5 Simple Exercises for Correcting Anterior Pelvic Tilt

A model performing a variation of the lower back stretch. (Photo by TerenceKearns.com)

Anterior pelvic tilt may sound like some horrible bone disease, but it's actually a fairly common problem with posture. In fact, according to some fitness people and gym teachers, it may even be the most common postural deviation.

What is anterior pelvic tilt?

In anatomical terms, "anterior" refers to the "front" side of the body (the side your face is on), and "pelvic tilt" means that the pelvis is tilted to one side. In this case, the tilt is towards the front, like in the image below:



As you can see, the spine is naturally slightly curved, but in anterior pelvic tilt the curve is excessive compared to a neutral posture. According to some physiotherapists, a desirable tilt is 0-5 degrees in men and 7-10 degrees in women. You can estimate your tilt by standing with your back against the wall and measuring how much space is between your lower back and the wall. If you can fit one hand in there you're fine. If you can fit a couple of wine bottles you're in trouble.

But what exactly is the problem with the anterior pelvic tilt? Well, for one thing, it doesn't make your posture look very good – at least not if you're a guy. If you're a woman, you may be able to pull it off. An arched back is considered a feminine trait, after all. Still, there's no need to go overboard, because the second reason to avoid (excessive) anterior pelvic tilt is that it causes lower back pain, especially with old age. Besides, a protruding belly doesn't look good on anyone.

Identifying the muscles that need fixing

There are several good articles out there with intricate anatomical descriptions of the interplay between muscles related to pelvic tilt, so I'll skip the details here and just give a brief overview. The gist is that not using certain muscles eventually causes other muscles to overcompensate, which leads to some muscles becoming lengthened and weak and other muscles short and stiff. Here's a list of things that typically lead to anterior pelvic tilt (or characteristics of anterior pelvic tilt; it's difficult to say what causes what):

• Lengthened (weak) hamstrings
• Lengthened (weak) abdominals
• Lengthened (weak) glutes
• Shortened (tight) erector spinae
  
• Shortened (tight) hip flexors
  

Hamstrings are the long thick muscles on the back of your legs that flex the knee and extend the hip. Abdominals are the muscles around the torso. While the outermost muscle (rectus abdominus) is responsible for that six-pack look, it's the deeper muscles that have the biggest effect on posture. Glutes are simply the butt muscles.

The erector spinae (or spinal erectors) is a group of muscles in the back that supports the spine. Finally, hip flexors are a group of muscles near the pelvis that move the hip forward during walking and running.

Exercises for correcting anterior pelvic tilt

To fix the problem and bring the pelvic tilt back to normal levels, a set of exercises that target these issues is needed. In essence, we need to do two things:

1. Make the hamstrings, deeper abdominals and glutes stronger
2. Stretch the spinal erectors and hip flexors

There are numerous exercises that can be done to achieve these ends, and quite possibly the most effective ones are those that also involve weights and gym equipment. However, there are also exercises that you can do at home using only your body weight. It's these exercises we'll be looking at next.

Exercise 1: Glute bridge

This exercise, also known as supine hip extension or pelvic lift, strengthens both the glutes and the hamstrings. Here's the basic way to do it:


One variation of the exercise is to straighten one leg so that only one foot is on the ground, hold for a while and then do the same with the other leg.

Exercise 2: Front and side plank

Plank exercises are good for making the abdominal muscles stronger. In contrast to sit-ups, which mainly affect the superficial muscles, planks target the deeper muscles. In addition to the usual front plank where both feet and elbows are on the ground, you can do side planks:


This exercise can also be made more difficult by lifting one of the legs up and holding for at least 30 seconds.

Exercise 3: Lunge stretch

The lunge stretch exercise stretches the hip flexors. It's also called by various other names like hip flexor lunge, lunging hip flexor stretch, psoas stretch, etc. Depending on who you ask, you may get a different answer as to how to perform the exercise, but here's one way:


This exercise can also be done as a forward lunge, in which you begin from a standing position and then lunge forward and drop your hips towards the floor. Performed this way, you'll target glutes and hamstrings more than the hip flexors, unless you also do the stretch.

