The Oxygen Advantage Book Review

The Oxygen Advantage Book Review



  • Breathing through your nose is more important than I realised
  • Nitric Oxide is produced in the sinuses
  • CO2 is needed to release O2 from red blood cells
  • Simulated high altitude training can increase natural production of EPO

A couple of months ago I dealt with a fairly serious case of pneumonia which knocked my training right off track. Spending almost a month unable to breathe properly and feeling fatigued all the time because my body wasn’t getting a good enough supply of oxygen was making me fat and depressed.

So I decided as soon as I was in shape to start training again I needed to do something about building my lungs back up and increasing my aerobic capacity.

The thing is, I’m not a fan of most traditional aerobic type exercise like steady state running, rowing or biking and jumping around trying to keep up with an instructor at a Zumba or boxercise class isn’t my cup of tea either. (Not to knock those types of things they’re just not for me)

So when I heard Patrick Mckeown on the Ben Greenfield podcast talking about his book The Oxygen Advantage and how it was possible to improve your aerobic fitness using breath holds alone I was intrigued to say the least.


After listening to the podcast and trying out the breath hold technique for unblocking your nose I decided to buy the book.

The book begins with explaining and really driving home the importance of breathing through your nose, for both inhalation and exhalation.

One of the main reasons for this is the fact that nitric oxide is produced and released by the sinuses to both clean the air you breath in, NO is a strong antimicrobial, and open up your airways, it’s also a bronchial and vasodilator which is why it’s in a lot of pre-workout supplements to help with the pumpz for the gainz.

Another fun fact is that apparently humming increases the production of nitric oxide in the sinuses 15 fold! That seems like a lot but I looked into the science and it checks out…OK I read the abstract of a couple of studies on pubmed but you get the idea. So next time you have a bit of a blocked nose try humming a tune to help unblock it. I do this a lot now since I tend to get a stuffy nose a lot.

As well as all that lovely nitric oxide action breathing exclusively through your nose means that you are forced to take longer and slower exhalations as your nostrils are much smaller than your mouth. This tends to result in a calming effect since it activates the parasympathetic nervous system which puts us in ‘rest and digest’ mode, the opposite of mouth breathing which activates the sympathetic nervous system ‘fight or flight’ leading to stress and anxiety when constantly stimulated.

These are just a few of the benefits of exclusive nasal breathing that stuck out to me, the book outlines many more but I’m not going to list them all here you’ll have to buy the book if you want to know more.


Once I got my head around the importance of nasal breathing the next revelation was the bohr effect.

“The Bohr effect is a physiological phenomenon first described in 1904 by the Danish physiologist Christian Bohr: hemoglobin’s oxygen binding affinity (see Oxygen–haemoglobin dissociation curve) is inversely related both to acidity and to the concentration of carbon dioxide.” – Wikipedia


But what does that mean?

Well basically most people’s blood oxygen saturation level is between 95-99% even ‘unhealthy’ people. So the problem of getting more oxygen to your muscles and organs isn’t necessarily about getting more oxygen into the blood, but rather building up the carbon dioxide in your blood to force your red blood cells to realise that sweet sweet O2.

This is where the breath holding really comes into play. Using specialised breath hold techniques the idea is to train your body’s tolerance to the build up of CO2, or lack of oxygen, and lactic acid.


One of the ways to test these breath hold exercises are working is to check your BOLT score.  The BOLT (Body Oxygen Level Test) Score measures how much carbon dioxide we can accumulate while oxygen concentrations lower.  

To test your BOLT Score, After a normal exhalation, hold your breath until you get the urge to breathe again.  It is not about willpower, if you have to take a bigger inhalation than normal you tried too hard. This length of time is your BOLT score.  You should aim for 40 seconds (most people will be around 20 seconds).

My initial score was only 15 (yikes!) but I am recovering from pneumonia so that was kinda expected. After a couple weeks of nose breathing all day and doing breath holds whilst on walks I managed to increase my score to 18, not a massive improvement but again I’m recovering from illness.

Once I’d gotten my BOLT over 20 seconds I decided it was time to introduce strict nasal breathing into my workouts. I started off just trying to concentrate on breathing through my nose but once I reach a certain level of exhaustion I lose focus and end up breathing through my mouth instinctually.

So it was time to tape my mouth shut.

This was a game changer.

Being forced to make those longer slower exhalations through my nostrils instead of being able to blow off the carbon dioxide building up in my blood quickly through my mouth felt very uncomfortable. My body began to ache really quickly as the CO2 and lactic acid built up in my blood faster than usual which in turn required me to focus on my form and breathing pattern.

