Celiac disease

I know that this question is not particularly technical, but I also know that there is a wealth of knowledge and experience here.

My question is, how have any of you dealt with accommodating someone with Celiac disease taking the sacrament?

Thank you for any insights.

those that I have seen have brought their own bread in a bag and given to the Priests blessing the sacrament then either

1. the Deacons then make sure that that tray goes down the proper isle
2. one of the priests would take a separate tray to the individuals

Both my Bishop and his son (a Deacon) are gluten-intolerant. They have a small container of a piece of rice cake on the tray with the rest of the broken bread. The challenge is making sure that container gets on the tray which is passed to the Bishop and his son.

It's a separate little container, so it doesn't take a separate tray.

rpyne wrote:My question is, how have any of you dealt with accommodating someone with Celiac disease taking the sacrament?

Our ward has about 5 people with special sacrament needs. The teachers prepare a special tray just for those needs (a pretzel, or a wrapped piece of bread brought by the family). One deacon has the responsibility to locate each of the three families involved, the priests make sure he gets that tray, and he takes the special tray to those families first, then continues passing with a regular tray.

We used to put the special items on one tray, but we had problems with the wrong people taking the special items, and we also ended up with more people with special needs, so we've found it to be easier to just have one special tray.

We have a couple people in the ward with Celiac, one is my daughter. A separate tray is used and one Deacon carries two trays on his route...eventually finding the family that has the member in need. In most cases, at least ours, the whole family partakes of the non-wheat product, to keep things a bit more sorted out in that row.

My only suggestion is to be sensitive to possible contamination issues...meaning, it should be understood that in some cases even a small bit of wheat flour or bread, if it gets on the member's sacrament, can cause significant intestinal problems for the member. Not just an upset stomach, but damage to their body. Priests should not remove the product from a napkin or bag and reposition it on a tray if it's already there, break it up (further than it may already be), etc., if their hands have touched a wheat product. There will be times when the product arrives late and handed to a Priest just before sacrament meeting starts--they should do their best to handle it with care.

Good question, so thanks for asking!

One of my big concerns has been the contamination issue. We are an old ward so we have the old metal trays. We have purchased a brand new plastic tray that we will be labeling for this purpose. My current plan is to put labels inside the bottom of the tray with large bold lettering "GLUTEN FREE", "DO NOT PUT WHEAT PRODUCTS IN THIS TRAY". We are also planning to have a training session with the Aaronic Priesthood covering how important it is to not contaminate the special tray or its contents.

Those are good ideas, Rpyne. One thing to add that I think is valuable...just as some members may be anxious/concerned at possible contamination (being on a table full of bread), there are some members who may not be overly concerned with contamination. I knew a member in another ward that would just drop off his cracker in the tray and didn't care if it mixed with other items. Same with another friend who just picks croutons out of salads and is OK with it. Usually it's because they don't feel effects from small (or large) doses of gluten.

I don't like to tell these folks they need to be more careful, but whether the effects are felt or not--it can be different for those with Celiac disease--there is damage being done to the intestines if gluten is ingested. That's a long way of saying that adopting a consistent practice like you are suggesting is a great idea for everyone.

A possibly silly question from someone who knows very little about this: Is there a reason to not have gluten-free bread for everyone? Is it a cost issue, or a taste issue? The reason I ask is that it seems that it would solve the contamination and logistics issues.

I think it is a combination issue. Yes, gluten free items are usually quite expensive and most people don't have them on hand so it would be difficult to rotate the responsibility to provide the bread for the sacrament. It can also be an issue of taste and appearance in that most people will not be familiar with gluten free items, which are usually a cracker of rice crisp rather than what most think of as bread.

dandavidgarcia wrote:Those are good ideas, Rpyne. One thing to add that I think is valuable...just as some members may be anxious/concerned at possible contamination (being on a table full of bread), there are some members who may not be overly concerned with contamination. I knew a member in another ward that would just drop off his cracker in the tray and didn't care if it mixed with other items. Same with another friend who just picks croutons out of salads and is OK with it. Usually it's because they don't feel effects from small (or large) doses of gluten.

