Isotopic Examination of Links Between Diet, Social Differentiation, and DISH at the Post-Medieval...

Isotopic Examination of Links Between Diet, SocialDifferentiation, and DISH at the Post-Medieval CarmeliteFriary of Aalst, Belgium

Kim Quintelier,1,2* Anton Ervynck,1 Gundula M€uldner,3 Wim Van Neer,4,5

Michael P. Richards,6,7 and Benjamin T. Fuller5,6,8

1Flanders Heritage Agency, Koning Albert II laan 19 bus 5, B-1210 Brussels, Belgium2Department of Archaeology, Ghent University, Sint-Pietersnieuwstraat 35, B-9000 Ghent, Belgium3Department of Archaeology, University of Reading, Whiteknights, Reading RG6 6AB, UK4Royal Belgian Institute of Natural Sciences, Vautierstraat 29, B-1000 Brussels, Belgium5Laboratory of Biodiversity and Evolutionary Genomics, Center for Archaeological Sciences, Katholieke UniversiteitLeuven, Ch. Deb�eriotstraat 32, B-3000 Leuven, Belgium6Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103Leipzig, Germany7Department of Anthropology, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada8Department of Earth System Science, University of California, Irvine, Keck CCAMS Group, B321 Croul Hall,Irvine, CA 92697

KEY WORDS dietary differences; sex differences; status; pathology

ABSTRACT Stable isotope ratios (d13C and d15N)were measured in human burials from the post-medieval(16th–18th c. AD) Carmelite friary burial grounds atAalst, a town in Flanders, Belgium. Dietary patterns of39 adult individuals were analyzed, from a mixedmonastic and lay population buried in three differentlocations, reflecting groups with differing social status.The data show significant variation in the consumptionof perhaps meat, but certainly also marine proteinbetween females and males. This result represents aremarkable continuity with medieval dietary patterns,suggesting that the social and economic changes of theearly modern period had a limited effect on everydaylife. When both sexes were examined together, individu-als buried in the cloister garth consumed significantly

less marine protein compared to people buried in thechurch, likely reflecting social stratification. No statisti-cal differences were observed between isotopic valuesfrom the church and the cloister alley, suggesting a simi-larly diverse diet of the monastic part of the buried pop-ulation and that of the richer lay population. Finally, thehypothesis that diffuse idiopathic skeletal hyperostosis(DISH) is linked to a diet rich in animal protein wastested. No systematic or statistically significant differen-ces between pathological and non-pathological bonesfrom the same individuals affected with DISH wereobserved, and no statistical differences were foundbetween individuals with DISH and individuals withoutDISH. Am J Phys Anthropol 153:203–213, 2014. VC 2013

Wiley Periodicals, Inc.

The 16th–18th centuries AD witnessed significantsocio-cultural and economic changes in Western andCentral Europe, with the Protestant Reformation endingthe unity of the Roman Catholic Church, leading towidespread unrest and political instability. Meanwhilesecular states and early capitalist economies began toemerge against the backdrop of the establishment of thefirst European colonies overseas (Palmer et al., 2006).Studying the diet of people in this crucial period for theformation of modern Europe can provide valuableinsights into the effects these changes had on everydaylife. The main goal of this study is to investigate possibledietary variation within a post-medieval mixed lay andmonastic population, by comparing the isotopic resultsby social class, sex and age. Because food consumption isdetermined by a range of social and cultural parameters,aspects such as sex, age, wealth, ethnicity, and religionare expected to have influenced the dietary customs ofhumans (Parker Pearson, 2003), and thus their isotopicsignatures. Additionally, isotopic analysis was performedon skeletons that display diffuse idiopathic skeletalhyperostosis (DISH), a condition of the vertebral columnof uncertain etiology, but which has been linked to high

animal protein and/or high calorie diets and obesity(Waldron, 1985; Rogers and Waldron, 2001; Roberts andManchester, 2005; Mays, 2006). Here the focus is to dis-cover if the stable isotope ratios of individuals afflictedby DISH can be linked to unique or different diets com-pared to the other members of the population.

Additional Supporting Information may be found in the online ver-sion of this article.

Grant sponsor: Max Planck Society; Center for Archaeological Sci-ences (Special Research Fund, Programme Financing); Belgian Sci-ence Policy Office (Interuniversity Attraction Poles Programme).

*Correspondence to: Kim Quintelier, Flanders Heritage Agency,Koning Albert II laan 19 bus 5, B-1210 Brussels, Belgium.E-mail: [email protected]

Received 5 January 2013; accepted 21 October 2013

DOI: 10.1002/ajpa.22420Published online 14 November 2013 in Wiley Online Library

(wileyonlinelibrary.com).

� 2013 WILEY PERIODICALS, INC.

AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 153:203–213 (2014)

Diet reconstruction using stable isotope ratios

While the reconstruction of human dietary patternsusing the stable isotope ratios of carbon (d13C) and nitro-gen (d15N) has become widely applied in scientificarchaeology, particularly in prehistory, only a smallnumber of studies have been published on post-medieval(16th–19th c. AD) populations from Europe (Mays, 1997;Richards et al., 2006; M€uldner and Richards, 2007;Nitsch et al., 2010, 2011; Lamb et al., 2012; Robertset al., 2012; Beaumont et al., 2013; Salesse et al., 2013).This is unfortunate since, unlike most documentarysources, skeletal remains have the ability to act as animportant and unbiased source of paleodietary informa-tion which is specific to a site or population. Bone colla-gen stable isotope data are semiquantitative andprimarily record the protein portion of the diet, butrecent studies have shown that nearly 40% of the carbonin bone collagen can originate from nonprotein sources(Froehle et al., 2010). The isotopic signal in bone colla-gen reflects dietary inputs averaged over at least thelast decade of life but often with a particular emphasison the period of adolescence (Stenhouse and Baxter,1979; Hedges et al., 2007). Isotopic results are reportedas the ratio of the heavier isotope to the lighter isotope(13C/12C or 15N/14N) and defined as d values in parts per1,000 or “per mil” (&) relative to internationally definedstandards for carbon (Vienna Pee Dee Belemnite, VPDB)and nitrogen (Ambient Inhalable Reservoir, AIR)(Schwarcz and Schoeninger, 1991). The combination ofisotopic results with the macroscopic analysis of thehuman, animal, and plant remains from archaeologicalsites, and the study of artifacts related to food use (Gil-bert and Mielke, 1985; Polet and Katzenberg, 2003), cancreate a clearer picture of the dietary patterns of a soci-ety. For a more in-depth and detailed discussion of howstable isotope ratios can be used to reconstruct diet inarchaeological humans the reader should consult thereviews by Schwarcz and Schoeninger (1991), Katzen-berg (2000), Sealy (2001) and Lee-Thorp (2008).

Previous isotopic research on human remains fromBelgium has been limited in size and scope. Isotopeinvestigations on the Belgian Neanderthal specimensaside (Bocherens et al., 2001), the chronologically ear-liest human remains were analyzed by Bocherens et al.(2007) who investigated dietary patterns in 93 Meso-lithic and Neolithic specimens from the Meuse Basin.This study documented dietary changes occurring in Bel-gium during the early Holocene and revealed subtle die-tary differences which were interpreted as variations inthe consumption of terrestrial and freshwater foods.Polet and Katzenberg (2002) examined two Merovingiancemeteries in Wallonia (Torgny and Ciply), dating to the5th–6th century AD and exhibiting a mainly terrestrialdiet, while the late medieval (12th–15th c. AD) Cister-cian community of Koksijde on the Flemish coast con-sumed a mixture of terrestrial and marine resources(Polet and Katzenberg, 2002, 2003). Intrapopulation dif-ferences at Koksijde appeared related to social statussince higher d13C and d15N values were observed in indi-viduals buried in privileged areas of the cloister, mostlikely reserved for the upper classes of society, than inindividuals buried elsewhere. In two pilot studies,Ervynck et al. (2003) and Vandenbruaene et al. (2003)published human and animal bone data from a numberof Belgian (mostly Flemish) sites, spanning the entiremedieval period (6th–15th c. AD). While the available

paleodietary datasets from archaeological sites in Bel-gium are growing in number, no analyses, to date, havefocused on post-medieval populations.

Diffuse idiopathic skeletal hyperostosis (DISH)

Diffuse idiopathic skeletal hyperostosis (DISH) is acondition characterized by the ossification of soft tissuesof the spine, especially of the anterior longitudinal liga-ment, in a typical “flowing candlewax” appearance (Fig.1), as well as excessive enthesophyte formation at extra-spinal sites. DISH is more common in people older than40 years; its prevalence increases later in life and itaffects more men than women (Forestier and Rotes-Querol, 1950; Pappone et al., 1996; Rogers and Waldron,2001; Roberts and Manchester, 2005). Despite being rel-atively easy to diagnose, little is known about the etiol-ogy of the condition. Many theories about the causes ofDISH have been postulated, for example, that it may bethe result of repeated microtrauma (Pappone et al.,1996; de Vlam, s.d.), that it may be an occupationallyrelated disease (Waldron, 1985; Pappone et al., 1996),that it may be a “state” rather than a disease (Hutton,

Fig. 1. Part of the vertebral column of a male individual(AAHOP 1413) from the Carmelite friary site of Aalst (Bel-gium), affected with DISH. The arrow indicates the ossificationof the anterior longitudinal ligament of the spine.

