PDF Summary:The Oxygen Advantage, by Patrick McKeown

Imagine there was a miracle cure that could help you feel less stressed, lose weight, sleep better, run farther without losing your breath, and live longer. According to breathing coach Patrick McKeown, not only does this cure exist, but it’s also free to anyone with a set of lungs—it’s practicing proper breathing. He says modern living conditions cause the average person to breathe too much, but by training yourself to breathe less, you can greatly improve your physical fitness and overall health.

In this guide, we’ll explain why excessive breathing results in less oxygen getting to your body, and you’ll learn specific exercises for training yourself to breathe less. We’ll supplement McKeown’s advice with other tips that may help you get more out of his Oxygen Advantage program. Additionally, we’ll compare McKeown’s breathing techniques to other popular breathing exercises from experts like Wim Hof and Andrew Huberman.

(continued)...

Benefit #2: Better Respiratory Hygiene

Nasal breathing is essential to proper hygiene within your respiratory system, asserts McKeown. Air you inhale through the nose is healthier than air you inhale through the mouth. Inside the nose, there’s a complex system of twisting bones, passageways, and layers of mucus. This system strips harmful germs out of the air, warms the air up, and adds moisture to it before allowing the air to pass into the lungs.

(Shortform note: Although your nose naturally filters, warms, and moistens the air you breathe, some experts note that your breathing will be even healthier if the air you breathe is already clean, warm, and moist. Frequently open windows in your home and activate exhaust vents to keep air moving and avoid the buildup of airborne particles. Wear a scarf around your face in cold weather to warm air before it reaches your nose. Last, if the air in your house is dry, consider using a humidifier or taking a steamy hot shower. These steps may help you avoid getting sick, as dry air can cause inflammation and infection in your airways. Cold air is unhealthy primarily because it’s dry—it can’t hold as much moisture as warm air.)

Mouth breathing, on the other hand, causes you to lose moisture every time you take a breath, increasing the likelihood of general dehydration and a dry mouth. In particular, having a dry mouth increases the likelihood of mouth infections, including cavities and gum disease, and it often results in bad breath.

(Shortform note: Why is a dehydrated mouth prone to infection? The saliva in your mouth contains many compounds that kill bad bacteria, including hydrogen peroxide, lactoferrin, and lysozymes. If you dry out your mouth with excessive mouth breathing, you allow this bacteria to infect your mouth—and, in some cases, your airways. This can cause respiratory infections.)

Benefit #3: Increased Nitric Oxide

McKeown asserts that nasal breathing makes you healthier by increasing the nitric oxide in your body. Your nose naturally produces this gas, and you get more of it in your body every time you breathe in through your nose. Nitric oxide helps your blood vessels remain relaxed and open, increasing blood flow and improving cardiovascular health. It also lowers your blood pressure and cholesterol, and it reduces the risk of heart attack or stroke.

(Shortform note: To further boost your body’s production of nitric oxide, thereby improving your cardiovascular health, some experts recommend eating foods that are high in nitrates. These are compounds that the body can convert into nitric oxide. Nitrate-rich foods include vegetables such as celery, lettuce, and spinach. Nitrates are also sometimes added as a preservative to meat products like bacon and cold cuts, but the nitrates in these products aren’t balanced out by antioxidants and other nutrients like they are in vegetables, so they form different compounds. Some research shows that these compounds may cause cancer.)

Benefit #4: Improved Sleep

Nasal breathing helps improve your sleep quality, according to McKeown—it helps you fall asleep faster, stay asleep more easily, and wake up with more energy to start your day. Additionally, it decreases the likelihood that you’ll suffer from snoring or sleep apnea.

If you wake up with a dry mouth in the morning, it’s a sign that you’re breathing through your mouth while asleep. In this case, put paper tape or commercially available sleep tape over your mouth just before you go to bed until you’ve built the habit of sleeping with your mouth closed.

(Shortform note: Arguably, sleep problems and morning grogginess are so widespread because mouth breathing is more common at night than any other time of day. Lying flat on your back causes more blood to flow up into your nasal passages, which causes swelling and nasal congestion. This understanding reveals an additional solution to nighttime mouth breathing: If you find taping your mouth shut at night to be too uncomfortable, use pillows to elevate your head and upper back at a 30- to 60-degree angle, mitigating blood flow to your nasal passages and clearing up congestion.)

How to Breathe Less: Specific Exercises

Next, we’ll describe several exercises that McKeown offers to improve your respiratory health.