I don't like to tell these folks they need to be more careful, but whether the effects are felt or not--it can be different for those with Celiac disease--there is damage being done to the intestines if gluten is ingested. That's a long way of saying that adopting a consistent practice like you are suggesting is a great idea for everyone.

I am aware of the contamination issues because I have a niece that when she was diagnosed with Celiac was told to buy new pans and dishes to use because the ones she had were contaminated and could not be adequately cleaned to remove the contamination to an acceptable level. She now takes her own cooking utensiles with her when she travels.

The sister that we are working to accomodate is a recent convert. She tried taking the sacrament the sunday after her baptism, hoping that the small amount would be tolerable, but ended up very ill for several days afterword.

I guess it depends on the sensitivity of the ward members. Our ward has a couple of families with celiac, and we had tried using a single tray (the YM bring bread AND rice cakes) and targeting the assigned route, but the families kept moving where they sat. So now we have 4-5 pieces of rice cake in every tray with the bread. In our case, the contamination issues aren't very severe, so the rice and gluten in the same tray haven't been a problem.

We only have a couple of people in our ward with this issue. In our circumstance, the gluten free product is wrapped and placed on the tray with the other bread. The people who have this issue have also been asked to sit in the same location so that it can be placed on the same tray each time.

I'm glad bread is the only thing we have to worry about
http://www.startribune.com/lifestyle/284225771.html

As a suggestion for another possible solution, my daughter is in a ward with quite a few gluten-intolerant folks. I believe they clean the trays each Sunday (3 wards share the building) and several members provide gluten-free bread for use in the sacrament (for the entire ward). My grandson has been on and off gluten (for a different reason) and my daughter takes a turn at bringing the gluten-free bread. The last time I attended her meetings, I think the bread was homemade. If it is important to the discussion, I will see her this weekend and can ask about the details.

My ward has a dedicated gluten free section (one "column" of short pews) and a dedicated gf tray. Standard procedures are that the gf bread is broken first, a napkin is placed over it and then the rest of the bread is broken. As far as I am aware, this system has worked well in a ward that has members that need to be completely gf (as in having a gf substitute touching regular bread could make them seriously ill). The bishopric reminds people of this from time to time during announcements.

I believe that the gf bread is kept in the freezer so the Aaronic Priesthood can just pull out the required number of pieces as gf bread is quite expensive.

We have a lady in our ward who makes our sacrament bread and it is gluten free for the entire ward.

I appreciate everyone's comments as we too have about 5 with various levels of intolerance or diagnosed cases. Currently they bring their own bread. I have not wanted the liability of a Teacher bringing bread at the last minute and it is not gluten free. They place it on a tray and sit in the same seats each week, like many families in the Church.

My current concern in regards to cross contamination is the breaking of the bread. Right now those members bring their own small piece and the priests don't break it. I know in the handbook it talks about breaking the bread and I understand the requirement in emulation of what the Savior showed us as the proper procedure. So my question is if others have their priests break the gluten free portions, or do not due to concerns about cross contamination? I would like to make this as easy and reverent as possible and also not have members worried about taking the sacrament.

I will ask my Stake President for guidance, but wanted to hear more ideas or thoughts of how to best make the ordinance both sacred and safe.

Thanks!

silus99 wrote:So my question is if others have their priests break the gluten free portions, or do not due to concerns about cross contamination? I would like to make this as easy and reverent as possible and also not have members worried about taking the sacrament.

I will ask my Stake President for guidance, but wanted to hear more ideas or thoughts of how to best make the ordinance both sacred and safe.

Since we're only worried about cross-contamination in one direction, my thought is to have the priest wash their hands and break the gluten-free first.

I think the trick would be how to make sure that happens and how everyone knows that tray is the gluten-free tray. I think I'd try to make the tray different somehow. Perhaps a label on the handle.

russellhltn wrote:

silus99 wrote:So my question is if others have their priests break the gluten free portions, or do not due to concerns about cross contamination? I would like to make this as easy and reverent as possible and also not have members worried about taking the sacrament.

