Book summary “The oxygen advantage”: summary

Introduction

You can dramatically improve your sports performance, health, and weight by retraining your breathing volume and increasing your carbon dioxide tolerance.

Modern lifestyles encourage chronic overbreathing and mouth breathing. This habit reduces your energy, limits your stamina, and triggers hidden health issues. Patrick McKeown demonstrates that breathing less, rather than more, unlocks your physical potential.

The author argues that carbon dioxide controls how efficiently your red blood cells release oxygen to your tissues. You must learn to restore proper biochemical balance through targeted nasal breathing and simulated high-altitude training.

This book answers several practical questions:

• How does overbreathing damage your health?
• What is your true breathing efficiency score?
• Can you train at high altitude without leaving home?

1. The Hidden Epidemic of Overbreathing

Your blood oxygen saturation is almost always between 95 and 99 percent during rest. Taking bigger breaths does not increase your blood oxygen levels. Instead, carbon dioxide determines how effectively hemoglobin releases oxygen to your muscles and organs.

Blood oxygen saturation remains near complete at rest, making carbon dioxide the true regulator of oxygen release to your tissues.

A healthy person breathes 4 to 6 liters of air per minute during rest. Because you exhale 75 percent of this oxygen at rest, adding more oxygen provides no benefit. The actual limiting factor in your performance is carbon dioxide. It acts as the key to unlock oxygen delivery from red blood cells through the Bohr Effect.

Modern living fosters chronic overbreathing. You might unconsciously inhale more air than your body requires, triggering systemic fatigue, narrowed airways, and reduced blood flow. Factors such as chronic stress, sedentary lifestyles, overheated homes, and processed diets have warped natural breathing patterns.

An overweight tourist and an Olympian carrying luggage up a flight of stairs illustrate how inefficient breathing leads to huffing and puffing under minimal stress. Chronic overbreathing washes out carbon dioxide and causes hypocapnia. This state forces your blood vessels to constrict and hemoglobin to hold onto oxygen rather than releasing it to tissues.

Excessive breathing constricts your blood vessels and reduces circulation to the brain and organs. Just two minutes of heavy breathing can restrict your blood circulation. Studies show that excessive breathing can reduce the diameter of arterial blood vessels by up to 50 percent. This reduction translates via the mathematical formula for the area of a circle into a fourfold decrease in blood flow.

Carbon dioxide also acts as a critical regulator of blood pH. Normal blood pH must remain tightly regulated at 7.365. When your blood becomes too alkaline, your breathing reduces to allow carbon dioxide levels to rise. If your blood is too acidic from processed foods, your breathing increases to offload carbon dioxide as acid.

2. Assessing Your Breath with the BOLT Score

The Body Oxygen Level Test measures the time you can comfortably hold your breath after a normal exhalation until the first distinct urge to breathe.

Unlike maximum breath-hold tests that rely on sheer willpower, the BOLT score reflects your sensitivity to carbon dioxide. A lower score indicates hyperventilation, greater breathing volume, and increased breathlessness during physical exertion.

You can measure your score easily:

• Take a normal breath in through your nose and allow a normal breath out through your nose.
• Hold your nose with your fingers to prevent air from entering your lungs.
• Time the number of seconds until you feel the first definite desire to breathe, or the first stresses of your body urging you to breathe.
• Release your nose, stop the timer, and breathe in through your nose.
• Resume normal breathing.

Initial scores vary widely across populations:

• 10 seconds: Initial BOLT score often found in unhealthy individuals or those experiencing heavy breathing and fatigue.
• 20 seconds: Common starting BOLT score for individuals who exercise regularly at a moderate intensity.
• 40 seconds: The ideal target BOLT score for a healthy individual and endurance athletes.

Increasing your BOLT score requires stopping carbon dioxide losses, improving carbon dioxide tolerance through reduced breathing, and simulating high-altitude training during exercise.

Stopping losses involves eliminating mouth breathing, sighs, and heavy yawns. Improving tolerance resets the brain receptors through a sustained light air hunger, while high-altitude simulation conditions the body during physical exertion.