Exercise 4: Lower back stretch

The lower back stretch is an exercise that stretches the erector spinae. It's also known as all fours back stretch, back arch stretch, cat pose stretch, and various other names. Here's how to do it:


You can alternate between the two arches as seen in the video, but keep in mind that it's the upward arch that stretches the erector spinae.

Exercise 5: Supine pelvic tilt

Finally, here's an exercise imitating what you want to happen through all your hard work. Like planks, the supine pelvic tilt mainly targets the deeper abdominal muscles. Here's a good example of how to do it (nevermind the Swedish subtitles):


The exercise itself is very subtle, but it gives a good idea of what you're trying to achieve. You can alternate between short reps and holding the tilt for a longer period.

Summary and my experiment

The muscles that are required to maintain a natural posture don't get enough exercise during daily routines, especially if you work at a desk job. This causes some muscles to weaken and others to compensate. As a result, the pelvis tilts forward, which in turn results in a postural problem known as anterior pelvic tilt. Many people have some degree of (excessive) anterior pelvic tilt, whether or not they realize it.

There are several exercises that can be performed to train the muscles that are weakened (hamstrings, deeper abdominals and glutes) and stretch the ones that are overcompensating (hip flexors and the erector spinae). You may get better and faster results by combining many different exercises, but the ones shown here will get you started.

Personally, I recognize my posture from the first picture showing excessive anterior pelvic tilt. I also have occasional problems with pain in the lower back. Until now, I haven't really known what the precise issue with my posture was, but thankfully, I was pointed in the right direction by some members of the imminst.org forums.

So for my newest human experiment, I'll be doing these exercises (and possibly others as I discover them) at least three times a week and seeing whether I can fix my anterior pelvic tilt. Meanwhile, if you have suggestions for other and/or better exercises, please drop a comment and share them!

For more information on exercise and health, see these posts:

L-Carnitine, Exercise Performance & Oxidative Stress
Green Tea Extract Increases Insulin Sensitivity & Fat Burning during Exercise
Green Tea Extract Enhances Abdominal Fat Loss from Exercise
Coenzyme Q10, Exercise and Oxidative Stress

Alternate-Day Feeding and Weight Loss: Is It the Calories Or the Fasting?

Weight loss with one slice of pizza one day and anything you want on the next? (Photo by nettsu)

I don't know if you noticed, but a new study on intermittent fasting recently made headlines in several media. The paper basically found that alternate-day fasting (or "on-off fasting" as it was named in some articles) helped obese adults to lose weight.

That's not a huge surprise, really. If you're obese, it means you eat too much of the wrong foods and probably too often. Fasting every other day means you'll at least be eating them less often, if not less per se. However, the conclusions that have been drawn in various articles from the study seemed a little suspicious to me, so I decided to read the whole paper.

Indeed, the authors themselves appear to be somewhat confused as to what really caused the weight loss. So without further due, let's take a closer look at what the study actually found (link).

Study design

12 obese women and 4 obese men were recruited for the study. Mean age was 46 years, mean body weight was 96.8 kg, and mean BMI 33.8. Not exactly the featherweight league.

The study consisted of three phases. The first one was a 2-week control phase, during which the subjects were told to maintain their usual weight by eating and exercising as they normally would. In the second phase, which lasted for 4 weeks, all participants were given a standard menu containing 25% of their baseline energy needs on the fast days. On the feeding days they could eat as much as they wanted. The third phase, also 4 weeks, was similar to the second one. The only difference was that the participants could choose what they wanted to eat on their fasting days, as long as they only ate 25% of their baseline needs.

So, the first thing that sets this study apart from how most people do intermittent fasting is that they didn't consume zero calories during their fast. They just ate significantly less. The second thing is that the fasts began and ended at midnight. Most people (including me) start and end their fast sometime during the day, because it allows them to eat at least once a day. If the participants went to sleep before midnight, their "fasts" were significantly longer than 24 hours.

Their standard diets were also less than optimal in my opinion. Things like chicken fettucini, vegetarian pizza, chicken enchilada, cookies, and crackers aren't exactly paleolithic foods consistent with the idea of intermittent fasting. But then, this wasn't a paleo study, which explains why they were fed high-carb, low-fat foods. For the third phase, they were given diet tips by a registered dietitian:

On the ad libitum food intake day, subjects were instructed to limit fat intake to <30%> dairy options.