I will ask my Stake President for guidance, but wanted to hear more ideas or thoughts of how to best make the ordinance both sacred and safe.

Since we're only worried about cross-contamination in one direction, my thought is to have the priest wash their hands and break the gluten-free first.

I think the trick would be how to make sure that happens and how everyone knows that tray is the gluten-free tray. I think I'd try to make the tray different somehow. Perhaps a label on the handle.

That is good advice. I will work on the finer points. Thanks!

This is a growing issue in our Ward. We've tried the dedicated tray, but that means one Deacon has to remember everyone on the list and then find them. If that Deacon is not in church that Sunday it's more of an issue as people get missed.

Additionally I've heard of a Ward using Rice Chex as a low cost GF substitute.

Anyone have any ideas or experience on how to effectively include GF sacrament where the number of GF individuals seems to be growing and individuals are scattered all over the chapel?

Thank you.

You may need to ask them to sit together in a certain section of the chapel and have gluten-free bread (broken first to avoid contamination) on the tray that goes to that side.

We dealt with this by buying only gluten free bread so all members eat the same bread. I am aware that it is more expensive. However as ward clerk I buy a number of loaves,(not a cracker or rice crisp)and put in the freezer and then give the receipt to the Bishop who then reimburses me in the normal way. That is the Bishop and a Counsellor does the tithing and expenses for that week. It works very well. However this is in the UK so the USA supermarkets might not be able to provide this type of bread.

The solution for our ward - along with the regular bread, a plain rice cake was used. We used 4 rice cakes on 8 trays. The teachers would carefully place a rice cake so it rested on two trays. Regular bread was placed on the the trays away from the rice cakes. The priests would break the rice cakes first - each rice cake was broken in half with the first half broken into small pieces into the corner of one tray and then the other half was broken up into the corner of the second tray. All rice cakes were broken BEFORE handling/breaking the regular bread into the other corners. Every tray had broken rice cakes and regular bread. Also, BEFORE each sacrament meeting the teachers were instructed to rinse and dry the sacrament bread trays to ensure they were gluten free. Unused rice cakes were stored in the clerks office with attention on making sure we always had enough for the next Sunday. We did not use a napkin or other partition to separate the bread from the rice cakes, the people with the allergies would take the pieces that were furthest from the bread. Small children or visitors without allergies took the broken up rice cakes but occasional reminders by the bishopric over the pulpit helped to ensure we had sufficient rice cakes for those who needed it.

At the UK & Ireland Single Adult Conference in Manchester there a number with celiac disease, rice cakes are broken up and put in dishes and each dish goes on the sacrament tray and the celiacs take from the dish.

Fwiw, in the ward where I attend, because there are several good-sized families with at least some family members who have celiac disease, the ward leaders have settled on a paper cup similar to a larger muffin paper in each tray and apple chips in that paper cup. As far as I have observed, the teachers pour the apple chips (probably directly with no hand contact) into the paper cups. The priests break the wheat-based bread for everyone else but (as far as I am aware) do not break or touch the apple chips. I don't know at what level the ward leaders might have (or might have not) received direction or approval for that arrangement.

My ward simply buys a special bread that is free of gluten as well as dairy. It's not very tasty, but it makes the membership happy. Everyone eats the same bread.

In our ward we have two approaches. For those with gluten sensitivity (not celiac), we have Rice Chex in about half the trays. We put them in small paper cups (like a small cupcake liner - purchased from a restaurant supply like "Cash and Carry" or "Smart and Final") to keep them separate from the bread/gluten. 4-6 Chex in a tray is adequate. This is easy and inexpensive to manage. A box of Chex will last quite a while.

For those with Celiac or high sensitivity to gluten, they will package the Chex at home into a very small ziplock bag (like a jewelers bag) with as much care as needed. A member of that family brings the individual bag to church, hands it to the priests, and and tells them where they are sitting so the bagged Chex get into the right tray. When it is passed, someone in the family opens the bag carefully and dumps the Chex into the hand of the person with Celiac. That way, the individual/family has confidence that they won't have to deal with cross-contamination.