You can follow these daily steps:

• Breathe through your nose, day and night.
• Stop sighing; instead, swallow or suppress the sigh.
• Avoid taking big breaths when yawning or talking.
• Observe your breathing throughout the day so it is not seen or heard.

You can typically expect a 3 to 4 second BOLT increase during the first 2 to 3 weeks. However, your score can remain stuck at 20 seconds for 8 to 10 weeks before advancing.

3. Breathe Light and Warm Up Correctly

Practicing reduced breathing at rest and incorporating breath-hold warm-ups prepares your body for efficient physical exertion.

Counting inhalation lengths in seconds does not control whether you take a gentle breath or a massive inhalation. Cutting the number of breaths per minute in half often causes you to double the volume of each breath, leaving total air minute-volume unchanged.

To accumulate arterial carbon dioxide and reset your respiratory center, you can practice reduced breathing against manual resistance. Sit up straight with relaxed shoulders while the space between your ribs gradually widens.

• Sit up straight and allow your shoulders to relax.
• Place one hand on your chest and one hand just above your navel.
• Feel your abdomen gently moving outward as you inhale and gently moving inward as you exhale.
• Exert gentle pressure with your hands against your abdomen and chest to create resistance to your breathing.
• Breathe against your hands, concentrating on making the size of each breath smaller.
• Take in less air than you would like to with each breath, making the in-breath smaller or shorter.
• Gently slow down and reduce your breathing movements until you feel a tolerable hunger for air.
• Breathe out with a relaxed exhalation, allowing the natural elasticity of your lungs and diaphragm to play their role.
• Notice visible breathing movements reducing as the in-breath becomes smaller and the out-breath is relaxed.

Maintain this air hunger for 4 to 5 minutes. You can reduce your breathing movements by 20 to 30 percent. Perform 2 sets of 5-minute exercises daily to help reset your breathing center.

Skipping a warm-up causes a net loss of carbon dioxide, leading to constricted airways and early breathlessness.

Aisling, an amateur soccer player in Ireland, experienced severe breathlessness during the first 10 to 20 minutes of games due to insufficient warm-up and poor breathing habits.

You can prevent exercise-induced asthma with the Oxygen Advantage Warm-Up.

• Begin walking at a pace that is comfortable for you.
• Breathe regularly and calmly through your nose, using your diaphragm to maintain a relaxed breathing technique.
• Feel your abdomen gently moving outward as you inhale and gently moving inward as you exhale.
• Allow a feeling of relaxation to spread throughout your body by silently encouraging the area around your chest and abdomen to relax.
• Exhale normally through your nose after 1 minute of walking and pinch your nose with your fingers to hold the breath.
• Walk for 10 to 30 paces while holding your breath, or until you feel a moderate need to breathe.
• Let go of your nose and resume breathing through your nose when you feel this hunger for air.
• Continue walking for 10 minutes, performing a breath hold every minute or so.

Your ability to perform physical exercise with a closed mouth is directly dictated by your BOLT score. A 5-second score seriously hampers walking, while a 10-second score allows slow walking. A 20-second score supports fast walking or light jogging, and a 30-second score permits medium to fast jogging. Quick running requires a 40-second score. You can increase your measurement by 10 to 15 seconds over 6 to 8 weeks.

During your post-exercise cooldown, you can perform the Breathing Recovery Exercise to restore calm nasal breathing.

• Exhale as normal through the nose.
• Pinch your nose with your fingers to hold the breath for 2 to 5 seconds.
• Breathe normally through the nose for 10 seconds.
• Repeat the first 3 steps throughout your 3 to 5 minute walking cooldown.
• Resume regular breathing.

