Hywel George
Taking the Lord’s Supper is the privilege and duty of all Christians. However, many Christians have eating disorders which inhibit them. This raises vital pastoral issues which are considered briefly here. I am a pastor who has had to work through this with a few Christians. Before serving a pastor, I was a hospital pharmacist on gastro-intestinal surgical wards. This providence has given me additional perspectives.
By ‘eating disorders’ I do not limit the discussion to the psychological conditions which may first spring to mind. Anorexia, orthorexia, bulimia, and others are included, but what follows applies more pertinently to physical conditions.1 Birth defects, disease, surgery, and degrees of disability or learning difficulty are other ways in which Christians may be inhibited in taking the Lord’s Supper in the usual manner: taking, chewing, and swallowing bread and drinking and swallowing wine. Thanks be to God, nothing can prevent Christ from communing with us spiritually in his Supper.
Here, I draw attention to the necessity of sensitivity to individuals’ contexts. Nuance is required to wisely handle this in a case-by-case basis. I lay some basic foundations, which leads to an examination of the two potential responses to the question at hand. Finally, I collate some of the Scriptures in which I find support for my conclusions.
Context
It is crucial to appreciate the context of any pastoral situation. Consider the differences between, for example, a young man wrestling with anorexia during an Anglican Eucharist and an elderly woman with an oesophagostomy2 during the annual Scottish Presbyterian communion. Practically speaking, no single solution suits every circumstance because of the depth and variety of cases. Indeed, a given eating condition may change day-to-day for an individual.
In Jesus’ ascension, he showered gifts on the church in the form of people specially gifted by his Spirit for service (Eph 4:7–13). The specific people set over us in the church are gifts of the risen Lord. Therefore, we honour Christ in submitting to their leadership (Eph 6:1–9). This essay cannot replace the wisdom of local church leaders. I intend it only to assist them as they prayerfully care for the flock.
Basics
Christians who have eating disorders which disrupt participation in the Lord’s Supper have two options: abstain or take a substitute. The choice is not as simple as first seems. The fact that conditions and conscience change over time presents a rainbow of resultant situations.
To help these Christians, church leaders bring Scripture to bear in their contexts. We also keep in mind the relation of their conscience and the complexity and sometimes instability of their conditions. The pre-requisites to tackle pastoral issues include familiarity with Scripture, a relationship with the communicant, and prayer. Without the wisdom and help of the Spirit who is given to those who ask for him, we should shrink even from the privilege of helping the Lord’s people and touching these holy things.
Abstention
In the one act of taking the Supper are two events. In one, we eat bread and drink wine. In the other, we apprehend the body and blood of Jesus by faith. Does it follow that abstention from the Supper means Christians never take hold of Christ? Not at all! Faith has been described as the empty hand which receives Christ. It is not necessary to take the Lord’s Supper to take hold of Jesus by faith. This is proved by texts such as John 6, examined briefly below.
The classic examples showcasing this point include sinners converted to Christ in their dying moments, including the thief on the cross (Luke 23:42–43). We may add our brothers and sisters in Christ who lived and died before the institution of the Supper. These took hold of Jesus by faith, having never taken the Supper.
Faith takes priority over eating bread and drinking wine. Therefore, Christians with eating disorders may abstain from the Supper without fear that they do not have hold of Jesus. They may abstain from the sign and still enjoy the signified. Theirs may be only ‘the better part’ of the two—exercising faith and so taking hold of Jesus—while their brothers and sisters do the same in taking bread and wine.
Lastly on abstention: it is not the same as absenting oneself from the administration of the Lord’s Supper. Augustine of Hippo taught that the sacraments are the visible word; therefore, it is not only in tasting but also in witnessing the Lord’s Supper administered that we participate.3 Christians with eating disorders, even if they abstain from eating and drinking, maintain a degree of participation by witnessing the administration and fellowshipping with the gathered body of Christ. This is supported by 1 Corinthians 11, discussed briefly below.
Sometimes, it is simply impossible for a Christian to take the Supper by eating and drinking. In many cases it would be irresponsible, even dangerous, to force a solution. For those Christians, what does a communion service look like? They remain in the service, witness the administration, decline the elements but no less take hold of Jesus Christ by faith. Thus, like everybody else, while they do not get a better Christ in the sacrament, they get Christ better.4 In this way, they get to mimic Jesus himself who, though present at the table, abstains from the meal in anticipation (Matt 26:29).