We had someone in one of my past wards who had Celiac disease back in 2009. She had a rice cake that was set aside on the tray, in its plastic wrapper.

I actually had to go on a strict gluten-free diet shortly after that, coincidentally. I used a certain brand of corn tortillas that didn't give me issues (*Mission brand); I put them in zipper bags or something (but if I had to do it again, I'd probably use the small clear bead bags by the crafts they sell at Walmart, or something else; the plastic bag I used made some noise). I don't have Celiac disease, though. I can eat wheat, other products containing gluten, and milk products as long as I don't eat very much rice, now, and as long as I take food grade diatomaceous earth every once in a while (but back then, I didn't know that). I don't have to take the DE very often at all anymore (maybe once a month).

I think a lot of people didn't believe me that I had issues with gluten, especially as I didn't have issues when we first met (which made it kind of hard). To be fair, it wasn't just gluten, though (but also lots of other things). I pretty much could eat cabbage, baked vegetables, bananas, corn chips (Mission brand), corn tortillas (Mission brand), corn generally, yogurt, meat (sometimes), rice (or so I thought; I was fine with rice as long as I wasn't eating wheat), and a few other things. My favorite things to eat ended up being baked vegetables/meat and vegetable corn bread (no wheat flour) tied with it. The baked vegetables were so much healthier-feeling than stir fry, and tasted better, too (you could even bake rice with it, and it could turn out better than in a rice cooker, as long as it was a convection oven). I baked stuff in an 8-inch cast-iron pan in a toaster oven, and a glass pan when I did rice.

It's a good thing I don't have to be on that diet, still, because I probably would have suffered a *lot* from malnutrition, eventually (although I certainly did notice a huge difference when I was on the diet). However, now I know a lot of things that would have made things nutritionally easier for me back then (like lacto-fermenting food is one way to enhance nutrition, and provide extra flavor—and probiotics). I could have made all kinds of sauerkraut, which probably would have helped me with other issues I had, too (but I wasn't very trusting of fermented foods at the time, since I didn't know much about them). FYI, even yogurt is lacto-fermented. Plus, it really helped me to be the one to lacto-ferment my own food to begin to appreciate it.

As to what condition I have, I don't know, but it's probably something like chronic (as opposed to acute) mercury toxicity, since mercury (lead, and perhaps other heavy metals) can block enzymes needed to digest wheat gluten and milk casein (and food grade diatomaceous earth is really good at chelating heavy metals; plus, I had a lot of symptoms of it—but you never know). Rice is really good at absorbing toxic metals in the soil if they're present, too (and a number of foreign rices tested had high levels of mercury and arsenic).

*I don't know if Mission brand corn stuff is still free from gluten-contamination, but it was at the time I ate it. I did make sure to verify stuff like that, and contact the manufacturer if necessary.

I have a daughter & a grand daughter who are celiac. There are multiple ways to handle the problem. In my current ward, a member of the bishopric is celiac, as well as several other members, & there is a very small ziplock hard container on the corner of each tray, which contains several pieces of rice Chex cereal. This has worked well, because the container protects the contents from cross contamination. In one of our daughters’ college wards, there was a Cheeto piece on the corner of the tray for the member with celiac, but that would probably not work in a family ward. Our daughter with celiac lives in a small branch, & the solution there has been for her to provide home baked gluten free bread for the sacrament, since they bake all their own, anyway. In a worst case scenario, remember that when providing the sacrament in rest homes, touching the bread to the lips is acceptable for those who cannot swallow. Our granddaughter has used that solution a couple of times.

marivenezohner wrote:In a worst case scenario, remember that when providing the sacrament in rest homes, touching the bread to the lips is acceptable for those who cannot swallow.

Good point! We have a brother in our ward who cannot swallow solids or liquids, and must always carry a spit bottle. I believe he chews the bread and then spits into his bottle.

In case it might be of some use, there are some wards where the ward leaders are very aware and go to considerable lengths to safeguard the health of those in their wards. The ward in which I live has several people with celiac disease, at times including some who have been in the bishopric.