That was just whilst I was performing my set, you know after you’ve usually powered through a cardio session and gasping for air at the end? well that part sucks twice as hard when you’re only breathing through your nose. But you also get twice the payoff, forcing your body to become more efficient at processing and releasing oxygen to your muscles and organs.


The next step after mastering breathing exclusively through the nose whilst training is simulated altitude training. This involves using breath hold exercises after some kind of aerobic exercise to simulate the lower oxygen concentrations at high altitude.

Altitude training is the practice by some endurance athletes of training for several weeks at high altitude, preferably over 2,400 metres (8,000 ft) above sea level, though more commonly at intermediate altitudes due to the shortage of suitable high-altitude locations. At intermediate altitudes, the air still contains approximately 20.9% oxygen, but the barometric pressure and thus the partial pressure of oxygen is reduced.

At high altitudes, there is a decrease in oxygen hemoglobin saturation. This hypoxic condition causes hypoxia-inducible factor 1 (HIF1) to become stable and stimulates the production of erythropoietin (EPO), a hormone secreted by the kidneys, EPO stimulates red blood cell production from bone marrow in order to increase hemoglobin saturation and oxygen delivery. Some athletes demonstrate a strong red blood cell response to altitude while others see little or no gain in red cell mass with chronic exposure.It is uncertain how long this adaptation takes because various studies have found different conclusions based on the amount of time spent at high altitudes.

While EPO occurs naturally in the body, it is also made synthetically to help treat patients suffering from kidney failure and to treat patients during chemotherapy. Over the past thirty years, EPO has become frequently abused by competitive athletes through blood doping and injections in order to gain advantages in endurance events. – Wikipedia


Basically training or living at high altitude where the oxygen levels are lower than at sea level forces the body to adapt by producing EPO (the stuff Lance Armstrong was caught using in the tour de france) from the kidneys which in turn causes bone marrow to create more red blood cells making the body better at delivering oxygen where it’s needed.

If catching my breath after a set just strict nasal breathing was twice as uncomfortable than normal then these post set breath holds made it thrice as horrible.

I’ve only tried it a couple of times just to see how it feels because I don’t think I’m quite ready for these advanced techniques, but let me tell you, it sucks. The level of lactic acid and CO2 build up made things very uncomfortable, but that’s the point, we have to push our body into uncomfortable states to stimulate adaptation.

Another way to measure whether you are performing the breath holds correctly and not over or under doing it is to use a pulse oximeter. Those little devices they clip onto the end of your finger at hospital to check your pulse, well these also check the oxygen saturation of your blood. At sea level normal blood oxygenation levels varies from 95-99%. The benefits of breath holding start to occur when this drops below 94% whilst dropping below 80% can start to cause negative effects. So using a pulse oximeter whilst performing breath holds allows you to keep an eye out for over doing it or not creating enough drop in oxygen levels to force and adaptation.

Now you can buy a cheap pulse oximeter or you can buy an expensive one, the only real difference is response time of readings. Basically the cheaper ones have a bit of a lag displaying the changes in blood levels, this can be a bit of a pain as you tend to get the reading from your breath hold time after you’ve began breathing again, the more expensive oximeters have less lag so are easier to work with. But for £10 for the cheaper option and going into the hundreds for the advanced versions, a little lag isn’t the end of the world.

I know the last couple of descriptions might not exactly be selling the idea of nasal breathing and breath holds whilst training, but those are the workouts, they’re supposed to suck at least a little if we want to force our bodies to adapt. The benefits I’m seeing from doing all this is worth the discomfort, I feel I have a lot more energy these days for one. Not the overstimulated just had a double espresso energy, more like it takes a lot more before I become fatigued, basically all the benefits you would expect from an increase in cardio and aerobic health but I feel like I’ve had to put in way less work than if I’d tried to get these benefits from traditional aerobic exercise. For me the information and exercises in The Oxygen Advantage have made aerobic training a less laborious task and for the first time in a while my cardio and aerobic fitness is improving leading to me feeling less fatigued during the day and helping me recover and adapt to training quicker.

All in all I highly recommend The Oxygen Advantage for anyone who wants to improve their aerobic fitness or has ever had any breathing related difficulties, I haven’t gone into everything the book covers in this post but the benefits to all these ideas and exercises in the book help with a great deal of issues from asthma to sleep apnea, anxiety to weight loss.

With claims of helping to lose weight without exercise, learning to breathe efficiently should be the first step in anyone’s journey into improving their physical health.

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