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2026 Convention Workbook 258

THEOLOGICAL DOCUMENTS —COMMISSION ON THEOLOGY AND CHURCH RELATIONS

/three.lnum/three.lnum The Lutheran Church/emdash.lnumMissouri Synod of LCMS congregations throughout recent history, to change this would result in needless confusion.

There remains the pastoral question of how the spiritual needs of Christians with celiac disease or gluten intolerance are to be addressed: What is the most appropriate pastoral care for individuals with a diagnosed medical consideration like CD that makes the reception of the bread in the Lord’s Supper cause physical harm?

53 There is something of a parallel here with the question of the potential danger to an alcoholic in receiving the wine of the Lord’s Supper. We recall the counsel offered by the CTCR earlier in this document, together with the Synod’s 1998 Res. 3-16B, which both acknowledge the need for pastoral discretion. Acceptable suggestions for pastoral care in the case of alcoholism included diluting the wine and intinction, but the Commission also acknowledged that in some cases there may be “no fully satisfactory answer” to the question of how best to respond to alcoholism.

While both alcoholism and CD are conditions plaguing individual Christians, they must be distinguished. Alcoholism is understood as “a disease characterized by compulsive decision-making, impulsive behavior and relapse” and thus a mental health disorder.

54 CD is a physical disorder, that is, an autoimmune disease in which gluten triggers an attack on the small intestines, potentially leading to many other serious physical conditions.

The danger of gluten is real for individuals with CD, although it was unknown prior to World War II, when wheat shortages resulted in vastly improved health outcomes for celiac patients. Over time the practice of following a gluten-free diet expanded beyond celiacs and also for those with non-celiac gluten sensitivity (NCGS), about 1 percent of all people, to include many people without CD or 53 It is important to distinguish the challenge of CD from missiological questions—such as whether in Asian countries a rice host would be preferred over a wheat host.

54 “Is Alcoholism a Mental Illness?” Hazelden Betty Ford Foundation, October 9, 2019, https://www .hazeldenbettyford.org/articles/why-is-alcoholism-classified-as-a-mental-illness#:~:text=Since%20 1956%2C%20the%20American%20Medical,making%2C%20impulsive%20behavior%20and%20 relapse.

/three.lnum/four.lnum Proper Administration of the Lord’s Supper NCGS. 55 The only known treatment is dietary—“a lifelong adherence to a strict gluten-free diet.” 56 Most gastroenterologists recommend that a CD patient consume less than 50 milligrams of gluten each day for adults and less for children to remain symptom free. However, as little as 10 milligrams of gluten causes intestinal abnormalities in some patients.

57 The average communion wafer contains about 22 milligrams of gluten. As such, it may be consumed without triggering symptoms by most who suffer from CD or NCGS. The operative word is “may,” however, and many individuals do suffer problems from even such a small amount. What options can be considered for such individuals in light of no specific direction from Scripture?

Decisions regarding these alternatives should remain a matter of pastoral discretion in consultation with those who suffer. However, several options may be suggested for consideration by pastors and members with CD/NCGS. We list them in order of preference after due consideration by the Commission.

Perhaps the single best option is to use low-gluten wheat hosts. The North American Society for the Study of Celiac Disease found these hosts to be “safe for consumption by celiac disease patients.” 58 A second option is to receive only a fragment of the normal host, which thereby reduces the amount of gluten consumed. This may present practical problems in distribution and reception, however.

A third option is to use non-wheat, gluten-free hosts made from rice flour or another grain. (Even though we are here recommending low-gluten hosts, an al- 55 Jacqueline Howard, “Gluten-Free Diets: Where Do We Stand?,” CNN Health, updated March 10, 2017, https://www.cnn.com/2017/03/01/health/gluten-free-diet-history-explainer/index.html.

56 “What Is Celiac Disease?” Celiac Disease Foundation, https://celiac.org/about-celiac-disease/ what-is-celiac-disease/ (accessed September 23, 2024).

57 Inna Spector Cohen et al., “Gluten in Celiac Disease—More or Less?” NIH National Library of Medicine, January 28, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363368/#:~:text=studied%20 the%20long%2Dterm%20effect,communion%20wafer)%20prevented%20histological%20recovery.

58 “NASSCD Confirms Use of Low-Gluten Host for Catholic Mass,” Celiac Disease Foundation, September 1, 2017, https://celiac.org/2017/09/01/nasscd-statement-use-low-gluten-host-catholic-mass/#:~ :text=Accordingly%2C%20considering%20the%20total%20weight,safe%20in%20various%20 clinical%20studies. This option has another potential benefit, namely, that such low-gluten wheat hosts could be used for the entire congregation and not only for people with CD/NCGS.

/three.lnum/five.lnum The Lutheran Church/emdash.lnumMissouri Synod ternative recommended by the Roman Catholic Church, it is important to state forthrightly that we disagree with the Roman view that the use of bread made by another grain invalidates the Sacrament.) However, we emphasize that caution is necessary if the third option is employed. Gluten-free “bread” for Communion is offered now by many vendors, but in many cases it is made without grain flour.

Other starches are used instead (e.g., potatoes, garbanzos, tapioca, palm fruit oil, cellulose, sunflower). The CTCR urges congregations that decide to use non-gluten bread to ensure that the alternative hosts are made from actual grain crops. /three.lnum/six.lnum Proper Administration of the Lord’s Supper

CONCLUSION

2023 Res. 5-15 instructed the Commission “to take up these concerns.” To summarize the results of our study herein we Strongly reaffirm the long-standing LCMS understanding that only wine, of whatever alcohol content, should be used in the consecration of the Lord’s Supper;

Recommend against the use of prefilled wine and wafer sets in the Lord’s Supper because of potential confusion and the potential encouragement of bad Communion practices; and Suggest that the medical needs of celiac patients and others with gluten intolerance may best be met through the use of low-gluten wheat hosts, or if that is not possible, the use of hosts made from another grain crop.