Exercise #1: Testing Your Carbon Dioxide Tolerance

McKeown recommends regularly testing your carbon dioxide tolerance to track how healthy your breathing habits currently are. The breathing exercises that McKeown recommends vary depending on your current CO₂ tolerance, so testing it helps you know which exercises to include in your routine. Tackling intense breathing exercises before your body is ready will tire you out quickly with minimal benefits, and trying and failing at these exercises will only discourage you from sticking with the program.

To test your carbon dioxide tolerance, take a normal breath; then, at the end of your exhale, plug your nose and hold your breath. Time how long it takes before you first feel the need to breathe (not how long you can hold out before you have to breathe).

This time represents how tolerant your body is to carbon dioxide, and it’ll increase as your tolerance increases. A typical adult who exercises frequently can go 20 seconds before feeling the need to breathe, but McKeown recommends training your body until you can make it to 40 seconds to achieve peak physical fitness.

For the most accurate assessment, perform this exercise immediately after waking up. Your unconscious breathing while asleep will be the same every night, putting your respiratory system in a neutral state and ensuring that your test will be consistent and objective.

Use Carbon Dioxide Tolerance to Gauge Physical Recovery

Other than McKeown’s test, the most popular method of testing your tolerance to carbon dioxide is one created by free divers training to hold their breath longer. Andrew Huberman has more recently refined and popularized these divers’ carbon dioxide tolerance test. He uses the test to enhance fitness training in a different way. While McKeown uses CO₂ tolerance as a long-term metric that measures which exercises you’re fit enough to benefit from, Huberman uses CO₂ tolerance as a short-term metric that measures how well your nervous system has recovered from recent exercise.

Huberman’s test is also unlike McKeown’s in that it doesn’t measure your body’s desire to offload carbon dioxide (the feeling that you need to breathe). Instead, it measures your ability to control the diaphragm and activate the parasympathetic nervous system in the presence of carbon dioxide. According to Huberman, this is a direct indicator of how well your nervous system has recovered from exercise, which helps you avoid pushing your body past its limits.

To do this test, inhale through your nose and exhale through your mouth, slowly and deeply, four times in a row. Then, take one big diaphragmatic inhale, purse your lips, start a timer, and exhale through your mouth as slowly as you’re able to. As with McKeown’s test, stop the timer when you’ve run out of breath to exhale—not when you feel a need to inhale. Like McKeown, Huberman recommends doing this test first thing in the morning.

If your exhale lasts 30 to 60 seconds, your nervous system has recovered to a sufficient degree for further exercise. A full 120 seconds generally indicates that your body is performing at the highest possible level. However, if your exhale lasts less than 25 seconds, it indicates that your nervous system is still recovering from recent exertion, and you should give yourself time to rest or enhance recovery in some other way before engaging in more physical training.

Exercise #2: Unblocking the Nose

As we’ve established, the first step in improving your breathing habits is breathing through your nose at all times. McKeown notes that unfortunately, nasal congestion is a major obstacle for many habitual mouth breathers who want to make this change. Mouth breathing can cause your nasal capillaries to become inflamed and your nose to produce more mucus, which contributes to nasal congestion.

(Shortform note: The condition of inflamed nasal capillaries resulting in increased mucus production is called vasomotor rhinitis. However, if your nasal congestion is accompanied by an itchy nose, itchy or watery eyes, and a sore or irritated throat, it’s likely that you’re simply suffering from allergies rather than excessive breathing—this is called allergic rhinitis.)

Luckily, McKeown prescribes a specific exercise to break out of this cycle and start breathing through your nose. Exhale, then plug your nose, hold your breath, and walk around until you feel a strong need to breathe. Let go of your nose and take a calm, slow nasal breath in. Recover for a short time, then repeat until your nose is less congested. Eventually, repeating this exercise will allow you to hold your breath for longer, and as your body adapts, your nose will become permanently clearer.

(Shortform note: According to the Buteyko Clinic, the company where McKeown serves as Director of Education and Training, you can perform this exercise while seated and still successfully unblock your nose. Additionally, they note that if this exercise is ineffective, you can try an alternative practice: Dissolve salt and baking soda in warm water, then use a plastic syringe to squirt this water through your blocked nasal passages and into your throat to clear them directly.)

Exercise #3: Breath Reset

This next exercise resets your breath from heavy breathing back to a calm state. McKeown recommends using it as a post-workout cooldown.

