Consubstantiation is the inclusion of one substance in another where the body and blood of Christ co-exist in the elements of the Lord's Supper. It suggests that a third substance is formed. The body and blood of Christ are "in, with, and under" the elements. There is no permanent relationship with the elements. Instead, the association is limited to the sacramental action. The transformation is effected by the Word of God and not by a priest. This term is often used to describe the Lutheran understanding of the real presence in communion.