Substitution
Most Christians take it for granted that there is an ‘ideal’ manner of taking the Supper—the way, say, as intended by Jesus. For example, what percentage alcohol the wine should be, whether the bread is leavened or not, how much of each kind to consume, whether a congregation shares a single loaf or cup, whether or not the bread is torn, what grain was used to make it, how often it is celebrated, who precisely distributes the elements, etc. The list goes on, and various points have flared up over history with varying degrees of fallout.
Assuming the existence of such an ‘ideal,’ it is fair to suggest that most, if not all, celebrations of the Lord’s Supper are deviations, substitutes of the ideal. The notion of substitution in the Supper is not novel; it is how Christians have done it for centuries. Perhaps nobody would say that a church is any less communicant because they worship in a country in which bread is not the staple, or where the climate does not allow for grape vines. Do we say that a recovering alcoholic believer is not in communion with her church because she is not taking alcoholic wine? Do we say that a believer with coeliac disease is not taking the Supper because they take gluten-free bread?
Throughout Church history, where usual communion was impossible, substitution consistently won out over abstention. Why we have not unhesitatingly applied this logic to Christians with eating disorders may be simply that such instances are rarely encountered pastorally. Just as substitution is the instinctive default for tee-total and gluten-free Christians—and for those living in especially cold and/or remote environments—so it should be, I propose, for those with eating disorders such as anorexia, dysphagias, or gastro-intestinal complications such as gastrectomies or unstable anastomoses.5
What substitutes could be considered for Christians with eating disorders who wish to participate in the Lord’s Supper? This would obviously depend on the nature of the disorder. The principle I propose is that some sustenance is ingested, orally or otherwise, to feed the body and thus signify the sustenance which Christ is to the soul as he is taken by faith. For those who cannot masticate, dissolving wafers can substitute for bread. For those with feeding tubes like gastrostomies or jejunostomies, a tolerable solution can be injected.6 Dysphagic Christians may benefit from thickeners being added to communion wine.7 It is crucial that church leaders seek medical advice and keep the Christian’s physicians informed as these issues become more complex. Unintended harm can follow administering substitutes without due care.
Relevant Biblical Passages
Disappointing results come from searching a Bible concordance for ‘eating disorder.’ Nevertheless, there are passages which are helpfully instructive in laying down applicable principles to guide prayerful shepherds in the care of their flock.
Luke 22
It is easy to forget the simple command of our Lord in reference to his Supper: ‘do this.’ While the right conclusion to a particular matter may be that a Christian abstain from the Supper, it must never be the thoughtless first resort. Wherever possible, the regular observance of the sacrament must be maintained because we need it and because Jesus commanded it of us. ‘Is there any way to make this work?’ should be a persistent question in our minds.
John 6
Not everybody is prepared to consider John 6 to be using sacramental language when Jesus describes masticating his body and drinking his blood.8 There is no room here to enter that debate. Were it to be allowed, then John 6 has something to say to our present question.
Jesus teaches that our eternal life and union with him is contingent upon our feeding on him (6:51–58). This feast of Christ is offered to the crowd immediately present; it is not to be taken literalistically (cf. 6:52). Jesus means that sinners take hold of and feast upon him by faith (6:27–29), and thus we have our union and life with him.
Eating Jesus is offered to all, independently of observing the Supper, since it is by faith, not chewing. We eat him with the soul, not the mouth.9 Thus, if a Christian must abstain from the elements, this does not mean abstention from Christ any more than driving past a road sign means we cannot reach the destination.
1 Corinthians 11
It is possible to believe that we are taking the Lord’s Supper when we are not. In the case of 1 Cor 11:17–22, 33, the church was divided into factions within itself, these factions were not celebrating the Supper together, and therefore they weren’t celebrating it at all.
Therefore, if communicants must abstain from the elements, they may not absent themselves from the service. They must participate in the Supper by witnessing its administration, fellowshipping with the church, and taking hold of Jesus by faith. This is precisely how they may continue to participate in the Supper in a worthy manner; thus, they discern the Lord’s body in the sacrament (11:29).