To practice this exercise, walk around, breathing smoothly and slowly. Exhale, then hold your breath for two to five seconds. Release and breathe normally for 10 seconds, and repeat until you’ve reset to your normal at-rest breathing pattern.

The Importance of Cooling Down

Why is it necessary to cool down post-workout? During exercise, your heart beats faster, pumping blood to your extremities. Your moving muscles help to pump blood from your extremities back into the heart—however, if you abruptly stop moving, this pumping stops, causing blood to pool and stagnate in your extremities. This can cause dizziness or fainting. It arguably makes sense that McKeown would recommend holding your breath to avoid this problem because (as we’ve discussed) restoring carbon dioxide in your blood dilates your blood vessels, increasing blood flow and preventing symptoms like dizziness or fainting.

However, some other experts recommend cooling down after exercise by intentionally slowing your breathing rather than holding your breath. To ensure that this breathing successfully calms your system, maintain a 1:2 cadence in which your exhales are twice as long as your inhales—for instance, a four-second inhale followed by an eight-second exhale.

Exercise #4: Basic Carbon Dioxide Training

The core exercise you’ll use to increase your carbon dioxide tolerance is a breathing procedure you can do while sitting or lying down (McKeown calls this the “Breathe Light to Breathe Right” exercise). If your carbon dioxide tolerance time is 15 seconds or more, you’ll typically be able to complete and benefit from this exercise. McKeown recommends practicing this for 10 minutes, three times a day.

Place one hand on your chest and one hand on your belly. Breathe slowly and deliberately with your diaphragm—the hand on your belly should move while the hand on your chest remains relatively still. Press into your body with your hands, physically pushing against the breath as you inhale. The goal here is to reduce the amount of air you breathe in—with every breath, inhale less air until you’re breathing far less air than you typically do. If you feel like you’re breathing less than your body wants you to, you’re successfully training your carbon dioxide tolerance.

When performing this exercise, relax your body—none of your muscles should feel tense. If you ever feel yourself involuntarily tense up or your breathing becomes jerky and unstable, take a break—the goal is smooth, easy breathing that slightly challenges your desire to breathe. If you struggle to achieve this, you may need to build some carbon dioxide tolerance before adding this exercise to your routine. You can use nasal breathing and the breath reset exercise described above to do so.

(Shortform note: If you struggle to relax your body during this exercise, try using a technique called progressive muscle relaxation. Some experts assert that by tensing one part of your body at a time for four seconds and then releasing this tension, you neutralize your body’s stress response and experience full-body relaxation. This will automatically slow your breathing, theoretically making it a valid way to increase your carbon dioxide tolerance in itself. If McKeown’s training exercise is too challenging at first, this may be a good place to start.)

Comparing McKeown’s Exercise to Pranayama

McKeown’s diaphragmatic breathing exercise is nearly identical to one prescribed by yoga practitioners. In the ancient yogic tradition, disciplined breathwork is called pranayama, and practitioners use it to control the essential energy of the universe, called prana. Modern practitioners use pranayama for spiritual growth as well as more general health benefits.

Like McKeown, modern pranayama practitioners recommend sitting or lying down, placing one hand on your chest and another on your belly, and intentionally breathing into your diaphragm. Additionally, some experts recommend placing a light sandbag on your stomach while you practice this exercise, applying a more consistent pressure than the forceful palms McKeown suggests. They specify that this pressure helps strengthen your diaphragm and abdominal muscles, making it easier to breathe in a healthy way.

Yoga experts also provide an alternative technique for people who struggle with basic diaphragmatic breathing: the crocodile pose. Lie on your belly and rest your head on your crossed arms so your stomach is slightly lifted off of the floor. This pose makes it easier to ensure you’re breathing diaphragmatically—when you feel your stomach touch the floor, you know you’re inhaling into the diaphragm successfully. If your carbon dioxide tolerance is low and you have a hard time understanding what diaphragmatic breathing feels like, consider starting with this exercise.

Some yoga experts recommend practicing pranayama in sessions that last at least 15 minutes and as frequently as 10 times a day.

Exercise #5: Carbon Dioxide Training in Motion

Once you’ve practiced the basic carbon dioxide training at rest and your carbon dioxide tolerance has measurably increased, McKeown recommends working your way up to executing the training during physical exercise—while walking, running, or cycling. This intense practice will further increase your tolerance to carbon dioxide. There’s no need to use your hands when doing this, but continue to keep your body relaxed and stretch your ability to breathe less than you feel like you need to.