204 K. QUINTELIER ET AL.

American Journal of Physical Anthropology

1989), that it may be present only in “bone-formers”(people who respond to musculoskeletal stress withexaggerated bone deposition) and that it has a geneticcomponent (Pappone et al., 1996; Rogers et al., 1997;Sarzi-Puttini and Atzeni, 2004). However, one of themost prevalent theories is that DISH is caused by a dietrich in protein or calories (Waldron, 1985; Rogers andWaldron, 2001; Mays, 2006). In recent clinical literature,DISH has been associated with a number of risk factors,including obesity (greater body mass index), hyperinsu-linemia with or without diabetes mellitus type 2 (adultonset diabetes), hypertension, coronary artery disease,and elevated levels of uric acid, lipids or growth hor-mone (Daragon et al., 1995; Sarzi-Puttini and Atzeni,2004; Sencan et al., 2005; Mader and Lavi, 2009).

In the osteoarchaeological literature the condition isoften described in past monastic populations, whereby ahigh calorie diet, which would typically be rich in animalproducts, is ascribed as a probable cause (Waldron, 1985;Rogers and Waldron, 2001; Verlaan et al., 2007; but seeMays, 2006). Historical sources indeed suggest thatmany monks had a rich diet compared to the generalpopulation (Gasquet, 1922; Henisch, 1976; Harper-Bill,1985; Harvey, 1993; Jotischky, 2011). This, combinedwith little exercise, represents a lifestyle that can leadto obesity, diabetes and, as the theory goes, DISH. How-ever, there are also reports from non-medieval, non-monastic populations, suggesting that the prevalence ofDISH is not restricted to a particular time period orsocial context (Crub�ezy and Trinkaus, 1992; Jankauskas,2003; Oxenham et al., 2006; Verlaan et al., 2007).

Previous studies by M€uldner and Richards (2007) andSpencer (2008, 2009) have employed carbon and nitrogenstable isotopes to explore the relationship between dietand DISH in the later medieval period. In both cases,the data suggested that individuals with DISH mayhave elevated d15N values compared to the average pop-ulation. The large number of skeletons affected by DISHor lesions suggestive of DISH in the Aalst assemblagemakes it an ideal site to test these observations.

The Carmelite friary of Aalst (Flanders, Belgium)

The remains of the Carmelite friary at Aalst were dis-covered in 2004/2005 during rescue excavations at theHopmarkt, a marketplace in the center of Aalst (prov-ince of East Flanders, Belgium) (Fig. 2). Excavation ofthe church, parts of the cloister alley and the cloistergarth unearthed human remains, dating from the end ofthe 15th century to the end of the 18th century AD inall three locations (Fig. 3). Unfortunately, a major partof the church was destroyed by the construction of abunker during WW II. Historical sources indicate thatthe friary at Aalst was founded in 1497 but experienceddestruction during the religious wars of the 16th centuryAD. Nevertheless, the monastic community recoveredand prospered until 1797, when the friary was aban-doned as a result of anti-clerical movements during theFrench Revolution.

The friars at Aalst were Carmelites of the AncientObservance, one of the mendicant orders. Initiallyobliged to absolute poverty, mendicants settled in

Fig. 2. Map showing the location of Aalst.

DIET, SOCIAL STATUS AND DISH 205


European towns and cities to preach from the 13th cen-tury onward but were relatively soon taken up into theecclesiastical establishment (Smet, 1988; s.n., 1989; Bur-ton, 1994; Lawrence, 2004). Friary grounds were popularlocations for burial among late medieval townspeople,who sought spiritual benefit from the friars’ intercessoryprayers and often paid considerable sums in return.This tradition continued into the post-medieval period,when burials in friaries remained sought after by thewell-off laity who considered it more prestigious than agrave in or around the local parish church (Van Nuffel,1908; De Groote et al., 2011). Based on the historicalburial records of the friary at Aalst (De Groote et al.,

2011), it is indeed clear that both lay men and women(including subadults) were buried in the church, thecloister alley and the cloister garth, a fact confirmed bythe physical anthropological evidence (i.e., the presenceof female and subadult skeletons). Unfortunately,because of the uniformity of the burial rite, it is usuallyimpossible to distinguish burials of friars from those of(male) lay people. However, the archives indicate thatthe inhabitants of the friary were preferentially buriedin the cloister alley, which is consistent with a concen-tration of male skeletons in this part of the site (DeGroote et al., 2011). While, at least where male individu-als are concerned, the skeletal assemblage therefore

Fig. 3. Map of the excavated building remains of the Carmelite friary at Aalst, with location of the burials (De Groote et al.,2011). The filled pin-heads represent the skeletons excavated including the cranium, the empty pin-heads have been found withoutcranium.



represents a mixed lay and monastic population, it isreasonable to assume that a relatively large number ofthe males buried in the cloister alley were members ofthe Carmelite order.

