Part of Introduction: Do More With Less
We can live without food for weeks, water for days, but air for just a few brief minutes. While we spend a great deal of time and attention on what we eat and drink, we pay practically no attention to the air we breathe. It is common knowledge that our daily consumption of food and water must be of a certain quality and quantity. Too much or too little spells trouble. We also recognize the importance of breathing good quality air, but what about the quantity? How much air should we breathe for optimum health? Wouldn’t it be fair to surmise that air, which is even more important than food or water for human survival, must also meet basic requirements?
The quantity of the air you breathe has the potential to transform everything you thought you knew about your body, your health, and your performance, whether you’re a “pre-athlete” just trying to get off the couch, a “weekend warrior” running a 10k on the weekend, or a professional athlete in need of a game-changing edge over your competition.
You may be asking yourself what I mean by quantity. After all, air isn’t exactly something you can binge on at the kitchen table late at night, or take too many swigs of on the weekend. But what if, in a certain sense, it was? What if healthy breathing habits were just as important as healthy eating habits in fostering maximum fitness—or in fact even more so?
In this book you will discover the fundamental relationship between oxygen and the body. Improving fitness depends on enhancing the release of oxygen to your muscles, organs, and tissues. Increased oxygenation is not only healthier it also enables greater exercise intensity with reduced breathlessness. In short, you will be able to discover better health and fitness as well as better performance.
Part of Chapter One: The Oxygen Paradox
The Oxygen Advantage® By Patrick McKeown
Delivery of Oxygen from the Blood to the Muscles and Organs
Hemoglobin is a protein found in the blood and one of its functions is to carry oxygen from the lungs to the tissues and cells. A fundamental element of the Oxygen Advantage® technique is to understand the Bohr Effect – the way in which oxygen is released from hemoglobin and delivered to the muscles. This exchange forms the core of unlocking your body’s true potential when it comes to fitness, allowing you to raise your game and achieve the results you really want.
The Bohr Effect was discovered in 1904 by the Danish physiologist Christian Bohr (father of Niels Bohr, the Nobel Prize winner physicist – and footballer). In the words of Christian Bohr, “The carbon dioxide pressure of the blood is to be regarded as an important factor in the inner respiratory metabolism. If one uses carbon dioxide in appropriate amounts, the oxygen that was taken up can be used more effectively throughout the body.”2
The crucial point to remember is that hemoglobin releases oxygen when in the presence of carbon dioxide. When we over-breathe, too much carbon dioxide is washed from the lungs, blood, tissues and cells. This condition is called hypocapnia, causing the hemoglobin to hold onto oxygen, resulting in reduced oxygen release and therefore reduced delivery of oxygen 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. In contrast, when breathing volume remains nearer to correct levels, the pressure of carbon dioxide in the blood is higher, loosening the bond between hemoglobin and oxygen and facilitating the delivery of oxygen to the muscles. John West, author of Respiratory Physiology, tells us that “an exercising muscle is hot and generates carbon dioxide, and it benefits from increased unloading of O2 [oxygen] from its capillaries.”3 The better we can fuel our muscles with oxygen during activity, the longer and harder they can work. Over-breathing is the opposite of what Bohr advised. It limits the release of oxygen from the blood, and in turn affects how well our muscles are able to work.
Dilation and Constriction of Airways and Blood Vessels
Breathing too much can also cause reduced blood flow. For the vast majority of people, two minutes of heavy breathing is enough to reduce blood circulation throughout the body, including the brain, which can cause a feeling of dizziness and light-headedness. In general, blood flow to the brain reduces proportionately to each reduction in carbon dioxide4. A study by Dr. Daniel M. Gibbs, which was published in the American Journal of Psychiatry to assess arterial constriction induced by excessive breathing, found that the diameter of blood vessels reduced in some individuals by as much as 50%.5 This shows you how radically overbreathing can affect your blood flow—it can halve the capacity you are born with.
Most people will have experienced constriction of blood flow to the brain resulting from over-breathing. It doesn’t take very long to feel the onset of dizziness from taking a few big breaths in and out through the mouth. Similarly, many individuals who sleep with their mouths open may find it difficult to get going in the morning. Regardless of the amount of time spent sleeping, they are still tired and groggy for the first few hours after waking. It is well-documented that habitual mouth breathing during waking and sleeping hours results in fatigue, poor concentration, reduced productivity and a bad mood.6-12 Hardly an ideal recipe for quality living, or a productive exercise program.
The same can also be true of individuals whose occupation involves considerable talking, such as school teachers or salespeople. People in these professions are often all too aware of how tired they feel after a day of work, but the exhaustion that follows endless business meetings is not necessarily due to mental or physical effort – more likely it is a result of the effects of elevated breathing levels during excessive talking. It is normal for breathing to increase during physical exercise as the body demands more oxygen to convert food into energy. However, in the case of talking, breathing increases without an actual need for more oxygen, causing a disturbance to blood gases and reducing blood flow.