Note that McKeown doesn’t recommend advancing to any breath exercise more intense than the basic carbon dioxide training if you suffer from a medical condition that could be exacerbated by physical exertion. In this case, consult your physician before undertaking these more advanced breathing exercises. Similarly, if you start to feel dizzy or sick, stop the exercise immediately.

(Shortform note: Why might these exercises prove dangerous? Some experts note that if your body isn’t accustomed to exercise and you suddenly put it under intense stress, you run the risk of rhabdomyolysis—when muscle cells burst, leaking into the blood and causing kidney failure. Another possibility is that McKeown is warning against the risks of respiratory acidosis—when you fail to exhale enough carbon dioxide from your blood, turning it acidic. Dizziness when holding your breath may be an early sign of respiratory acidosis, as the carbon dioxide overloading your bloodstream forces oxygen out, cutting off oxygen to the brain.)

Set the Right Breathing Rhythm to Avoid Injury

Some experts say that as you start paying attention to how you breathe during physical exercise, it’s important to get the rhythm of your breath right—the wrong breath timing can cause injury. As you walk or run, you momentarily lose stability in your core every time you exhale, putting greater stress on whichever foot is hitting the ground. If the rhythm of your breath means that your exhale lines up with the same foot hitting the ground every time, you’ll put chronic stress on one side of your body.

To avoid this, practice breathing at an asymmetrical cadence, where you inhale for three steps and exhale for two steps. This way, the foot you land on every time you exhale will naturally alternate, evening out the stress across your body. You can apply this practice to walking, running, and presumably cycling (although it may not be necessary while cycling, as it’s considerably less stressful on your joints than running).

The Benefits of Breathing Less for Athletes

McKeown puts particular emphasis on the benefits of breathing less for athletes—let’s take a look at the two main benefits athletes can claim by breathing lighter. After this, we’ll outline two advanced breathing exercises that athletes can use to enhance their performance.

Benefit #1: Increased Physical Performance

Breathing less results in vastly improved athletic performance, contends McKeown. The improved oxygenation of your muscles and organs caused by greater carbon dioxide tolerance is particularly impactful during exercise. In athletic training, the amount of oxygen your body can utilize in one minute during intense exertion is called VO₂ max. Carbon dioxide tolerance has been shown to sharply increase VO₂ max, resulting in vastly improved stamina.

(Shortform note: Aside from being a reflection of your physical stamina, VO₂ max is a remarkably accurate predictor of how long you’ll live, according to some researchers. A 23-year-long study of 122,000 adults who were 53 years old on average found that every increase in VO2 max correlated with a statistically significant decrease in mortality from all causes. Most strikingly, the top 5% of participants were five times less likely to die than the bottom 25%. This is what we would expect to see if McKeown’s understanding is correct—if high VO₂ max means you have more CO₂ in your bloodstream at all times, it makes sense that you would reap the health benefits of increased oxygen flow at all times, not just during exercise.)

Benefit #2: Reduced Risk of Injury

McKeown contends that training your body to breathe less reduces your chance of injuring yourself by mitigating the damage done by free radicals. When your body uses up oxygen, it produces these unstable and potentially harmful molecules, which can damage various tissues in your body and greatly increase the risk of injury during exercise. This is called oxidative stress. Typically, your body has enough antioxidants from the food you eat to counteract free radicals. However, intense exercise can create more free radicals than your body is prepared for, increasing oxidative stress beyond manageable levels.

McKeown asserts that breathing less prompts your body to produce more antioxidants, which neutralize the free radicals. Additionally, by restricting yourself to nasal breathing, forcibly reducing the amount of oxygen you inhale, you ensure that you don’t exercise more intensely than your body is prepared for. This limits the number of unbalanced free radicals in your system.

(Shortform note: Although exercising more intensely than your body is ready for (and suffering from excessive oxidative stress) should be a concern, it’s arguably much less common than the opposite problem—not exercising enough. The US Department of Health and Human Services recommends a minimum of 150 minutes of moderate aerobic exercise per week, or 75 minutes of intense aerobic exercise per week. However, almost 80% of adults in the US fail to reach this benchmark.)

Common Myths About Free Radicals

Although there’s research showing the harmful effects of too many free radicals and the power of antioxidants to combat them, the general idea of “antioxidants versus free radicals” has been used to promote theories about health that lack substantial evidence.

