The Oxygen Advantage: The simple, scientifically proven breathing technique that will revolutionise your health and fitness

by Patrick McKeown

oxygen is the fuel that muscles need to work efficiently. It is, however, a common misconception that breathing in a larger volume of air increases the oxygenation of the blood. It is physiologically impossible to increase the oxygen saturation of the blood in this way, because the blood is almost always already fully saturated.

Oxygen saturation (SpO2) is the percentage of oxygen-carrying red blood cells (haemoglobin molecules) containing oxygen within the blood. During periods of rest the standard breathing volume for a healthy person is between 4 and 6 litres of air per minute, which results in almost complete oxygen saturation of 95 to 99 per cent. Because oxygen is continually diffusing from the blood into the cells, 100 per cent saturation is not always feasible. An oxygen saturation of 100 per cent would suggest that the bond between red blood cells and oxygen molecules is too strong, reducing the blood cells’ ability to deliver oxygen to muscles, organs and tissues. We need the blood to release oxygen, not hold on to it. The human body actually carries a surplus of oxygen in the blood – 75 per cent is exhaled during rest and as much as 25 per cent is exhaled during physical exercise. Increasing oxygen saturation to 100 per cent has no added benefits.

The idea of taking bigger breaths to take in more oxygen is akin to telling an individual who is already eating enough food to provide their daily caloric needs that they need to eat more. Many of my students initially have a hard time grasping this. For years they have been indoctrinated with the ‘benefits’ of taking deep breaths by well-meaning stress counsellors, yoga practitioners, physiotherapists and sports coaches, not to mention the Western media. And it’s easy to see why this belief is perpetuated: taking a large breath can actually feel good, even if it can actually be bad for you. Just as a cat enjoys a good stretch following a midday nap, taking a big breath into the lungs stretches the upper part of the body, allowing a feeling of relaxation to follow. But this leads many to believe that with breathing, bigger is better.

The rate and volume of breathing is determined by receptors in the brain that work in a way similar to a thermostat regulating the heating system in a home. However, instead of monitoring fluctuations in temperature, these receptors monitor the concentration of carbon dioxide and oxygen in your blood, along with the acidity or pH level. When levels of carbon dioxide increase above a certain amount, these sensitive receptors stimulate breathing in order to get rid of the excess gas. In other words, the primary stimulus to breathe is to eliminate excess carbon dioxide from the body.

Carbon dioxide is an end product of the natural process of breaking down the fats and carbohydrates we eat. CO2 is returned from the tissues and cells to the lungs via blood vessels and any excess is exhaled. Crucially, however, part of your body’s quotient of carbon dioxide is retained when you exhale. Correct breathing both relies on and results in the right amount of carbon dioxide being retained in your lungs.

Think of it this way: CO2 is the doorway which lets oxygen reach your muscles. If the door is only partially open, only some of the oxygen at our disposal passes through and we find ourselves gasping during exercise, often with our limbs cramping. If, on the other hand, the door is wide open, oxygen flows through the doorway and we can sustain physical activity longer and at a higher intensity.

One’s breathing volume can be two or three times the required amount without it being overtly noticeable. Once the pattern of overbreathing is established, it is often maintained by an occasional deep breath or sigh.

The crucial point to remember is that haemoglobin releases oxygen when in the presence of carbon dioxide. When we overbreathe, too much carbon dioxide is washed from the lungs, blood, tissues and cells. This condition is called hypocapnia, causing the haemoglobin to hold on to oxygen, resulting in reduced oxygen release and therefore reduced oxygen delivery to tissues and organs. With less oxygen delivered to the muscles, they cannot work as effectively as we might like them to. As counterintuitive as it may seem, the urge to take bigger, deeper breaths when we hit the wall during exercise does not provide the muscles with more oxygen but effectively reduces oxygenation even further.

As we age, blood vessels lose flexibility and reduce blood circulation throughout the body. It is no coincidence, therefore, that as men grow older, conditions related to reduced blood flow – including erectile dysfunction – become more prevalent. The potency of nitric oxide in opening blood vessels becomes clear when you realise that this simple gas plays a significant role in erection of the penis. This discovery, in fact, led to the production in 1998 of Viagra,

Taping the mouth at night ensures the benefits of good breathing during sleep, allowing you to fall asleep more quickly, stay asleep longer and wake feeling energised. The tape that I have found most suitable, as it is simple to use, hypoallergenic and light is 3M Micropore tape, which can be bought from most chemists. To help make the tape easier to remove in the morning, gently press the tape against the back of your hand a couple of times to remove some of the glue. All you need to do is tear off about 15cm of tape, fold a tab over at both ends to make removal easier in the morning, dry your lips, close your mouth and gently place the tape horizontally over the lips.

Abdominal breathing is more efficient simply because of the shape of the lungs. Since they are narrow at the top and wider at the bottom, the amount of blood flow in the lower lobes of the lungs is greater than in the upper lobes. The fast, upper chest breathing of people who chronically hyperventilate does not take advantage of the lower parts of the lungs, limiting the amount of oxygen that can be transferred to the blood and resulting in a greater loss of CO2. Not only this, but upper chest breathing activates the fight-or-flight response, which raises stress levels and produces even heavier breathing.