So more carbs and less fat once again. They probably took some of this advice and applied for their feeding days as well, which makes me wonder if they wouldn't have lost even more weight had they opted for low-carb foods instead. Still, as you can see from the results below, they did manage to lose weight even with this diet.

Results

During the first phase, there was no weight loss. This is unsurprising, since all the participants just kept on eating whatever made them obese in the first place. During the eight weeks of alternate-day fasting they did lose weight, however.

In the second and third phase the subjects lost weight at a rate of ~0.7 kg per week. At the end of the study, they had lost about 5.6 kg, most of which was fat. Mean BMI decreased from 33.7 to 29.9, while body fat percentage dropped from ~45 to ~42%.

Cholesterol levels were also reduced as a result of alternate-day fasting. HDL remained the same, but LDL decreased by almost 25%. This to me is a more impressive result than the weight loss, which I think could've been greater with proper food choices.

Systolic blood pressure was lowered by 4.4 mm Hg, but diastolic blood pressure remained the same. Heart rates varied throughout the study, but at the end, they were about 4 beats per minute lower than in the beginning.

Discussion

Okay, so everyone lost some weight and improved their LDL/HDL ratio on this modified version of intermittent fasting. But what exactly is behind these results? The first thing that came to my mind as I was reading the paper was: how much were these people eating on their feeding days? Surely that would have a drastic effect on weight loss.

Unfortunately, there's no mention of this in the paper. Yes, they were told they could eat ad libitum, but apparently they were not told to keep a record of what or how much calories they ate when they were not fasting. I know food diaries are generally unreliable (people tend to underestimate how much they eat), but it would've been better than nothing. The authors seem surprised that the subjects lost as much weight as they did:

We predicted that subjects would lose a total of 4.5 kg fat mass after 8 wk (on the basis of a 75% decrease in energy intake on the fast day, with no change in energy intake on the feed day). The actual fat mass lost (5.4 kg) exceeded our predictions.

With no change in energy intake on the feed day? I'm not sure where the authors got the idea that when you eat very little on one day, the next day you won't be extra hungry and compensate. That's certainly not my experience. On the contrary, I fully compensate for any missed calories by just eating twice as much the next day. Certainly not compensating can be done if one wants to, which may be what happened here:

This indicates that these subjects were also limiting their energy intake on the feed day, which may have occurred because the subjects knew they were enrolled in a weight loss trial.

On the other hand, some articles in the media (such as this one) have reported that there was a slight compensation going on:

On non-fasting days people typically ate between 100 percent or 125 percent of their calorie needs.

This statement is probably from a press release by the authors, but the paper itself is silent on the issue. In any case, if you're eating 75% less on one day and only 25% more the next, you're still 50% short.

That, in effect, makes this a study on caloric restriction, not intermittent fasting. How is it surprising in any way that people who eat half (or even less) than what they're used to manage to lose weight? Isn't that obvious? The amount of weight they lost is pretty much what you'd expect on a low-fat, calorie-restricted diet. And based on other studies, if they'd eaten more calories but restricted carbohydrates, they'd have lost more weight.

The whole point of intermittent fasting is that you don't have to restrict your energy intake, you just don't eat all the time. If energy intake is the same and yet there are health benefits, then we can conclude that it's the fasting that is behind them. If, at the same time, calorie intake is restricted, there's no way of knowing whether it's the reduced calories or the fasting that is the cause. And of course, if intermittent fasting leads to a voluntary reduction in energy intake, that tells us something too.

I have a feeling that eating the small meal every other day magically resulted in no hunger in this study. They were probably consciously limiting their food intake even though they were told they could eat as much as they want. The fact that the authors actually expected the participants to eat only their usual calories on feeding days makes me even more suspicious.

Try eating 500 kcal on one day and then seeing how you feel the next day. If you typically eat 2,000 kcal, somehow I don't think 2,500 kcal is going to cut it. I know it doesn't for me, at least not in the long term. As for this diet being much easier to follow than old-school calorie restriction (which the paper seems to suggest), I doubt it.

