The Oxygen Advantage: The Simple, Scientifically Proven Breathing Techniques for a Healthier, Slimmer, Faster, and Fitter You

by Patrick McKeown

  One way of tapping into your own natural resources is to purposefully 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 program you undertake. Who doesn’t want to do more with less effort?

  While striving for improved performance, however, there will always be athletes who choose to participate in illegal methods of blood doping, either through blood transfusion or by taking a banned substance such as erythropoietin (EPO), testosterone, or human growth hormone.

  Blood transfusions are a testament to the drastic and illegal measures that some athletes go to in order to gain the edge over their competitors. A few weeks before competition, blood is extracted from the athlete’s body and stored in a freezer or refrigerator. The body, sensing that blood levels are lower than normal, will produce additional red blood cells to bridge the gap. Closer to the endurance event, typically between one and seven days, the stored blood is reinfused into the body of the athlete. This addition of blood increases quantities of red blood cells above normal levels, which in turn increases VO2 max and enhances physical performance.

  By the early 1990s EPO had become the banned substance of choice amongst athletes seeking to increase their endurance performance. EPO is a naturally occurring hormone produced in the kidneys that stimulates the bone marrow to release more red blood cells into circulation. Because red blood cells carry oxygen from the lungs to the muscles, having a higher concentration in the circulation can greatly improve an athlete’s aerobic capacity. EPO that is produced in a lab is almost identical to the naturally occurring hormone that is produced in the body. For medical purposes, EPO is prescribed to people with chronic kidney disease–induced anemia as their condition results in a decrease in the amount of red blood cells in circulation. However, soon after its inception, some members of the athletic community realized that taking an artificial version of EPO improved sports performance by increasing the oxygen-carrying capacity of the body.

  The most notorious endurance event on earth for blood doping has to be the Tour de France. Regarded as the most prestigious of all cycle races in the world, and with places limited to around two hundred athletes, participation in the Tour de France is the dream of any budding amateur or professional cyclist. Not for the fainthearted, the event consists of a grueling 2,200-mile cycle over twenty-two days, with some mountain climbs lasting for twenty miles or more. Ever since its inception in 1903, there have been allegations of cyclists resorting to various illegal techniques to help them complete the event or improve their performance. Early reports involved cyclists fueling their bodies with alcohol, stopping off at various stages to load their pouches with wine, beer, or whatever else they could get their hands on, more so to numb the pain to help finish the race rather than improve athletic performance. However, in more recent decades, competitors took greater risks to gain an edge.

  A granite memorial to the renowned British cyclist Tom Simpson stands on the spot where he collapsed and died during the 1967 Tour de France. The epitaph reads: OLYMPIC MEDALIST, WORLD CHAMPION, BRITISH SPORTING AMBASSADOR. At twenty-nine, Simpson was regarded as one of the all-time best British cyclists. During the race, as the route made its way through the Alps, Simpson fell ill with diarrhea and stomach pains.

  In the searing heat, close to the summit of Mont Ventoux, Simpson fell. With a determined effort to continue, he ordered onlookers to “put me back on my bike,” and continued to ride 500 yards farther before collapsing again. Despite efforts by a nurse to resuscitate him, he was pronounced dead after being airlifted by helicopter to the hospital. Simpson’s postmortem revealed amphetamines in his system. Later, investigators would discover more evidence of the drugs in his hotel room and the pockets of his jersey.

  In later years, methods of doping became more sophisticated. Tyler Hamilton, who was the now-disgraced former champion Lance Armstrong’s teammate, described how he got goose bumps as blood, fresh from the refrigerator, entered his veins. In his book, The Secret Race, Hamilton claims that Armstrong also had a blood transfusion to improve his performance, and that during the 1998 Tour de France the riders were followed on a motorbike by an accomplice carrying fresh vials of EPO. “To Lance’s way of thinking, doping is a fact of life, like oxygen or gravity,” Hamilton wrote.

  Lance Armstrong’s fall from grace came on October 10, 2010, when the U.S. Anti-Doping Agency (USADA) released a statement concluding that the “evidence shows beyond any doubt that the U.S. Postal Service Pro Cycling Team [Lance Armstrong’s team] ran the most sophisticated, professionalized, and successful doping program that sport has ever seen.” Summed up in the statement was the courage of eleven of Armstrong’s former teammates who participated in the doping conspiracy but assisted the agency in its investigation in order to “help young athletes have hope that they are not put in the position they were.”

  In January 2013, in a no-holds-barred interview with Oprah Winfrey, Armstrong admitted to taking banned substances, including EPO, testosterone, human growth hormone, and cortisone, and confessed to blood doping and blood transfusions to enhance his cycling performance. When Winfrey asked if he had used illegal substances or doping methods during all seven of his Tour de France victories, the crushing answer was “yes.”