Depending on genetic predisposition to asthma, the loss of carbon dioxide in the blood can also cause the smooth muscles of the airways to constrict, resulting in wheezing and breathlessness. However, an increase of carbon dioxide opens up the airways to allow a better oxygen transfer to take place and has been shown to improve breathing for asthmatics. But at the end of the day, we’re all operating on the same spectrum, with good breathing at one end and bad breathing on the other. It’s not just asthmatics who benefit from less constricted airways. The feeling of chest tightness, excessive breathlessness, cough and the inability to take a satisfying breath is experienced by many athletes, including those without a prior history of asthma, but can be eliminated by simply improving the way you breathe.
Part of Chapter Two: How Fit Are You Really: The Body Oxygen Level Test (BOLT)
As far back as 1975, researchers noted that the length of comfortable breath hold time served as a simple test to determine relative breathing volume during rest and breathlessness during physical exercise. The Body Oxygen Level Test (BOLT) is a very useful and accurate tool for determining relative breathing volume during both rest and physical activity. BOLT is simple, safe, involves no sophisticated equipment and can be applied at any time. BOLT differs from other breath hold tests because it represents the length of time until the first definite desire to breathe. Holding the breath until you feel the first natural desire to breathe provides useful information on how soon the first sensations of breathlessness take place and is a very useful tool for the evaluation of breathlessness. Other breath hold tests tend to focus on the maximum time you can hold your breath, but this measurement is not objective as it can be influenced by willpower and determination.
Athletes possess bucket-loads of willpower and determination, so there is no doubt that many of us will be tempted to measure our BOLT score by holding the breath for as long as possible. But if you are serious about improving your breathing efficiency and VO2 max using the breath hold exercises in this book I would urge you to follow the instructions above and measure your BOLT correctly – by holding your breath only until the first distinct urge to breathe is felt. The rule of thumb is: the lower the BOLT, the greater the breathing volume. And the greater your breathing volume, the more breathlessness you will experience during exercise.
To obtain an accurate measurement, it’s best to rest for ten minutes before measuring your BOLT score. You can measure your BOLT now:
- 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. These sensations may include the need to swallow or a constriction of the airways. You may also feel the first involuntary contractions of your breathing muscles in your abdomen or throat as the body gives the message to resume breathing. (Note that BOLT is not a measurement of how long you can hold your breath but simply the time it takes for your body to react to a lack of air.)
- Release your nose and breathe in through it. Your inhalation at the end of the breath hold should be calm.
- Resume normal breathing.
Please be aware of the following important points when measuring your BOLT score:
- The breath is taken after a gentle exhalation.
- The breath is held until the breathing muscles first begin to move. You are not measuring the maximum time that you can hold your breath.
- If you do not feel the first involuntary movements of your breathing muscles, then release your nose when you feel the first definite urge or first distinct stress to resume breathing.
- Your BOLT is not an exercise to correct your breathing.
Remember that measuring your BOLT involves holding your breath only until you feel the first involuntary movements of your breathing muscles. If you need to take a big breath at the end of the breath hold, then you have held your breath for too long.
How the Body Oxygen Level Test (BOLT) Works
When you hold your breath you prevent oxygen from entering your lungs, and prevent excess carbon dioxide from being expelled into the atmosphere. As the breath hold continues, carbon dioxide accumulates in the lungs and blood while oxygen levels slightly decrease. Since carbon dioxide is the primary stimulus for breathing, the length of your breath hold time is influenced by how much carbon dioxide you are able to tolerate, or your ventilatory response to carbon dioxide.
A strong ventilatory response to carbon dioxide means that your threshold will be reached sooner, resulting in a lower breath hold time. Conversely, a good tolerance and reduced ventilatory response to carbon dioxide results in a higher breath hold time.
When your BOLT is lower, your breathing receptors are especially sensitive to carbon dioxide and your breathing volume will be heavier as the lungs work to remove any carbon dioxide in excess of programmed levels. However, when you have a normal tolerance to carbon dioxide and a higher BOLT, you will be able to maintain calm breathing during rest and lighter breathing during physical exercise.
You may find that the first time you measure your BOLT, you are surprised that your score is lower than expected, but remember that even elite athletes can score a low BOLT! The good news is that your BOLT can easily be increased with a series of simple breathing exercises incorporated into your existing exercise regime. A common starting BOLT score for an individual who exercises regularly at a moderate intensity will be approximately 20 seconds. If your BOLT score is below 20 seconds you will probably find you experience breathlessness during exercise and symptoms of over-breathing during rest. The aim of the Oxygen Advantage® program is to increase your BOLT to 40 seconds, and this can be realistically achieved.
