cup. Without enough preparation, the communion chalice could end up being the one used in the commingling rite (when the small piece of the host is placed in the cup). You may not be able to get in line first, allowing someone else to cross-contaminate the cup with the gluten on their lips. In some cases, Catholics with celiac disease will notify the sacristan or priest before Mass and ask for a separate chalice to be consecrated so they may receive. This, as you might imagine, can be stressful. In some cases, there might not be a second chalice available. Sometimes, the priest or sacristan doesn’t understand the request.

No matter how you receive, there is always a chance that the server, deacon, or priest might forget to place the gluten-free host or chalice on the altar before the Eucharistic prayer. And if you’re late for Mass, forget about it. There are many ways for things to go wrong.

Last summer we moved to a new home and began attending a new parish. We were delighted to learn that the parish offered valid gluten-free hosts regularly in one of the communion lines. Whenever anyone requests a valid gluten-free host when approaching the Eucharistic minister, they retrieve one from a pyx, using the opposite hand of the one they use with the glutinous hosts (to prevent cross-contamination). This system has worked far better than bringing our own pyx. Still, one time the extraordinary minister did not switch hands when she gave my daughter the valid gluten-free host. My daughter is still concerned it may happen again.

The fact of the matter is that for Catholics with celiac disease, receiving the Holy Eucharist often poses a health risk. In order to avoid these situations, and when traveling and not knowing what to expect at a different parish, Catholics with celiac disease often receive spiritual communion (just as so many of us do each Sunday until public Masses resume).

In the case of the pandemic, it is important that making a spiritual communion is possible since churches have been closed for the common good. In the case of celiac disease, spiritual communion is often necessary for a different reason: we Catholics have not taken this disease seriously enough, and we are not protecting the physical and mental health of our brothers and sisters in the faith with celiac disease.

A potential solution to this problem would be to have consecrated valid gluten-free hosts available at every Mass. At parishes where there are multiple communion lines, a Eucharistic minister who distributes only valid gluten-free hosts should be delegated at every Mass at every parish. It’s not unusual to find a dedicated line for valid gluten-free hosts at large Masses and at special occasions, as if these are the only Masses people with celiac disease attend! In smaller parishes where this is not feasible, a policy should be established mandating that consecrated valid gluten-free hosts should be available at every Mass, whether consecrated at the altar or in the tabernacle, and a process for distributing these hosts without risk of cross-contamination should be in place. The priest or extraordinary minister should not open the pyx, for example.

If we incorporated these practices universally, the possibility of cross-contamination would be removed. Catholics with celiac disease who are traveling will always be able to receive the Eucharist. This also is a concrete way to welcome those who feel marginalized because wheat is required in our most Blessed Sacrament.

We’ve encountered so many issues for our daughter receiving the Eucharist safely over the last year. Because of this, I can’t help but wonder: How many people with celiac disease have left Catholicism? How did they cope before valid gluten-free hosts were available? In one case, a devout Catholic and catechist was told that she would not be able to receive hosts made from rice. After some time and prayer, she left for an Episcopalian church and wrote in her diocesan paper:

“I am no longer welcome, not because of some sin but because of an auto-immune disease. I feel I have been cut off from the true vine because I can’t participate in the eucharistic banquet that is at the core of being Catholic.”

It’s easy to ignore the plight of Catholics with celiac disease. They often silently bear the burden of risking their health or of sitting out while others participate. I hope that now—as most of us are currently unable to receive the Eucharist, and are beginning to make decisions about attending Mass in the face of health risks—we can better understand and attend to the situation faced by Catholics with celiac disease throughout their lives.

May is Celiac Disease Awareness Month. For Catholics, celiac disease should always receive special attention. It needs attention because wheat is necessary in the Eucharist, the source and summit of the Christian life, and because of the great challenge this poses to the millions of people around the world who cannot eat wheat safely.

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