Some of the documents from Aalst give the exact costfor burial in a specific location within the friary (DeGroote et al., 2011; p 127). According to these, burial inthe church was more expensive than a grave in the clois-ter area (the sources unfortunately do not differentiatebetween alley and garth), reflecting the medieval idealof being buried in the vicinity of the altar (Sapin, 1996).Thus, it is likely that the church mainly contained theskeletons of the wealthier (lay) people. So, despite theapparent uniformity of the Christian burial ritual, post-medieval burials can still be differentiated in terms ofsocial background and status of the dead by their buriallocation, as is known from the medieval period (Daniell,1997; Gilchrist and Sloane, 2005). For a more detailedaccount of the history of the site, the features excavated,and of the study of the human remains the reader isreferred to De Groote et al. (2011).

MATERIALS AND METHODS

For this study, 39 individuals from a total of 238 skele-tons recovered during the excavations were sampled forcarbon and nitrogen stable isotope ratio analysis (Table1). These 39 individuals were selected from among theadults for whom sex and age-at-death could be deter-mined, and chosen to include individuals buried in dif-ferent locations: the church, the cloister alley, and thecloister garth, as well as those that displayed character-istic lesions of DISH (Table 2).

Standard osteological methods were applied to deter-mine sex and age. Sex was primarily identified on thebasis of morphological features on the pelvis and skull(Phenice, 1969; Ferembach et al., 1980). Additional meas-urements were also taken from the long bones (Bass,2005). The age determination of the adults was based onthe assessment of degenerative changes of the skeletonand teeth (Brothwell, 1963; Buikstra and Ubelaker, 1994;Bass, 2005; Schmitt, 2005) generally leading to a subdivi-sion of the adult individuals into 10-year intervals albeitthat individuals were later lumped into broader catego-ries for interpretation purposes (see below). The criteriaformulated by Rogers and Waldron (2001) were used forthe identification of DISH. However, incomplete preserva-tion sometimes hindered a full differential diagnosis.Therefore, when excess new bone formation in the spinewas observed, with a predilection for the right side andpreservation of disc spaces, in combination with severebilateral enthesophytosis in the postcranial skeleton,these specimens were identified as “probable DISH,” even

if the pathognomonic lesion, the ossification of the ante-rior longitudinal ligament affecting at least three adja-cent vertebrae (with/without fusion), could not beobserved. Both “DISH” and “probable DISH” groups onlyconsisted of males older than 40 years and were almostexclusively found in the church and the cloister alley(Table 3) (De Groote et al., 2011).

Samples for stable isotope ratio analysis were collectedfrom the ribs or, if no ribs were available, from diaphys-eal long bone fragments. For individuals with DISH, twosamples were taken, one from the ribs (unaffected bonetissue), the other from newly formed bone in the verte-bral spine (pathologically altered bone tissue). The aimof this sampling strategy was to compare normal andpathological bone as a methodological test, since it hasbeen suggested that some pathological conditions havean effect on bone stable isotope ratios (White and Arme-lagos, 1997; Katzenberg and Lovell, 1999), independentof the diet of an individual.

To understand the trophic context for the human iso-tope data, a range of contemporaneous terrestrial animalsamples (n 5 15), from consumption refuse excavated atthe site (Lentacker et al., unpublished data), was ana-lyzed. The samples consisted of cattle, sheep and pigbones. Isotopic data from fish bone are not availabledirectly from the site, but results from a range of speci-mens from the nearby Scheldt River basin and the NorthSea are used for comparison (n 5 56: Fuller et al., 2012).

The bone collagen from these 15 animals and 39human bone samples was extracted at the Departmentof Human Evolution, Max Planck Institute for Evolu-tionary Anthropology in Leipzig, Germany, using theprotocol outlined in Richards and Hedges (1999), modi-fied to include a final stage of ultrafiltration prior tolyophilization, as described in Brown et al. (1988).Where possible all samples were measured in duplicate.Repeat analysis of in-house standards gave standard

TABLE 1. Total number of skeletons studied from the post-medieval Carmelite friary at Aalst (De Groote et al., 2011)

(“unknown” indicating transitionary positions)

ChurchCloister

alleyCloisterGarth Unknown Total

Adult male 42 52 27 4 125Adult female 36 11 14 2 63Adult

indeterminate10 7 3 1 21

Subadult 8 5 16 0 29Total 96 75 60 7 238

TABLE 2. Frequency of skeletons diagnosed with DISH (DeGroote et al., 2011), by sex and age group, by burial area

(“unknown” indicating transitionary positions)

ChurchCloister

alleyCloisterGarth Unknown Total

Adult male 4/42 6/52 1/27 1/4 12/125% 9.5% 11.5% 3.7% 25.0% 9.6%Total skeletal

sample4/96 6/75 1/60 1/7 12/238

% 4.2% 8.0% 1.7% 14.3% 5.0%

Note that DISH was only identified in male adults.