4. Simulating High Altitude for Natural Advantage

Purposefully subjecting your body to reduced oxygen intake through breath holding or high altitude forces natural physiological adaptations that improve blood oxygenation without illegal doping. Cyclists in the Tour de France faced intense pressure to use illegal doping methods such as blood transfusions, EPO, testosterone, and human growth hormone, culminating in scandals like Lance Armstrong and the U.S. Postal Service Pro Cycling Team. A 0.5 percent difference in performance separates Olympic athletes. The Tour de France spans 2,200 miles over twenty-two days. British cyclist Tom Simpson died at age 29 during the 1967 Tour de France.

Short breath-hold exercises stimulate the spleen to contract and release stored red blood cells into circulation, enhancing the blood's oxygen-carrying capacity.

The spleen acts as a blood bank. Reducing oxygen availability through breath holding prompts the spleen to contract, increasing hematocrit and hemoglobin concentration without needing to be underwater. Studies comparing volunteers with and without spleens demonstrated that individuals with intact spleens showed increases in hematocrit and hemoglobin after breath holds, while splenectomized individuals showed no alterations. Most humans can maintain a static breath hold after inhalation for 50 seconds. Elite divers achieve static breath holds ranging from 8 minutes 23 seconds to 11 minutes 35 seconds. Individuals with spleens experience a 6.4 percent increase in hematocrit and a 3.3 percent increase in hemoglobin. Spleen size decreases by 20 percent during breath holding. Performing 3 to 5 maximum breath holds yields a 2 to 4 percent increase in hemoglobin.

Performing breath holds after an exhalation lowers blood oxygen saturation and increases carbon dioxide, eliciting a much stronger adaptation response than post-inhalation holds.

Exhaling before a breath hold reduces air volume in the lungs, causing a faster buildup of carbon dioxide, which improves hemoglobin concentration, contracts the spleen more strongly, and shifts the oxyhemoglobin dissociation curve via the Bohr Effect. The author monitored thousands of individuals practicing breath holds and found that the greatest decrease in blood oxygen saturation occurs after an exhalation. Post-exhalation breath holds achieve 94 percent or lower blood oxygen saturation after four or five days of practice. They simulate an altitude equivalent of 2,500 to 4,000 meters. Increased carbon dioxide delivers a 10 percent improvement in hemoglobin concentration. Lower oxygen levels produce a 24 percent increase in EPO concentration.

Ingesting bicarbonate of soda neutralizes acid accumulation during high-intensity exercise, improving endurance, maximum breath-hold time, and power output. Bicarbonate of soda acts as an alkaline buffer that helps maintain normal blood pH by decreasing lactic acid buildup during anaerobic exercise. It also increases maximum breath-hold time and reduces breathlessness. Numerous studies show that bicarbonate of soda improves swimming performance, boxing punch efficacy, and high-intensity interval training, while Dr. Mark Pagel received a $2 million grant to study its use in cancer therapy. Ingesting bicarbonate of soda produces an 8.6 percent increase in maximum breath-hold time.

You can prepare this buffer using a simple mixture:

• Put 0.5 teaspoon bicarbonate of soda in a glass.
• Add 2 tablespoons apple cider vinegar and stir for about 1 minute, or until the soda is thoroughly dissolved.
• Drink the mixture.

5. Integrating Breath Holds into Sports Training

Combining intermittent breath holds with walking, running, and cycling builds your lactic acid tolerance and breathing economy.

Patrick McKeown calls this method Bring the Mountain to You. Combining hypoxia and hypercapnia lowers your sensitivity to carbon dioxide and increases your endurance. Brazilian track coach Valério Luiz de Oliveira used breath-hold training for Olympic athletes like Joaquim Cruz and Mary Decker to maintain form during anaerobic races. This practice helped Cruz win 800m gold at the 1984 Olympics in the 400-800m distance for anaerobic races using 30 seconds partial rest across 3 sets of 4 breath holds.

You can simulate high-altitude training while walking:

• Walk and hold: After a minute of continuous walking, gently exhale and pinch your nose to hold your breath.
• Continue walking for 30 seconds and repeat: Continue walking for around 30 seconds while breathing through your nose, then gently exhale and pinch your nose with your fingers.
• Repeat breath holds 8 to 10 times: While continuing to walk, perform a breath hold every minute or so in order to create a medium to strong need for air.