For more information on intermittent fasting and caloric restriction, see these posts:

Intermittent Fasting: Understanding the Hunger Cycle
Slowing Down Aging with Intermittent Protein Restriction
Caloric Restriction Improves Memory in the Elderly
Intermittent Fasting Reduces Mitochondrial Damage and Lymphoma Incidence in Aged Mice

The Long-Term Effects of Antibiotics on Health and Immunity

Garlic is the famous natural antibiotic. (Photo by stijn)

This is the third and last installment in a series of posts on immune function and gastrointestinal health. Given that the swine flu is still making rounds around the world, learning more about how beneficial bacteria can ward off viral infections has been very useful at least for me.

So far, we've seen that foods and supplements containing probiotics can reduce the occurrence and severity of the common cold. Probiotics also have other benefits, such as protection from cancer and increased resistance to cancer. We've also seen that another way to increase beneficial bacteria in the gut are prebiotics, which are a form of fiber found in foods such as Jerusalem artichoke and chicory root. The combinations of prebiotics and probiotics are known as synbiotics and may be superior to either one alone.

Antibiotics and resistant bacterial strains

The one group of biotics that's left to tackle is antibiotics. Most people have probably gotten a prescription of antibiotics at least once in their life. Most people are probably also aware that antibiotics are prescribed way too frequently these days by many doctors, even for health issues that antibiotics can't relieve. As antibiotics only work against bacterial infections, not viruses, taking them for flu symptoms is useless.

The commonly known problem is that as the use of antibiotics becomes more and more widespread, the bacteria become more and more resistant. This is especially common when people quit their antibiotics prescription halfway through because they "feel fine"; some of the surviving bacteria then mutate into more resistant strains and spread into other people.

In a way, there is an evolutionary war going on between medicine and bacteria, and while antibiotics are a fantastic discovery and have many applications, their overuse is a serious problem. That's why taking antibiotics "just in case" is not a great idea long-term.

Other health problems from antibiotics

If the well-being of the rest of humanity doesn't bother you all that much, there are also other, less known reasons to stay away from antibiotics unless you actually need them. Let's look at some of the evidence showing the harmful effects of antibiotics.

Most of the negatives stem from the positive fact that antibiotics are so effective. The problem is that antibiotics are not as specific as we'd like: while they do destroy harmful bacteria, they also destroy beneficial bacteria. That's why it's never recommended to take probiotics at the same time with antibiotics, because the probiotics are just rendered useless.

Since one of the functions of intestinal bacteria is to aid in food digestion, it's no surprise that antibiotics can cause digestive problems. Diarrhea occurs in about 25% of patients receiving antibiotics (link). Probiotics, on the other hand, can counter some of this effect. At least Lactobacillus GG and Saccharomyces boulardii appear to be effective. As mentioned before, leave about 3 hours between taking antibiotics and probiotics to avoid killing the beneficial bacteria right away.

The effect of antibiotics may be especially pronounced in babies, whose bacterial colonies have not yet matured. In one study, rats who were given an antibiotic for 10-17 days saw a near complete eradication of Lactobacillus in the intestine along with a drastic reduction in other bacteria (link). This would obviously have a negative effect on immunity in general.

Another group to whom antibiotics may pose a real danger are the critically ill. One study showed that not only did the microflorarl biodiversity of patients in the intensive care unit significantly decrease with antibiotics, but there were also more organ failures and deaths in patients given antibiotics (link).

Antibiotics also seem to have a negative effect on phytoestrogens. The levels of the lignan enterolactone, a type of phytoestrogen, were significantly lower in men and women who had taken oral antibiotics up to 16 months before measurement (link). The reduction was associated with the number of treatments and time from last treatment. Although not life-threatening, this reduction should be of some concern to those who are taking for example flax lignans for hair growth or other health benefits.

Long-term impairment of immunity from antibiotics

If the above reasons didn't put you off antibiotics for good, here comes the worst part: the previously unknown long-term effects of antibiotics.

Until recently, the effect of antibiotics was thought to be temporary. As long as you took your prebiotics at least 3 hours after your antibiotics, you'd be fine. Any long-term changes in intestinal microflora were considered to last only a few months, after which everything would return to normal.

Unfortunately, some new studies have begun to show that this is not necessarily the case. A study funded by the Finnish Academy found that the earlier estimates were too conservative, and that the effects of antibiotics on intestinal bacteria were visible even after a year (link). Surprisingly, they also discovered that using one type of antibiotic (such as penicillin or tetracycline) increases the resistance of bacteria to other types of antibiotics as well. The old idea of switching to a different antibiotic to avoid resistance doesn't seem so good after all.