TABLE 3. Skeletons sampled for stable isotope ratio analysisbased on sex and burial location

Church Cloister alley Cloister garth Total

Adult male 5 5 5 15Adult male

with DISH3 6 1 10

Adult female 6 3 5 14Total 14 14 11 39

A distinction is made between male individuals with DISH (and“probable DISH”) and male individuals without DISH. DISHindividuals were sampled both from pathological bone (verte-bra) and non-pathological bone (rib or long bone).



errors of <0.2& for both d13C and d15N values. Becauseof small sample sizes and non-normally distributed sub-groups, statistical significance between the characteris-tics of two groups was determined using non-parametricMann-Whitney U tests. Where more than two groupswere to be compared, nonparametric Kruskal–Wallis Hone-way ANOVA tests were applied, followed up in caseof significance by Bonferroni-adjusted Mann–Whitneypost hoc tests. Results were considered significant atP�0.05 or, when Bonferroni-corrected, the alpha level0.05 was divided by the number of paired comparisonsto be made.

RESULTS

A summary of the archaeological information and theisotopic results is given as Supporting Information inTable S1. Comparison between non-pathological (ribs)and pathological bone (affected vertebrae) of individualswith DISH reveals no systematic trend (SupportingInformation Fig. S1). Moreover, in the majority of thecases, differences do not exceed 0.2& and are thereforewithin the analytical error of the mass spectrometer. Inthe following, in order to not artificially inflate the sam-ple size by having two samples from the same individu-als, only the results for the samples of non-pathologicalbone will be discussed.

Clear differences are observed between the humans,the terrestrial mammals, the freshwater and the marinefish (Fig. 4, fish data after Fuller et al., 2012). For thehuman samples (non-pathological bone only), the d13Cvalues range from 220.5& to 218.5& with a mean of219.6& 6 0.5& (1 s.d.), while the d15N values rangefrom 9.9& to 13.5&, with a mean of 11.9& 6 0.9&. As awhole, the human d13C and d15N values display a moder-ate positive correlation (R2 5 0.50; P 5<0.001).

The data distributions of males (n 5 25) and females(n 5 14) overlap at one standard deviation (Table 4).Nevertheless, the differences between the two sexes arefound to be statistically significant for both elements(Mann–Whitney U tests: d13C: P 5 0.001, d15N: P 5 0.02).

No statistically significant differences are foundbetween the non-pathological bone samples of the “DISH”and the “probable DISH” group (Mann–Whitney U tests:d13C: P 5 0.9, d15N: P 5 0.6). For the purpose of furthertesting, these data are therefore combined representingthe “DISH population.” Comparing the data by sex (maleswith and without DISH and females), a significant Krus-kal–Wallis H test (d13C: P 5 0.003; d15N: P 5 0.03) fol-lowed by Mann-Whitney tests with Bonferroni correction(adjusted a-level is 0.05/3 5 0.017). revealed interestingdifferences. When males with DISH (n 5 10) are com-pared to males (n 5 15) and females without DISH(n 5 14) through Mann-Whitney post-hoc tests, no statis-tically significant differences are found between the twomale groups (d13C: P 5 0.4; d15N: P 5 0.2). However, thefemales have significantly lower carbon and nitrogen iso-tope values than the males with DISH (d13C: P 5 0.002;d15N: P 5 0.01) and significantly more negative d13C thanthe males without DISH (d13C: P 5 0.01; d15N: P 5 0.1)(Table 4, Fig. 4).

To create sufficiently large samples for statistical anal-ysis and bearing in mind that DISH predominantlyaffects individuals over 40 years of age, the age catego-ries are pooled into two groups: “younger” (20–40 yearsold) and “older”(>40 years old) (Table 5). No statistical

Fig. 4. Stable isotope data (d13C and d15N) from human skeletons (n 5 39) from the post-medieval Carmelite friary at Aalst(with distinction made between females, males without and males with DISH). Data from three domestic mammal species (n 5 15),sampled from consumption refuse from the site, represent the terrestrial animal protein in the former humans’ diet. The fish dataare derived from a general study for Flanders (Fuller et al., 2012).

TABLE 4. Summary of isotopic results from males (with andwithout DISH) and females

n

d13C (&) d15N (&)

Mean 6SD Mean 6SD

Males with DISH 10 219.3 0.6 12.5 0.7Males without

DISH15 219.5 0.5 12.0 0.9

All males 25 219.4 0.6 12.3 0.9Females 14 220.0 0.3 11.4 0.8



differences are noted between the isotopic values of theyounger (n 5 11) and older males (including the oneswith DISH, n 5 14) (Mann–Whitney U tests: d13C P 5 0.4and d15N P 5 0.1) and between those of the younger(n 5 11) and older (n 5 3) females (Mann–Whitney Utests: d13C P 5 1.0 and d15N P 5 1.0).

Interesting differences are observed when the humandietary values are compared between burial locations atthe friary: cloister alley (n 5 14), church (n 5 14), andcloister garth (n 5 11) (Fig. 5, Table 6). The results of aKruskal–Wallis H test are significant for carbon but notnitrogen (d13C P 5 0.03 and d15N P 5 0.1). A Mann–Whit-ney U test with Bonferroni correction (adjusted a-levelis 0.017) demonstrates that individuals buried at thecloister garth have the most 13C-depleted results andare significantly different from those buried in thechurch (P 5 0.009) (Table 7). No statistical differenceswere found between burial locations for the two sexesseparately (Kruskal-Wallis H tests: males: d13C P 5 0.2and d15N P 5 0.4, females: d13C P 5 0.1 and d15NP 5 0.2).