Improving your BOLT score is an important key to attaining greater physical endurance. As we have already seen, having an improved tolerance to carbon dioxide means you are able to achieve a higher VO2 max and improved performance. The Oxygen Advantage® program is all about increasing your BOLT and maximising your potential!
How Your BOLT Score Relates to Breathlessness During Sports
The ideal BOLT score for a healthy individual is 40 seconds. In the book entitled Exercise Physiology: Nutrition, Energy, and Human Performance by William McArdle and colleagues, the authors make the following observation, “If a person breath holds after a normal exhalation, it takes approximately 40 seconds before the urge to breathe increases enough to initiate inspiration.”
The truth of the matter is that the vast majority of individuals, including athletes, have a comfortable breath hold time of about 20 seconds, often less. What is accepted in theory is not always evident in practice. However, in this instance it should be.
Breath hold measurements have also been used to study the onset and endurance of breathlessness (dyspnea), and asthmatic symptoms. The result that comes up again and again is that the lower the breath hold time, the greater the likelihood of breathlessness, coughing, and wheezing during both rest and exercise.
Over the past 12 years I have worked with thousands of children and adults with asthma. Although breath hold time is not generally used by doctors to evaluate asthma severity, it is an excellent measurement to evaluate respiratory condition and symptoms such as coughing, wheezing, chest tightness, breathlessness and exercise-induced asthma. If you experience breathlessness or asthmatic symptoms when you exercise, you may find that your athletic performance is limited and hampered by your condition. By implementing the Oxygen Advantage® program and tracking your progress with your BOLT score you will be able to quickly and easily improve your performance and eliminate symptoms of exercise-induced asthma. The overall goal of the Oxygen Advantage® program is to increase BOLT score to over 40 seconds, but every time you improve your BOLT by five seconds you will find that symptoms such as coughing, wheezing, chest tightness and breathlessness reduce drastically.
Part of Chapter Three: Noses are for Breathing, Mouths are for Eating
Nasal breathing is often an integral part of an animal’s survival or hunting techniques. The cheetah, which is considered the fastest land animal on earth, is capable of accelerating from 0-60 miles per hour in just three seconds. Most high performance cars cannot accelerate so quickly, with the notable exception of the Bugatti Veyron, which will set you back a million dollars to experience the natural acceleration speed of a cheetah. With such incredible efficiency and speed it doesn’t take long for the cheetah to catch up with its prey, but maintaining nasal breathing is especially advantageous during the chase, ensuring that its victim is the first to run out of air.
The dog is probably the best known example of an animal that periodically breathes through its mouth – dogs can commonly be seen panting on a hot day or after a long walk to help cool themselves down. But at all other times a dog will breathe through its nose, only using its mouth for eating, drinking and barking. Nature has ensured that the vast majority of land mammals breathe through their noses by positioning the windpipe so that the back of the nose leads directly to the lungs. In other words, it is not easy for most animals to breathe through their mouths. The same is true for humans at birth, but after a few months the windpipe drops down to just below the back of the tongue in order to allow the baby to breathe through both its mouth and nose. Charles Darwin was puzzled by this adaptation in humans; how, unlike most animals, the openings for carrying food to the stomach and air to the lungs are placed side by side. This parallel position seems fairly impractical as it increases the risk of food going down the wrong way, requiring the development of a complicated swallowing mechanism. The cause for this is likely to do with our ability to speak, and to enable us to swim, since both actions require voluntary control over breathing. Had Darwin investigated the negative impact of mouth-breathing in human beings, however, I have no doubt that he would have considered the ability to mouth-breathe to be a far worse flaw in the evolution of our species than the risk of choking while eating.
The rest of the animal kingdom relies on nasal breathing for survival, and mouth breathing usually only occurs as an adaptation within a species. Birds, for example, are predominantly nose-breathers, aside from diving birds such as penguins, pelicans or gannets. Generally, when an animal breathes through its mouth it is a sign of sickness, injury, or distress. Guinea pigs and rabbits will continue to breathe through their nose even under heavy exertion, and will only breathe through their mouths if they have developed a breathing abnormality. The same goes for all farm animals, including the cow, sheep, donkey, goat, and horse. Mouth-breathing in these animals would be a clear signal to a farmer or pet-owner that there is something wrong. Experience tells the farmer that when a cow or sheep stands motionless with their neck extended and mouth open, they are very sick and it is time to call the vet.