This 10 to 15 minutes duration exercise involves 15 seconds minimized breathing recovery across 8 to 10 breath holds total in 12 minutes total exercise time. Nick Marshall, an Australian businessman and cyclist, utilized walking breath holds of 60 to 80 paces as part of his daily routine to dramatically improve his BOLT score and cycling efficiency.

Incorporating breath holds into running or cycling adds an extra load equivalent to maximum intensity exercise, enhancing carbon dioxide accumulation and training quality.

Practicing breath holds mid-run or mid-ride builds carbon dioxide tolerance and improves lactate buffering during hard efforts. Cyclist Nick Marshall successfully integrated Oxygen Advantage principles into his training, lowering his lap times and resting heart rate while reducing his overall training hours.

You can apply the same principle to running:

• Run and hold: Ten to fifteen minutes into your run, when your body has warmed up and is sweating, gently exhale and hold your breath until you experience a medium to strong air shortage.
• Break for 1 minute and repeat: Following the breath hold, continue to jog or run with nasal breathing for about 1 minute, until your breathing has partially recovered.
• Repeat breath holds 8 to 10 times: Repeat the breath hold 8 to 10 times during your run, followed each time by a minute of nasal breathing.

These runs incorporate 10 to 40 paces breath hold length or 5 to 15 pedal rotations for cycling over 8 to 10 repetitions. Controlled and reduced breathing volumes during swimming minimize hydrodynamic drag and enhance both stroke efficiency and carbon dioxide tolerance. Former Olympic swimmer and triathlete Sheila Taormina achieved the fastest 1.5 km swim during the Sydney Games in 2000 by utilizing reduced breathing training effects.

• Increase the number of strokes between breaths in gradual increments, increasing from 3 to 5 to 7 over a series of lengths.

Advanced hypoxic simulation protocols lower arterial blood oxygen saturation below 90 percent to significantly boost erythropoietin production and red blood cell counts. This method is strictly reserved for physically fit individuals with a BOLT score over 30 seconds, targeting an 80 to 94 percent SpO2 target window during 1 to 2 minutes exercise duration. Don Gordon applied the Oxygen Advantage program and raised his hematocrit level to 52 percent, achieving a 24 to 36 percent increase in EPO and enhancing his aerobic performance within the upper normal range.

• The first breath hold is between 40 and 60 paces, or until you feel a medium to strong need for air.
• After the first breath hold, subsequent holds are performed every 5 to 10 paces.
• Following each breath hold, either exhale through your nose or take a sip of air in through your nose before the next breath hold.

Children can safely learn and master breath-hold exercises to quickly alleviate respiratory issues like asthma, coughing, and wheezing. Patrick McKeown has worked with thousands of children aged four to fifteen years over thirteen years using targeted breath-hold exercises.

• Beginners are gently introduced to the exercises by walking a distance of 10 paces while they hold their breath.
• After 3 or 4 repetitions, the number of paces is increased in increments of 5 until the child understands the exercise and experiences a moderate need for air.

Children progress from a 10 paces initial breath hold to 30 paces expected during first session, with a 10 extra paces increase each week up to 80 paces target in two to three weeks.

6. Mind, Focus, and Brain Oxygenation

Eliminating overbreathing restores proper carbon dioxide levels to protect brain oxygenation and help you enter the flow state.

Peak performance requires entering the flow state, where conscious thinking ceases and action is driven by instinct. Total immersion leaves the ego behind and lets your innate intelligence operate automatically without distractions.

During the 1974 Rumble in the Jungle, Muhammad Ali used psychological tactics to undermine George Foreman's focus and cause him to tire out.

Nervousness can induce hyperventilation, which lowers blood carbon dioxide, constricts blood vessels, and deprives your brain of oxygen. Studies on jet fighter pilots and anxious students show that low carbon dioxide levels reduce mental performance. During a final exam at Trinity College, the author took big mouth breaths to calm down, which induced dizziness by depriving his brain of oxygen.