  Preparation to compete in the Tour de France often takes place at a young age. From their early teens, cyclists sacrifice their social lives and spare time to cycling and training to build strength, stamina, and endurance. I would like you to put yourself in this situation for a moment. Imagine that for years you have devoted every waking hour to training, living, and dreaming cycling. After a roller-coaster few years, you are finally good enough to take part in your greatest aspiration: the Tour de France. But soon within your first season, your colleagues present you with two options: Either blood dope and have some chance of competing on a level playing field, or choose not to blood dope and return home, leaving your dreams behind. This is likely the scenario that faced many cycling greats, including Tyler Hamilton, Floyd Landis, Bjarne Riis, and Marco Pantani, who wanted nothing more than to compete in the sport they loved. While many cyclists reluctantly gave into the temptation, others chose to abandon their chance at the Tour de France. Stephen Swart grew up on New Zealand’s North Island, and in his junior racing days both he and his brother were very successful cyclists. Swart cycled alongside Lance Armstrong in 1994 and 1995, but at age thirty he walked away from cycling completely and was later vilified by his fellow cyclists for “spitting in the soup” after he broke the code of silence about doping within the sport. Looking back, Swart said he felt cheated in a way, wishing he had never been put in the position to dope. His natural ability was undermined by the doping culture that surrounded him. For many years, winning the Tour de France seemed to be as much about whose doctor prescribed the best cocktail of banned substances than the athletic prowess of the competitors.

  Since the sporting world has come under increased attention from investigative journalists—including David Walsh, chief sportswriter with the London Sunday Times, and Paul Kimmage, former professional cyclist and award-winning sports journalist—dealing with cheating has now risen to the top of the agenda for many sporting authorities. Kimmage, who spent the past few decades exposing the doping culture in the Tour de France, commented: “I’ve always understood the pressure to dope. I’ve always understood the temptation to dope, and I understand because I’ve been there. The perception of the Tour de France now from the public is that it’s rotten, they all dope, and that saddens me because it shouldn’t have happened.”

  Fortunately for the future of sports, the culture is slowly changing, and the majority of athletes do not partake in the unethical practi
ce of blood doping. Instead, they choose naturally beneficial activities such as high-altitude training or other techniques designed to increase the body’s ability to carry more oxygen.

  The main purpose of altitude training and the Oxygen Advantage techniques outlined in this book is to increase red blood cell count. By practicing the breath-hold exercises outlined in this book, the kidneys increase production of EPO and the spleen releases red blood cells into the blood circulation. Both of these effects increase the oxygen-carrying capacity of the blood above normal levels, giving an athlete a competitive edge without the risks and ethical issues of illegal doping. A higher concentration of red blood cells can benefit your sporting performance in several ways, including:

  • Improving the oxygen-carrying capacity of your blood

  • Increasing your VO2 max

  • Extending your endurance potential

  Maximal oxygen uptake, or VO2 max, refers to the maximum capacity of an individual’s body to transport and utilize oxygen during 1 minute of exhaustive exercise. The V refers to volume, the O2 to oxygen, and max to the maximum capacity of your body. Your VO2 max is measured by the amount of oxygen that is used during 1 minute of exercise per kilogram of body weight. VO2 max is a factor that can determine an athlete’s capacity to sustain physical exercise, and is considered to be the best indicator of cardiorespiratory endurance and aerobic fitness. In sports that require exceptional endurance, such as cycling, rowing, swimming, and running, world-class athletes typically have a high VO2 max. The goal of most endurance programs is to increase an individual’s VO2 max, and this can be achieved by improving the oxygen-carrying capacity of the blood.

  The rest of this chapter explores several different training regimens along with their effects on VO2 max and the oxygen-carrying capacity of the blood. In order to understand how and why these techniques work, it is useful to know the following basic information about the composition of your blood and some common terms that we will be referring to regularly.

  Blood is made up of three parts: oxygen-carrying red cells, white blood cells, and plasma. Hemoglobin is a protein found within the red cells. One of the functions of hemoglobin is to carry oxygen from the lungs to the cells, tissues, and organs of the body, where it is released in order to burn nutrients for the production of energy. Once oxygen has been released, the resultant carbon dioxide is collected by hemoglobin and returned to the lungs, which exhale the excess.

  Levels of hemoglobin will vary from person to person, but the following figures provide a general guide for normal results:

  Male: 13.8 to 17.2 gm/dL

  Female: 12.1 to 15.1 gm/dL

  (gm/dL = grams per deciliter)

  Hematocrit refers to the percentage of red blood cells in the blood. Under normal conditions, hematocrit will relate closely to the concentration of hemoglobin in the blood. Hematocrit is usually found to be 40.7 to 50.3 percent for males and 36.1 to 44.3 percent for females.

  Another measurement relevant to Oxygen Advantage techniques is the oxygen saturation percentage of hemoglobin. Hemoglobin has a maximum oxygen-carrying capacity, and oxygen saturation simply means how much of that capacity is filled with oxygen. Normal arterial oxygen saturation is between 95 and 99 percent.