Part of Chapter Four: Breathe Light to Breathe Right
For thousands of years, masters of the ancient arts of Yoga, Tai Chi and Qi Gong have espoused the importance of quiet, gentle, and level breathing. I recently had the pleasure of meeting Tai Chi Master Jennifer Lee in London. Master Lee has reached Seventh Dan, and was awarded gold in ten categories during the international 2009 Wushu Championships held in Hong Kong and Hainan, China. As the two of us talked, Master Lee described the similarities between our work. She explained that during Tai Chi tournaments, judges pay particular attention to whether they can notice the breathing of competitors, with points being deducted when breathing is evident.
Without knowing why, other than the fact that it has been passed down from generation to generation, Master Lee practices a breathing exercise that is very similar to the reduced breathing exercise we will explore further on. It is no coincidence that Master Lee’s breathing was textbook perfect. It was diaphragmatic, effortless, and almost invisible to the eye. I have watched many people breathe – thousands, in fact – and without doubt, Master Lee displayed the most perfect breathing I have ever seen.
Well-known Qi Gong and Tai Chi master Chris Pei explains how breathing is at the very core of the Chinese concept of Chi (Qi): “Generally speaking, there are three levels of breathing. The first one is to breathe SOFTLY, so that a person standing next to you does not hear you breathing. The second level is to breathe softly so that YOU do not hear yourself breathing. And the third level is to breathe softly so that you do not FEEL yourself breathing. ”
This philosophy of effortless breathing is echoed by authentic teachers of Indian yoga and traditional Chinese medicine. I use the word “authentic” in order to differentiate practitioners who have a deep knowledge of breathing and how it affects physiology from those who don’t. Unlike many modern Western teachers who instruct students to breathe hard in order to remove toxins from the body, authentic teachers know that when it comes to breathing, less is more. The tradition Chinese art of Taoism succinctly describes ideal breathing as ‘so smooth that the fine hairs within the nostrils remain motionless’. True health and inner peace occurs when breathing is quiet, effortless, soft, through the nose, diaphragmatic, rhythmic, and gently paused on the exhale. This is how human beings naturally breathed until the comforts of modern life changed everything.
Part of Chapter Five: Secrets of Ancient Tribes
In 1974, Tom Piszkin was 21 years of age and enjoying his new found freedom and responsibilities while attending college at the University of California at Berkeley. Tom was a runner and worked part time in the sporting goods department at Montgomery Wards in Oakland. On October 24th he finished his shift and made his way to a bus stop near the Oakland Coliseum, known as one of the tougher parts of town. Soon after, Tom was joined by four young men who demanded he give them everything he had. Three of the four youths drew handguns and pressed them against Tom’s head, chest and leg. In shock, when Tom stood up to take his wallet from his pocket, he was shot point blank in the middle of the chest by a .38 special. Tom recalls that, surprisingly, the shot didn’t cause him a lot of pain.
Following an operation to remove the lead fragments, Tom was discharged from hospital and resumed running within a month, but recovering from such a traumatic experience was slow and arduous. Tom’s journey to improve his lung capacity took over a decade as he continued to fall short of his expectations, despite working hard at his fitness routine. Above all else, Tom’s wanted to regain the level of athletic fitness he enjoyed before he was shot and was determined to figure out a way to limit his heart rate and intensity during his workout sessions. Intuitively, he figured that by reducing the stress on his body during exercise, he would be able to improve his overall fitness and endurance. Tom’s theory was to restrict his breathing – ‘like a governor on a lawn mower engine’ – a solution that was also much cheaper than buying a heart rate monitor.1
Tom soon realised that if he couldn’t sustain his pace while breathing exclusively through his nose during training, then he was working too hard and going too fast. At first, he found breathing through his nose during physical training a little challenging, but soon discovered that nasal breathing could more easily be maintained by placing tape over his mouth. Not only did Tom tape his mouth during training, he also taped his mouth during sleep to ensure he continued nasal breathing during the night. One year after beginning his reduced breathing training, Tom went for a lung capacity test. His results showed that he was at 130% capacity for his weight and age.2
Despite Tom’s harrowing setback at the age of 21, he has since dedicated his life to his two passions of sports and inventing. Tom is currently a triathlon coach at the University of California, San Diego and creator of TitanFlex bikes. He is also certified as a USA Olympic Triathlon coach. After 13 years of serving at the leadership level in the Triathlon Club of San Diego, he was inducted into their Hall of Fame.
Switching to nasal breathing after spending years mouth breathing requires courage and commitment. Sometimes it is necessary to take one step back to move two forward if you want to truly improve your performance potential.
If you observe your athletic peers during physical exercise you will no doubt notice that most will be breathing through their mouths. A question I often hear is: “If nasal breathing is so good, then why do most elite athletes breathe through their mouths and not their noses?” A simple answer is that Western breathing habits have become so far removed from what they should be that mouth breathing has become the norm.