2 Chronicles 30
During the reign of King Hezekiah, certain circumstances transpired which meant that the Passover festival could not be observed at the correct time. Hezekiah, his leaders, and the assembly at Jerusalem had to decide: abstain from the Passover that year or substitute it with an observance one month later. They opted for the latter and summoned Israel and Judah to observe an unusual Passover—at the wrong time and with other deviant details, too.
Illuminating for our present discussion is 2 Chron 30:12, which reveals the Lord’s opinion of their decision to substitute rather than abstain: ‘the hand of God was on Judah to give them singleness of heart to obey the command of the king and the leaders, at the word of the Lord.’ When circumstances meant our fathers could not observe the feast in the usual manner, the Lord was pleased to bless them as they observed it in an unusual manner with adjustments as required by circumstance. He was also glad to hear and answer Hezekiah’s prayer to bless the people even though they worshipped in this deviant manner (30:18–20). This event parades great grace and patience from our Father and holy wisdom from the leaders of his people.
Leviticus 12
One of the sacrifices under Moses’ Law was for mothers, a month or two after they had given birth. The mothers were commanded to bring a lamb and a young pigeon or a turtledove. However, not every mother would be able to bring a lamb, for whatever reason.
In these cases, Lev 12:8 allows her to double the birds. This is precisely the case for Mary in Luke 2:24. Jesus’ mother substituted the usual sacrifice because the law made allowance for those who could not observe it in the usual manner.
The principle ‘Do this, but if you cannot, then you may do that’ seems to be more broadly applicable. Such appears to be the case in 2 Chron 30, Num 9:1–13 and, in my opinion, the matter at hand, too.
Conclusion
Christians with eating disorders may have to abstain from the Supper because of the extent to which their condition prohibits them. Others may abstain due to their conscience, which prohibits them from observing the sacrament in an unusual way. In such cases, they ought still to participate by their attendance, fellowship, and faith. That we together take hold of Jesus Christ by believing in him is absolutely indispensable.
However, it need not be the case that all believers with eating disorders must abstain from the elements. They may participate at the Lord’s Table by taking safe and appropriate substitutes. By taking a substitute, the Christian with an eating disorder can be assured with their brothers and sisters that as surely as our bodies are sustained by what we consume, so we know that our souls are sustained by Jesus, of whom we have taken hold by faith.
Augustine was right to say that in the Lord’s Supper, we see the gospel that we have heard. We may go further and say that in the Lord’s Supper we taste, eat, and feel within our bodies the gospel that we have heard. This should not be unnecessarily withheld from believers with eating disorders who cannot take the Supper in the usual manner.
As thickened fruit juice whets the dysphagic mouth and a zero-calorie wafer dissolves on the tongue, as apple juice courses through a feeding tube or water refreshes the dry mouth, Christians can so feed on their Saviour who will make good his promise to grant them new bodies.
Hywel George is a pastor in Maesycwmmer, Wales, United Kingdom and a graduate from Union School of Theology. You can follow him on Twitter @_HywelGeorge.
Image: Domenichino, The Last Communion of Saint Jerome
- Orthorexia, an obsession with eating ‘pure’ food, is not currently recognised as an official diagnosis but may be in the future.[↩]
- Oesophagostomies bring the gullet (food pipe) to open at the skin, rather than the mouth.[↩]
- This has its own relevance to the phenomenon of online communion.[↩]
- See Robert Bruce, The Mystery of the Lord’s Supper (ed. Thomas F. Torrance; Fearn: Christian Focus, 2012).[↩]
- Dysphagia is difficulty swallowing. A gastrectomy is an operation to remove part or all of the stomach. Anastomoses occur when a section of the bowel is removed and the two remaining openings are fixed together.[↩]
- Gastrostomies and jejunostomies are openings from the skin to the stomach and part of the bowel respectively.[↩]
- Dysphagic patients have difficulty swallowing.[↩]
- John 6:56 uses the word τρώγω, to chew.[↩]
- See Robert Bruce, The Mystery of the Lord’s Supper (ed. Thomas F. Torrance; Fearn: Christian Focus, 2012).[↩]