  In the following sections we look at research that investigates supplementary training programs, including high-altitude training, high-intensity exercise, and simulation of high altitude by breath holding, and compare how these techniques can improve oxygen-carrying capacity and athletic performance naturally.

  The Merits of High-Altitude Training

  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. Athletes still use this technique today, particularly those who live at high altitudes such as Kenyan and Ethiopian runners. However, there is a significant drawback to training at high altitude, since exercising in such an atmosphere increases resistance, which can prevent an athlete from achieving his or her maximum work rate. This reduction in exercise intensity can result in muscle deconditioning.

  To limit the detraining effects of working at high altitude while still maintaining the benefits, Dr. Benjamin Levine and Dr. James Stray-Gundersen from the University of Texas in Dallas developed the “live high and train low” model in the 1990s. This model requires an athlete to live at a moderate altitude of 2,500 meters but to train at an altitude lower than 1,500 meters. The premise of the method is to enable athletes to benefit from the positive physiological changes associated with living at a high altitude while enabling them to train at their maximum work rate.

  Levine and Stray-Gundersen conducted a study of thirty-nine male and female collegiate distance runners who were evenly matched in fitness level. Each runner was assigned to one of three groups:

  1. Live low (150 meters) and train low (150 meters)

  2. Live high (2,500 meters) and train low (1,250 meters)

  3. Live high (2,500 meters) and train high (2,500 meters)

  Results for the second group, “live high and train low,” showed a 9 percent improvement in red blood cell volume and a 5 percent improvement in maximal oxygen uptake (VO2 max). The improvement in maximal oxygen uptake was in direct proportion to increased red cell mass volume. This translated to an impressive performance improvement of 13.4 seconds in a 5,000-meter run.

  After returning to sea level, the “live high and train low” group was the only one to demonstrate significant improvements in both VO2 max and 5,000-meter run time. These improvements were attributed to the athletes’ acclimatization to altitude while maintaining the velocity of their sea-level training, most likely also accounting for the increase in their VO2 max.

  Another study replicated these results using national team distance runners. Following 27 days of training at an altitude of 2,500 meters, participants achieved an improvement of 1.1 percent in a 3,000-meter time trial. Although a 1.1 percent improvement in performance may not seem to be a large effect, at an elite level, races are won or lost by small fractions of a percent. Furthermore, the increase in running performance was accompanied by a 3 percent improvement in maximal oxygen uptake.

  The United States national team for long track speed skating utilized the “live high, train low” model to prepare for the 2002 Winter Olympics in Salt Lake City. That year they enjoyed unprecedented success, with six athletes winning eight medals (three of which were gold) and two world records broken. During the 2006 Torino Olympics, the U.S. long track speed skaters who continued to employ the “live high, train low” model brought home three gold, three silver, and one bronze medal.

  The Merits of High-Intensity Training

  Another training method that receives considerable attention from athletes and coaches is high-intensity training. The fundamental principle of high-intensity training is to exercise in short, intense bursts, performing at maximum work rate—a technique that is certainly not for the fainthearted. Numerous studies have investigated the different responses from training at different intensities, and in comparison to moderate exercise, high-intensity training provides greater improvements to both aerobic and anaerobic capacity. Aerobic exercise is related to endurance and ensures that the body is supplied with enough oxygen to continue to perform. Anaerobic exercise means “without oxygen” and is more concerned with speed, power, and strength, leading to improved performance in a shorter space of time.

  Japanese scientist Izumi Tabata and colleagues at the National Institute of Fitness and Sports in Japan conducted a study of two training experiments to compare moderate- to high-intensity training. The high-intensity group participated in the method known as Tabata training, in which athletes give their full effort at an exhausting work rate for periods of just 20 seconds at a time. The authors of the study concluded that although moderate-intensity aerobic training improved aerobic power, high-intensity intermittent training improved both anaerobic and
aerobic performance.

  In another study, Stephen Bailey and colleagues from the University of Exeter in the UK compared a high-intensity sprint training program with low-intensity endurance training, measuring VO2 uptake and muscle deoxygenation. Posttrial results showed that the high-intensity group experienced faster VO2 kinetics and an increased tolerance of high-intensity exercise. This means that the athletes experienced faster oxygen uptake when transitioning between rest and exercise, allowing them to perform at a higher standard more easily. This improved oxygenation of active muscles also contributes to decreased recovery time following exercise and a reduction in the production of lactic acid.

  It seems clear, therefore, that high-intensity training offers several positive benefits to athletes, including:

  • Improved anaerobic and aerobic energy supplying systems, allowing for greater endurance, strength, speed, and power

  • Faster VO2 kinetics, allowing the blood to carry more oxygen to the muscles

  • Increased tolerance to high-intensity exercise

  • Decreased recovery time from less than maximum exercise

  • Reduced lactic acid buildup

  • Improved oxygenation of active muscles, allowing you to exercise harder and longer

  In the next section we will examine how to produce the beneficial effects of high-altitude and high-intensity training to increase exercise performance.

  The Science of Simulating High-Altitude and High-Intensity Exercise