You can practice the Breathing Recovery Exercise to restore brain oxygenation:

• Take a small, silent breath in and out through your nose.
• Hold your breath for 2 to 5 seconds.
• After each breath hold, breathe normally for around 10 seconds without interfering with your breathing.
• Continue to do a small breath hold followed by normal breathing for around 10 seconds.
• Practice this exercise for at least 15 minutes.

You can also follow the breath to enter the zone:

• Choose a place where you will not be distracted and sit in an upright position with your eyes closed.
• Place one hand on your chest and one hand on your abdomen, just above your navel.
• Follow your breath as it enters the nostrils or passes down the throat, observing whether you are using your chest or abdomen without changing your breathing.
• Silently tell the muscles of your chest and abdomen to relax as you observe your breathing.
• Allow your breathing to become quiet and soft, reducing it to create a mild to moderate hunger for air.
• If breathing becomes disturbed, take a break for about 15 seconds and resume when normal.
• Try this breathing practice for 10 minutes or so.

The author spent several periods of 10 consecutive days of noble silence, waking at 5 o'clock in the morning and retiring at 8 o'clock at night. This practice left his mind razor-sharp and calm.

7. Reversing Asthma and Improving Heart Health

Correcting your breathing volume eliminates exercise-induced asthma and optimizes oxygenation for your heart and cardiovascular system.

Habitual overbreathing and mouth breathing expel too much carbon dioxide. This hypocapnia causes smooth muscle in the airways to constrict. 4 to 20 percent of the general population is affected by exercise-induced asthma. Adults with asthma often breathe 10 to 15 liters per minute at rest. You need a 40-second BOLT score to fully eliminate asthma symptoms.

Retraining the body to breathe lightly through the nose normalizes carbon dioxide levels. You can apply specific steps to eliminate symptoms:

• Take a small, silent breath in and out through your nose.
• Hold your breath and walk for 10 to 15 paces.
• Stop walking, release your nose, and resume gentle nasal breathing for 30 to 60 seconds.
• Repeat the cycle for at least 10 minutes.
• Wipe out mouth breathing during sleep by wearing paper tape across your mouth.

Julian suffered from severe childhood asthma requiring heavy medication and hospital nebulizers. After attending a Dublin course in 2007, he eliminated all medication within six months and later ran multiple marathons.

Nitric oxide is a vital molecule produced in the sinuses and blood vessels. It relaxes arteries, lowers blood pressure, and prevents plaque buildup and blood clotting. The human body contains 100,000 miles of blood vessels. On September 11, 2001, 3,000 people lost their lives to heart attack and stroke in the US alone.

10 Key Ideas

1. Carbon dioxide controls how efficiently hemoglobin releases oxygen to your muscles and organs, making the gas the true regulator of oxygen delivery.
2. The Body Oxygen Level Test (BOLT) measures your sensitivity to carbon dioxide and reflects your true breathing efficiency.
3. Consistently practicing nasal breathing day and night eliminates chronic overbreathing and restores proper biochemical balance.
4. Nitric oxide is a vital molecule produced in the sinuses that relaxes arteries, lowers blood pressure, and prevents plaque buildup and blood clotting.
5. Practicing reduced breathing against manual resistance accumulates arterial carbon dioxide and resets your respiratory center.
6. Performing breath holds after an exhalation lowers blood oxygen saturation and increases carbon dioxide to elicit a much stronger adaptation response.
7. Short breath-hold exercises stimulate the spleen to contract and release stored red blood cells into circulation to enhance the blood's oxygen-carrying capacity.
8. Retraining your breathing volume and increasing carbon dioxide tolerance dramatically improves sports performance, health, and weight.
9. Eliminating overbreathing restores proper carbon dioxide levels to protect brain oxygenation and prevent the dizziness caused by low carbon dioxide.
10. Correcting your breathing volume and achieving a 40-second BOLT score eliminates exercise-induced asthma symptoms and normalizes carbon dioxide levels.