DISCUSSION

General trends

The wide range of human stable isotope ratios (Fig. 4)suggests dietary diversity within the population. In par-ticular, the linear patterning in the individuals and theelevated d15N values in part of the population indicatethat there were varying degrees of protein consumptionfrom terrestrial plants, domestic animal products (pig,sheep, and cattle) to marine foods. Contextual evidencegives no indication that C4 plants (millet or New Worldfoods such as maize or sugar cane) were important for thediet in early modern Flanders or the surrounding areas(K€orber-Grohne, 1994; Kn€orzer et al., 1999) and theobserved positive correlation between d13C and d15N val-ues also indicates that marine foods, consumed in varyingproportions by a large part of the population, are the bestexplanation for the 13C-enriched values observed. Cer-tainly, these results are in agreement with the archaeo-zoological records from the site where marine fish (gadids,flatfish, and herring) were abundant and yielded morebiomass than the freshwater fish (Van Neer and Ervynck,unpublished data). Freshwater species are generally lessimportant than marine fish in post-medieval consumptioncontexts in Flanders (Van Neer et al., in press).

Comparative isotope data from the post-medievalperiod are nonexistent in Belgium and scarce elsewhere.Post-medieval datasets from England date mostly to thelate 18th and 19th century, somewhat later than theAalst samples (16th–18th c. AD). Of these, humans fromLondon and York especially demonstrate isotopicallyvery similar diets to the Aalst population, including theconsumption of marine fish in measurable quantities(M€uldner and Richards, 2007; Nitsch et al., 2010; Beau-mont et al., 2013). In other populations, a marine contri-bution to the diet is less clear, although possiblyobscured by dietary breadth and, in some cases, the

TABLE 5. Summary of isotopic results from males and femalesby age category

n

d13C (&) d15N (&)

Mean 6SD Mean 6SD

Younger males 11 219.6 0.5 11.8 1.0Older males 14 219.3 0.5 12.4 0.7Younger females 11 220.0 0.3 11.4 0.7Older females 3 219.9 0.5 11.4 1.3

Fig. 5. Stable isotope data (d13C and d15N) from human skeletons (n 5 39) from the post-medieval Carmelite friary at Aalst,with distinction made between burial location (raw data, mean values and error ranges representing 1 standard deviation).



consumption of C4 foods (Richards et al., 2006; Robertset al., 2012). Like the isotope values from London andYork, the results from Aalst are also remarkably similarto data from late medieval sites, in Belgium (Polet andKatzenberg, 2003) and other countries surrounding thesouthern North Sea, i.e., England (M€uldner and Rich-ards, 2005, 2007) and Denmark (Yoder, 2010, 2012), sug-gesting long-term continuity, at least in urbanconsumption patterns. The suggestion that fish con-sumption in post-Reformation England significantlydeclined over time (Spencer, 2004; Thirsk, 2007) is there-fore not fully supported by the available evidence.

Male vs. female diet

Distinct and statistically significant differences betweenthe diets of the males and females at the site of Aalst areobserved (Table 4, Fig. 4). The males display a wide vari-ation in their isotopic results, but, on average, exhibithigher d13C and d15N values than the females, reflectinga greater component of (terrestrial and marine) animalprotein in the male diet. The isotopic results of thefemales are more tightly clustered than observed for themales, indicating that their diet was less varied andincluded fewer animal products and marine foods.

Again, the closest parallels to the data presented herecan be found in late medieval populations, where malevs. female differences in diet, and especially increasedconsumption of marine resources by males, was observedby several authors (Richards et al., 2006; M€uldner andRichards, 2007; Kjellstr€om et al., 2009; M€uldner, 2009;Reitsema et al., 2010; Reitsema and Vercellotti, 2012). Itis likely that these dietary variations were a reflection ofthe different gender roles men and women had in medie-val society (see M€uldner, 2009), and the isotopic evidencefrom Aalst therefore again suggests a continuity of thesesocial divisions into the early-modern period.