I think in most cases, it's that those involved in the sacrament may not fully understand what the issues are, and how to deal with them. I would recommend setting up a meeting with the bishop, sharing resources produced by the Church (General Handbook 18.9.3 would be a good place to start), and following up making sure that issues are communicated from him to the Aaronic Priesthood quorums.

General Handbook, 18.9.3, is the official Church policy from Church headquarters. Information about gluten intolerance has not always been widely available, so there may not have been a clear policy in the past. If it happens that a ward currently is dealing with these challenges, I would kindly nudge them towards the General Handbook, 18.9.3:

If members have gluten intolerance, they discuss with a member of the bishopric what adaptations to make for the sacrament. Members may provide allergen-free bread or another broken bread-like substitute in a sealed plastic bag or cup. They give this to a priesthood holder to place on a separate tray. The bishopric helps those who pass the sacrament know which members to whom the allergen-free item should be passed. The bishopric may modify the procedure as necessary.

They should also consider the section on Food Allergies on the Church website (disability resources section), which goes into more detail:

How can those with food allergies safely partake of the sacrament?

• Leaders and teachers should be sensitive to the physical and emotional impact food allergies have on an individual and should develop ways to safely include people in all activities and worship—including partaking of the sacrament. The guidelines below may help:
• Members with food allergies, such as gluten intolerance or other conditions, should inform a member of the bishopric and discuss with him what adaptations may be appropriate for the sacrament.
• Members may provide their own allergen-free bread or other broken bread-like substitute. Members may bring a prebroken bread substitute in a sealed plastic bag and give it to a priesthood holder to place on a separate tray.
• During the sacrament, the priesthood holders break the regular bread but do not open the bags or touch the allergen-free bread substitute. The prayer to bless the bread is offered in the normal way.
• The bishopric sees that the priesthood holders can identify members to whom the allergen-free item should be passed. Those who prepare, administer, and pass the sacrament should receive training on how to avoid cross contamination.
• Depending on the number of individuals involved or specific circumstances, the bishopric may modify the procedure.

All wards in our building went all gluten free for sacrament. So much easier.

jakerose wrote:All wards in our building went all gluten free for sacrament. So much easier.

We tried that, but then another family was allergic to another ingredient, probably dairy, so we tried using some strange hypoallergenic bread for a while, which tasted like white rice foam.

In case it's helpful, the Food Allergies page from the Church website (quoted above) is now in Gospel Library:
https://www.churchofjesuschrist.org/stu ... eng#title7

Just sharing what we have done in our Ward. For background let me just say that there's been a LOT of good things shared in this forum, thank you to everyone. I am a a counselor in our bishopric and it was brought to our attention of a member in our Ward having celiac but would like to partake of the Sacrament. We weighed a lot of options and we were thinking of switching to using gluten-free bread altogether but the costs and concerns of other allergies, as well as someone not bringing gluten-free bread on any given Sunday, that we could possibly be causing more issues for concern for this one individual and possibly to others by such a change.

Instead what we decided to do was through discussion of General Handbook 18.9.3 we asked the member with the health issue to provide a suitable substitute to use. The suitable solution was using a Chex wafer, which does not require to be refrigerated (like gluten-free bread) and were put into individual small baggies and then placed inside a glass mason jar with a lid, and the jar and lid was written on to explain what it contains and how to handle it. This allows the substituted pieces to remain fresh without having to be refrigerated/frozen when not used, and could be left under the sacrament table or in the bishops office as the jar/lid prevents mice and other rodents/bugs from getting into it.

Now each Sunday one of the individual substituted items can be placed on each bread tray, so no matter where the member of concern sits (or any others with such condition/concern who may be visiting) will have access to a piece of gluten-free "bread"), and any left over wrapped/protected pieces can be put back in the jar for future use.

This may not be bullet-proof for everyone, but this has been the best solution that works for our friend/member and our Ward. Hope this helps others and if anyone has any other ideas, suggestions, concerns please share. Thanks again to all those who have already contributed!

@seelydan

Cool. Sounds great. However, some people are sensitive enough to need to be concerned about cross-contamination. So, the items may need to be handled first (before the bread, if handled at all), and may need to be put inside something to prevent cross-contamination.