A study from last year confirms these findings. Using a novel method of observing the human gut microbiota, the authors found that antibiotic treatment "influenced the abundance of about a third of the bacterial taxa in the gut, decreasing the taxonomic richness, diversity, and evenness of the community" (link). While the conditions partly returned to normal after four weeks, several bacterial taxa failed to recover even after six months.

Conclusion

While antibiotics certainly have their uses, taking them when unnecessary can be harmful in many ways. Here's a summary of the negatives:

• Increased resistance to antibiotics
• Diarrhea and digestive problems
• Reduction in beneficial phytoestrogens
• Impaired immunity, especially in children and the critically ill
• Long-term changes in gut microflora

Since antibiotics, by definition, are substances or compounds that kill or inhibit the growth of bacteria, it's good to keep two things in mind. First, antibiotics destroy not only bad bacteria but also good ones. Second, antibiotics are only effective against bacteria, not viruses. So before getting antibiotics for an infection, make sure it really is a bacterial and not a viral infection (the common cold, for example, is a viral infection).

For more information on health and immunity, see these posts:

Prebiotics, Synbiotics and the Immune System
The 7 Types of Aging Damage That End up Killing You
Intermittent Fasting Reduces Mitochondrial Damage and Lymphoma Incidence in Aged Mice
Swine Flu and Avoiding the Cytokine Storm: What to Eat and What Not to Eat?

Teeth Whitening Experiment: Plus White 5 Minute Bleach Whitening Gel

Do vampires dream of electric teeth?

It's been about three months since my last update on the teeth whitening experiment. This experiment is my attempt to find safe ways to whiten my teeth and keep gums from receding. Given that I drink copious amounts of green tea and coffee daily, the whitening part has proven rather challenging.

For those who haven't been following the blog for very long, here's a quick recap. The first toothpaste I tried was Beverly Hills Formula Natural White, which I found in a grocery store while abroad. On paper, this toothpaste had all the good stuff – including coenzyme Q10 and green tea extract – but I didn't really see any real results. For the next few months I turned to Colgate Sensation White with its "micro-cleaning crystals". Again, no visible whitening of the teeth.

After Colgate it was time to try an ordinary store brand. The product I tried contained a combination of hydrated silica and triglycerides, which were supposed to work together to remove plaque and whiten the teeth. Granted, my teeth didn't get any more discolored despite all that tea, coffee, dark chocolate, and turmeric, but still, they didn't get any whiter either.

So now, after discovering that none of these whitening toothpastes seem to have any real whitening effect, I've brought out the big guns. Or at least slightly bigger than those pathetic toothpastes. This product is called Plus White 5 Minute Bleach Whitening Gel (for sensitive teeth), which is not a toothpaste per se but a gel that you leave on the teeth for a few minutes.

The whitening effect of this gel is based on hydrogen peroxide, a common ingredient in DIY teeth whitening products, and best of all, a substance actually proven to whiten teeth. You could probably make a very similar gel at home if you got your hands on some hydrogen peroxide, but I took the easy way and ordered the product online (since they don't sell Plus White in Europe, at least not in Finland). With international shipping it was a bit costly, but if you live in the US, you can get this stuff for a few dollars in several retail stores.

The instructions say to apply the gel on the teeth twice a day and leave it on for five minutes. After two weeks of use, you can start applying it less often. I'm going to start by applying it once a day to track any possible whitening effects more carefully. I'll probably be too lazy to take pictures, though, as it's a hassle to get the lighting right to make any worthwhile comparisons of tooth color. But rest assured, once I see results (or once I run out of the stuff), you'll be the first to know.

I have to say this is the first teeth whitening product that I actually expect to work. But then, I've seen absolutely no effect from so many supplements I've experimented with that I won't be too surprised if it doesn't. I'm just worried that if this doesn't work, the next step is going be an expensive visit to the dentist.

For more information on oral health, see these posts:

Tea, Coffee and Cocoa: All Good for Your Teeth
Dental Health Effects of Green and Black Tea
The Role of Coenzyme Q10 in Oral Health
Preventing Mouth Ulcers with Tea Tree Oil Toothpaste - Results after Two Months