Nevertheless, it must be remembered that the maleskeletal population from the Aalst friary consisted of bothlay and monastic individuals, which cannot be entirely dis-tinguished on the basis of their burial context. It is there-fore possible that specific characteristics of the diet of thefriars contributed to the observed differences between themale and female dataset. Appropriately for members of amonastic order, the friars should, in theory, have lived inaccordance to food rules that led them to consume anincreased amount of fish over the course of the year (seeWoolgar, 2006; M€uldner and Richards, 2007), but it is

unclear how strictly the Carmelites followed these regula-tions by the 16th century. However, for the friary at Aalst,historical records (Vernaeve, unpublished data) and thearchaeozoological evidence (Lentacker et al.; Van Neer andErvynck, unpublished data) demonstrate the consumptionof meat and marine fish in ample amounts. Greater con-sumption of animal protein including fish may of coursehave been nothing more than the effect of a wealthier dietinstead of a strict obedience of religious food rules, as his-torical evidence already suggested for the late medievalperiod (see van Dam, 2009). The archaeozoological recordfrom Flemish monasteries nevertheless suggests thatmonks consumed more fish than laymen. At the sametime the evidence shows that a complete prohibition ofmeat consumption was never the case, and certainly not inpost-medieval times (Ervynck, 1997).

Burial location

Comparison of individuals buried in different areas of thefriary (church, cloister alley, and cloister garth), revealed afurther dimension of isotopic differences. With the exceptionof a single male (AAHOP 280), individuals buried in thecloister garth had significantly lower d13C and d15N values,regardless of their sex, indicating that their diet includedlittle, if any, marine protein (Fig. 5). A Kruskal–Wallis Htest confirmed that there are statistically significant differ-ences in d13C between individuals buried at the differentlocations. Further testing found that the individuals buriedin the cloister garth had more d13C-depleted results com-pared to the individuals buried in the church (Tables 6 and7). By contrast, no differences, neither in the averages norin the range of isotope values, were observed between indi-viduals from the cloister alley and the church, suggestingthey consumed a similarly diverse diet with varying contri-butions of meat and marine protein. Because the friarswere preferably buried in the cloister alley (and the churchcontained the burials of the richer townspeople), thisimplies that the diet of the (predominantly) monastic partof the buried population is isotopically indistinguishablefrom that of the richer lay population. Thus even whenthere were differences in the composition of a (richer) layand a monastic diet (respecting food rules theoretically lead-ing to increased fish consumption, see Woolgar, 2006), thisresulted in a similar isotope signal.

Comparing the sexes separately by burial locationrevealed no significant differences, which is probablydue to the small sample sizes and/or unequal distribu-tion of males and females among the burial locations.

TABLE 6. Summary of all isotopic results based on sex andburial location

n

d13C (&) d15N (&)

Mean 6SD Mean 6SD

MalesChurch 8 219.3 0.4 12.1 0.9Cloister garth 6 219.8 0.5 11.9 7.0Cloister alley 11 219.3 0.6 12.4 0.9FemalesChurch 6 219.8 0.3 11.6 0.6Cloister garth 5 220.2 0.2 10.9 0.9Cloister alley 3 219.9 0.4 11.7 0.9Combined sampleChurch 14 219.4 0.5 12 0.9Cloister alley 14 219.4 0.6 12.4 1.1Cloister garth 11 219.9 0.4 11.5 0.9

TABLE 7. Results of the non-parametric Bonferroni-correctedMann–Whitney U tests by sex by burial location

Statistical comparisons d13C d15N

MalesChurch vs. cloister garth 0.03 0.5Church vs. cloister alley 0.9 0.5Cloister garth vs. cloister alley 0.2 0.2FemalesChurch vs. cloister garth 0.0 0.1Church vs. cloister alley 0.6 1.0Cloister garth vs. cloister alley 0.3 0.2Combined sampleChurch vs. cloister garth 0.009* 0.2Church vs. cloister alley 0.8 0.3Cloister garth vs. cloister alley 0.1 0.04

*5 statistically significant value, P 5�0.017.



Based on historical sources which detail the prices forlay burial in different parts of the monastery, the mostexpensive burial locations were inside the church. Thesedocuments unfortunately do not discriminate betweenthe cloister alley and garth; however, based on historicalarchives and the anthropological evidence (i.e., high con-centration of male skeletons) friars were preferentiallyburied in the cloister alley, while all areas, church, clois-ter alley and garth, contained burials of the richertownspeople (i.e., those that could afford burial insidethe friary) (De Groote et al., 2011). While the mixing offriars and lay people in the different burial zones mayhave obscured some of the existing variation, the lack ofsignificant differences between the cloister alley and theother burial locations nevertheless suggests that the dietof the (predominantly) monastic part of the buried popu-lation was isotopically indistinguishable from that of thewealthy lay people of Aalst.

The cloister garth was likely used by lay people whowere less affluent than those buried in the church. Thestable isotope ratios vary by burial location, and this islikely related to dietary differentiation based on socio-economic status. At the later medieval Gilbertine prioryof St. Andrew, Fishergate in York (M€uldner and Richards,2007), it was also noticed that the individuals buried atthe cloister garth had consumed significantly less marineprotein than those from other locations, although here itwas suggested that the area received burials from indi-viduals outside the regular group of townspeople.

