The Lord’s Supper and Eating Disorders

Introduction and Definitions

Taking the Lord’s Supper is a duty of all Christians. However, many Christians have eating disorders which inhibit them. This raises vital pastoral issues which are considered a little here. I am a pastor who has had to work through this with a few Christians. Before 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, attention is drawn to the nuance required to wisely handle this in a case-by-case basis. Next, basics are explained which lead to an examination of the two potential responses to the question at hand. Some scriptures are then called on for support of the conclusion.

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 oesophagostomy[2] during the annual Scottish Presbyterian communion. Practically speaking, no single solution suits every circumstance because of their depth and variety. 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, ‘Christ himself gave the apostles, prophets, evangelists, pastors and teachers, to equip his people’ (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). When Christians with eating disorders seek help on the topic of the Lord’s Supper, they should ask counsel from their God-given elders. External help may be entirely appropriate, even necessary, but due respect ought to be given to the church officers. Should officers feel unequipped, prayerful use of this paper will help.

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 kaleidoscope of resultant situations.

To help these Christians, Church leaders bring scripture to bear in their contexts. 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! It is not necessary to take the Lord’s Supper to take hold of Jesus by faith. Not everybody is prepared to consider that John 6 uses sacramental language when Jesus describes masticating his body and blood.[3] This is not the place to enter that debate but were it allowed, then John 6 has something to say. Jesus teaches that our eternal life and union with himself is contingent upon our feeding on him (6:51—58). This feast is offered to the crowd immediately present; it is not to be taken literally (cf. 6:52). Jesus means that sinners take hold of and feast upon him by faith (6:27—29). Eating Jesus is offered to all, regardless of observing the Supper, since it is by faith, not chewing. We eat him with the soul, not the mouth.[4] Thus, abstention from the supper does not mean abstention from Christ any more than driving past a road sign means we cannot reach the destination.

Since faith takes priority overeating bread and drinking wine, Christians with prohibitive eating disorders may abstain from the Supper without fearing 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 thus taking hold of Jesus.

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.

Finally, abstention is not the same as absenting oneself. Augustine of Hippo taught that the sacraments are the visible word;[5] therefore, it is not merely in tasting but also in witnessing the Supper administered that we participate. This has its own relevance to the phenomenon of online communion. Christians with eating disorders, even if abstaining from eating and drinking, maintain some participation by witnessing the administration. It is possible to believe that we are taking the Supper when we are not. In 1 Cor 11:17—22, 33 this occurred when the church was divided within itself and factions were not taking the Supper together. Therefore, if communicants must abstain from the elements, they may not absent themselves from the service. By witnessing its administration and taking hold of Jesus by faith, they continue to participate in a worthy manner; thus they discern the Lord’s body in the sacrament (11:29).

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.[6] In this way, they get to mimic Jesus himself who, though present at the table, abstains from the meal in anticipation (Matt 26:29). It is easy to forget Jesus’ simple command: ‘do this’ (Luke 22) Although the wise conclusion to a particular situation may be that a Christian abstain from the Supper, it must never be the thoughtless first resort. Wherever possible, regular observance of the sacrament must be maintained because we need it, and Jesus commanded it. ‘Is there any way to make this work?’ should be a persistent question in our minds.

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. Assuming the existence of an ‘ideal,’ it is fair to suggest that all celebrations of the Supper are deviations, substitutes of the ideal. The notion of substitution in the Supper is neither novel nor anathema per se; it is how Christians have done it for centuries. Perhaps nobody would say that a church is less communicant because they worship in a country in which bread is not the staple, or where the climate kills grape vines. Is a recovering alcoholic believer not in communion with her church because she takes non-alcoholic wine? Is a believer with coeliac disease 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 for those with eating disorders such as anorexia, dysphagias or gastro-intestinal complications such as gastrectomies or unstable anastomoses.[7]

There are passages with instructive, applicable principles to guide prayerful Church leaders. During the reign of King Hezekiah (2 Chronicles 30), 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. What makes this particularly useful is 30:12 which reveals the Lord’s opinion of their decision. ‘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 by substitution. He was also glad to hear and answer Hezekiah’s prayer to bless the people 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.

One of the sacrifices under Moses’ Law (Leviticus 12) 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, 12:8 allows her to double the birds. This is precisely the case for Mary in Luke 2:24. Jesus’s 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.

For Christians with eating disorders seeking substitution, the substitutes which could be considered obviously depend on the nature of the disorder. The principle is that 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 bread. Those with feeding tubes like gastrostomies or jejunostomies, can inject a tolerable solution.[8] Dysphagic Christians may benefit from thickeners being added to communion wine.[9] It is important that medical advice is sought and the Christian’s physicians be informed as these issues become more complex. Unintended harm can follow administering substitutes without due care.

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 because of a conscience which prohibits them from observing the Supper in unusual or substitutive ways. In such cases, they ought still participate in that by their attendance and faith. That we 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 abstain from the elements. They may participate at the Lord’s table by taking safe and appropriate substitutes. By taking a substitute, Christians with eating disorders can be assured with their brothers and sisters that as surely as we know sustenance enters our bodies, so we know that we have taken Jesus by faith and he sustains our souls.

Augustine was right to say that in the Supper, we see the gospel that we have heard. We may go further and say that in the 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 washes down dysphagic gullets and  zero-calorie wafers dissolve on tongues; as apple juice is pumped down feeding tubes or water refreshes dry mouths, Christians can so feed on their Saviour who will make good his promise to grant them new bodies.

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References

[1] Orthorexia, an obsession with eating “pure” food, is not currently recognised as an official diagnosis but may be in the future.

[2] Oesophagostomies bring the gullet (food pipe) to open at the skin, rather than the mouth.

[3] John 6:56 uses the word τρώγω, to chew.

[4] See: Robert Bruce, The Mystery of the Lord’s Supper (Christian Focus, 2012).

[5] Augustine, Contra Faustum, Book XIX.

[6] See: Bruce, The Mystery of the Lord’s Supper.

[7] 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.

[8] Gastrostomies and jejunostomies are openings from the skin to the stomach and part of the bowel respectively.

[9] Dysphagic patients have difficulty swallowing.

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© Hywel George, 2023.

This work is licensed under Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).

Cover Image: “The Last Communion of St Jerome,” from Wikimedia licensed under CC0 1.0 Universal.