One way of tapping into your own natural resources is to purposely subject the body to reduced oxygen intake for a short period of time. When the human body is exposed to situations in which there are reduced oxygen levels – such as high altitude, or by holding the breath – adaptations take place that force the body to increase oxygenation of the blood. Even if you are not a competitive athlete, using these techniques will allow you to get the most out of your workout and accelerate whatever fitness programme you undertake. Who doesn’t want to do more with less effort?

Traditional altitude training methods involve living and training at a high altitude, forcing the body to adapt to exercising with less oxygen and therefore increasing the blood’s oxygen-carrying capacity.

Gently exhaling prior to holding the breath reduces air content in the lungs, allowing a quicker build-up of carbon dioxide and eliciting a stronger response. While this reduces the length of time for which you can hold your breath, increased carbon dioxide has been shown to improve haemoglobin concentration by around 10 per cent compared to a breath hold with normal carbon dioxide levels. Higher levels of carbon dioxide in the blood can produce an even greater contraction of the spleen, resulting in an increase in the release of red blood cells and therefore the oxygenation of the blood. Increased CO2 in the blood also causes haemoglobin to dissociate the oxygen it is carrying more readily. As described by the Bohr Effect, an increase in carbon dioxide decreases blood pH and causes oxygen to be offloaded from haemoglobin to the tissues, further reducing blood oxygen saturation. Holding the breath on the exhale also capitalises on the benefits of nitric oxide by carrying the gas into the lungs rather than expelling it. By exhaling and holding the breath, nitric oxide is able to pool in the nasal cavity so that when breathing resumes, air laden with nitric oxide is inhaled into the lungs.

Although heavier breathing brings greater quantities of oxygen to the lungs, it also increases the loss of carbon dioxide. As discussed earlier, the loss of carbon dioxide causes blood vessels to narrow and red blood cells to cling on to the oxygen they carry, resulting in reduced oxygenation of tissues and organs. Ironically, as the body breathes more intensely in an effort to take in more oxygen, less is delivered.

Our bodies strive to maintain a state of balance known as homeostasis, which includes normal blood pressure, normal blood sugar and normal blood pH within a narrow range of 7.35 and 7.45. This balance of chemicals is kept in check by the lungs and the kidneys. If blood pH drops below 7.35, blood will become too acidic, causing breathing volume to increase as the body offloads carbon dioxide (which is acidic) in an attempt to restore correct pH levels.

One small land-based mammal has managed to confound the overwhelming evidence to support the negative effects of oxidative stress. For the past few decades, scientists have studied the naked mole rat – a bald, blind creature that looks like a hot dog with teeth and lives for up to twenty-eight years, almost eight times longer than any other rodent. The naked mole rat lives in East Africa, where it is considered a pest by local farmers as it burrows tunnels underneath fields and eats vegetable crops. The breathing rate of the naked mole rat is very low in comparison to other rodents, and it lives in crowded colonies where there is little oxygen and high levels of carbon dioxide. As such, the naked mole rat is an excellent embodiment of the ‘less is more’ theory of breathing. This might also explain how, despite living with high oxidative stress from a young age, the naked mole rat maintains good health and longevity, and in all the years this rather ugly animal has been studied, it has never been known to develop cancer. Even when scientists have injected the mole rat with cancer-causing agents, the disease was resisted.

I soon discovered a study conducted by the University of Exeter that investigated the effects of increased dietary intake of beetroot juice, which is rich in the nitrates required to generate nitric oxide. A study group of men aged between nineteen and thirty-eight drank about 480ml of beetroot juice every day for a week. This resulted in a ‘remarkable reduction’ in the amount of oxygen required to perform exercise in comparison with a control group who drank water: the juice drinkers were able to cycle up to 16 per cent longer before tiring. Furthermore, blood pressure within the beetroot juice drinkers dropped (within normal levels), even though it wasn’t high to begin with.

Along with beetroot juice, essential nitric oxide-producing, heart-protecting food sources to include in your diet include fish, green vegetables, dark chocolate, red wine (a glass per day – not the bottle!), pomegranate juice, green or black tea and oatmeal porridge. Food sources to be limited in your diet include the usual culprits of meat and processed foods. Along with eating the right food, supplementing your diet with the amino acid L-arginine has been proven to increase nitric oxide production, although results vary depending on age and genetics. These simple changes to your diet, in addition to simply breathing lightly through your nose, may provide the key to lifelong cardiovascular health.

Quick Reference Summary of the Oxygen Advantage Programme Habitual overbreathing involves breathing more air than your body requires during rest and exercise. Overbreathing leads to: A reduction of the gas carbon dioxide in the blood Mouth breathing and under-utilisation of the gas nitric oxide Impaired release of oxygen from red blood cells (see the Bohr Effect, page 6) Constriction of the smooth muscle in the blood vessels and airways Adverse effects on blood pH Reduced oxygenation of working muscles and organs, including the heart and brain Increased lactic acidity and fatigue during exercise Limited sports performance Negative effects to overall health Benefits of practising the Oxygen Advantage programme include: Improved sleep and energy Easier breathing with reduced breathlessness during exercise Naturally increased production of EPO and red blood cells Improved oxygenation of working muscles and organs Reduction of lactic acid build-up and fatigue Improved running economy and VO2 max Improved aerobic performance Improved anaerobic performance

In the correct resting position, three-quarters of the tongue should press gently against the roof of the mouth, with the tip of the tongue placed just behind the top front teeth – the same place we put the tongue to make the ‘N’ sound ‘nuh’.