There are several isotopic studies that have reportedsocial variation within Christian burial populations asreflected in the diet of the deceased, for varying reasons(Mays, 1997; Richards et al., 1998; Herrscher et al., 2001;Polet and Katzenberg, 2003; M€uldner and Richards, 2007;Kjellstr€om et al., 2009; M€uldner et al., 2009; Yoder, 2012).In the case of Aalst, we suggest that increased consump-tion of animal products, including marine foods, was pri-marily related to wealth and status during this period(see van Dam, 2009). Isotopic variation in the populationmay not only have arisen by differences in the proportionsof animal products consumed but also from the specificchoice of marine products The cheaper herring, consumedin large quantities by the less wealthy, has lower d13C andd15N values than the more expensive and larger gadids(cod, haddock: fish higher up in the marine food chain)consumed by the richer town inhabitants (van Dam, 2009;see Fuller et al., 2012 for fish isotope data).

DISH

The purpose of this research was to test if DISH couldbe linked to a high protein diet as this has been sug-gested as a possible cause of the condition in archaeolog-ical populations (Waldron, 1985; Rogers and Waldron,2001; Mays, 2006). This test case of the post-medievalfriary yielded some new elements for the interpretationof DISH in former populations. From a methodologicalpoint of view, there is the fact that, for individualsafflicted with DISH, bone samples taken from normal(ribs) and pathological bone (vertebrae) showed littlesystematic differences and most of the changes werewithin the error of the mass spectrometry (0.2&) (Sup-porting Information Fig. S1). The few examples that doshow significant isotopic differences (�2&), may simplyhave been the result of dietary changes through life.DISH therefore does not appear to be one of the patho-logical conditions that have an effect on the stable iso-

tope composition of bone (see Katzenberg and Lovell,1999; White and Armelagos, 1997).

DISH was found in higher frequencies in the cloisteralley and the church, i.e., in the most expensive burialarea and that which contained the most burials of friars.As expected, only male individuals of older age wereaffected. Males with DISH showed slightly elevated d13Cand d15N results in comparison to the non-DISH males(Table 4, Fig. 4). However, these differences are not stat-istically significant, possibly as a result of the relativelysmall sample size. In general, it should be noted thatthe results for DISH individuals from Aalst show moreor less similar values compared to previous British stud-ies (M€uldner and Richards, 2007; Spencer, 2008, 2009),although the d15N values plot a little lower.

Although it is possible that all individuals with DISHin the Aalst population are monks, the data from Aalstcannot be used to establish a link between monastic lifeand DISH (as monks and lay males could not be discri-minated). Rather, the pattern of elevated isotope valuesfor DISH samples could well be a characteristic of simi-larities in the (wealthy) lifestyles of both monastic aswell as non-monastic (male) individuals (see Mays,2006). Finally, whether the absence of DISH in thefemales could be explained by a poorer diet or by somegenetic predisposition of the males, could not be deter-mined, because of the dietary differences between themales and females in the sample and the fact that therewere no females with very 15N-enriched isotope values(reflecting rich diets) in our sample set.

CONCLUSIONS

The diversity of diets reflected in the studied datasetfrom the post-medieval Carmelite friary at Aalst, Bel-gium, is evident in this pilot study, revealing social dif-ferentiation by ways of food consumption. Significantvariation is namely attested in the consumption ofmarine foods (and perhaps also meat) between malesand females. Males show the most 13C and 15N-enrichedisotope values. These results have parallels in otherpost-medieval data but mostly demonstrate remarkablecontinuity with medieval dietary patterns, suggestingthat the social and economic changes of the early mod-ern period had a limited effect on everyday life, asreflected in the diet. It must, however, be rememberedthat the male skeletal population from the Aalst friaryconsisted of both lay and monastic individuals. Variationis noticed between individuals buried in “higher” and“lower” status locations. Statistically significant differen-ces in carbon values are demonstrated between the clois-ter garth, which represents the “lower status” layburials, and the more prestigious burial area, thechurch. The isotopic data from the cloister alley and thechurch show large overlap, suggesting that a similarlyrich diet was enjoyed by the inhabitants of the friary,who were commonly buried in the cloister alley, and the“wealthy” (male) lay people who paid a substantial priceto be buried inside the friary. Finally, this study alsoaimed to contribute to a better understanding of a dis-ease attested in many archaeological populations, butstill poorly understood. It could not be proven but, at thesame time, nothing in the present isotope study contra-dicts a possible link between a protein-rich diet and thedevelopment of DISH. Further research using sulfur sta-ble isotope ratios or single amino acids in this area isnecessary.



ACKNOWLEDGMENTS

The authors thank Koen De Groote and Jan Moens, thearchaeologists of the site, for advice and discussions, AnLentacker for the animal bone identifications, as well asHans Denis for providing Figure 1 and Glenn Laeveren forpreparing Figure 2. All these people are employed by theFlanders Heritage Agency. Thank you to Dennis Braek-mans (Leiden University) and Maarten Vermeyen (Flan-ders Heritage Agency) for help with statistical analysis.

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