One obstacle is the sound the enclosure makes. When I was on a strict gluten-free diet in 2009, mine were in plastic bags, and they made a lot of sound as I removed the contents (which seemed to attract the attention of people around me). That wasn't ideal. Maybe a cloth pouch (or some such) would be better (not one that bread particles could penetrate).

It might be cool to have a dispenser filled with the item, and the Priesthood holder could use the unit to dispense one of the items into the recipients' hand. That way, no one has to touch it, it doesn't have to be wrapped up, and the recipient can focus on Christ, the atonement, and covenants with God instead of the manner of the sacrament's adminsitration. Filling it would be the anxious part.

We also faced this. We adhere to the diet found here https://en.wikipedia.org/wiki/Coeliac_disease

Members may bring a prebroken bread substitute in a sealed plastic bag

I definitely don't think the "letter of the law" should override any reasonable accommodation for these types of situations. That said, at the very least I think it's valuable to be aware of the guidelines regarding the allowance of a "prebroken bread substitute". The breaking of the bread is an important symbolic element of the sacramental ordinance, and I think it's worth considering if a different option other than a Chex wafer might be available, which the member could break themselves beforehand. If not, then I'd suggest simply ensuring the member in question is aware of this aspect ,so they can feel like they're still "fully included" even if their emblem is not broken.

BrianEdwards wrote:That said, at the very least I think it's valuable to be aware of the guidelines regarding the allowance of a "prebroken bread substitute". The breaking of the bread is an important symbolic element of the sacramental ordinance, and I think it's worth considering if a different option other than a Chex wafer might be available, which the member could break themselves beforehand. If not, then I'd suggest simply ensuring the member in question is aware of this aspect ,so they can feel like they're still "fully included" even if their emblem is not broken.

The interpretation of General Handbook 18.9.3 could go either way. The current wording is: "broken bread-like substitute". This could mean either a bread-like substitute that's broken (meaning, the piece of Chex or gluten-free bread must be broken), or a substitute that's like broken bread (where a small piece of Chex could qualify – because of its size/shape – without needing to be separately broken). Either interpretation leads to the same symbolism, being like broken bread. I wish I knew which interpretation the Handbook editors had in mind.

sbradshaw wrote:I wish I knew which interpretation the Handbook editors had in mind.

Or perhaps they left it a little ambiguous on purpose to allow for local circumstances.

in my ward, the bishop counseled me “a little won’t hurt”, i just recovered from liver failure caused by adverse reaction to gluten, circa1995, over the years since, not one bishop would alter the sacrament procedure to include a gluten free bread that i could take, by the time a modification to sacrament procedure appeared in the church handbook 2, i had given up on sacrament meetings, i am encouraged to hear that some wards have been more flexible and realize d&c 27:2 applies.

I have celiac disease and the solution for us has been that I bring a half piece of gluten free bread each week wrapped in tin foil which gets put on its own tray. We have 3 priests at the table and all priests in the ward have been taught about what gluten free means. They all use hand cleaner before breaking any bread. After the prayer, one of the priests opens the gluten free bread and breaks it into the newly-opened tin foil before touching any other bread. Then that priest waits until after the sacrament is passed to them, then he gets up and takes that gluten free tray/bread to those in the ward that he knows about. If there are visitors that need gluten free bread, they just let the priest know and he is responsible to get gluten free bread to those who need it. It has worked fairly well for us since the tin foil gets rid of the gluten on the tray issue, it is broken bread, and it only goes to those that need it.

I just get the member to bring a sealed container to put on the tray to be blessed and passed and tell the priesthood holders who it is for. I instruct them not to open the container under any circumstance. I am not willing to risk our priesthood bearers being responsible for the fate of a members mortal existence over some ambiguous point of church policy.

I was Bishop and we had too many issues with training for cross-contamination so we just switched to "Canyon bakehouse flying and dairy free bread." It tastes fine and avoids all of the possible issues that can make people sick. I purchased the bread from Walmart and put it in the freezer at the church. We got it out Sat and haven't had problems since