For instance, some people use antioxidants as the defining quality of “superfoods,” food items they claim you need to eat to have a healthy body. In reality, however, no antioxidant-rich food is significantly healthier than other healthy foods, and you don’t need to eat superfoods. Furthermore, you need to eat a wide variety of different kinds of food for optimum nutrition, not just “superfoods.”

Others claim that oxidative stress from free radicals is the primary cause of aging, and by increasing the antioxidants in your diet, you can stop or even reverse the aging process. Although some studies show that antioxidants may slow the aging process, other evidence indicates that in some situations, they may have the opposite effect. One study found that worms treated with more free radicals lived longer than worms with fewer free radicals.

McKeown’s take on antioxidants arguably has more scientific evidence backing it up than these claims. Several studies indicate that deep, slow breathing can reduce oxidative stress, including stress induced by vigorous exercise. In one study, a group of cyclists biked for eight hours. Then, half of them did an hour of deep breathing while the other half read magazines. The deep breathing group showed significantly reduced oxidative stress, as well as decreased cortisol and increased melatonin (an antioxidant hormone).

Breathing Exercises for Athletes

McKeown offers another set of exercises that athletes can use to take their performance to the next level. He also notes that anyone can practice them to further train their carbon dioxide tolerance and improve their fitness.

Exercise #1: Breath-Hold Warm-Up

First, McKeown recommends a pre-exercise warm-up that involves holding your breath to prepare your respiratory system for intense exercise in the near future. By holding your breath, you build up carbon dioxide in your blood rather than exhaling it. This prevents you from running out of carbon dioxide when the intense exertion makes you exhale more, meaning you can oxygenate your body more effectively for longer once you get going.

The exercise itself is essentially the same as the nose-unblocking exercise above, except you’ll be holding your breath for slightly longer and recovering for longer. Walk around, then exhale and hold your breath until you feel a strong need to breathe. Release and breathe normally through your nose for about a minute, then repeat. To warm up effectively, McKeown recommends doing this for 10 minutes before you start exercising.

Counterpoint: Sometimes, It’s Better to Breathe More Pre-Workout

While McKeown asserts that this breath-hold warm-up is ideal before every workout, some experts argue that the pre-workout breath exercise you choose should vary depending on how you’re feeling at the moment.

For instance, if you’re feeling lethargic and unmotivated to exercise, consider warming up by intentionally engaging your sympathetic nervous system. This fight-or-flight stress response gives you the energy and alertness you need to fight threats, which you can channel into healthy exercise. To engage the sympathetic nervous system, take full breaths quickly: Inhale for one second into your belly, then inhale for one second into your chest, and exhale for one second. Unlike McKeown’s warmup, which lasts for a full 10 minutes, you should only practice this exercise for 60 seconds—at which point you’ll ideally feel ready to move.

McKeown would likely say that this rapid breathing technique drains your body of carbon dioxide. By this logic, you’ll run out of carbon dioxide even sooner once you get moving, preventing you from oxygenating your body. However, if this breathwork motivates you to exercise, it may be worth it—imperfect exercise is arguably better than no exercise at all. Alternatively, experiment with combining these two exercises by breathing rapidly to perk yourself up, then transitioning to McKeown’s breath-hold exercise to prepare your body for intense exertion.

Exercise #2: Breath-Hold Training

McKeown recommends an exercise for achieving peak athletic performance that involves first holding your breath for extended periods while walking. Then, after you’ve increased your tolerance for carbon dioxide significantly, you hold your breath while running (or performing some other form of intense cardio). Training while holding your breath like this replicates the experience of training at a high altitude, where the air is thinner and you naturally inhale less oxygen. As Olympic athletes have demonstrated for decades, high-altitude training improves physical performance by causing your body to produce more oxygen-carrying red blood cells in response to a low-oxygen environment.

(Shortform note: Some research suggests that high-altitude training doesn’t work for everyone. One study of Olympic athletes training at high altitudes found that their red blood cell production only significantly increased 56% of the time. Some experts have used this data to conclude that some people can’t adapt to the oxygen level of their environment, calling them “non-responders.” However, others contend that these “non-responders” may have been training wrong, theorizing that they didn’t have enough iron in their system to support red blood cell production, or they were training through mild illness that hampered red blood cell production.)

To try this breath-hold training, start moving. Exhale and hold your breath until you feel a medium need to breathe. Then, release and breathe intentionally small breaths for 15 seconds. Finally, recover by breathing normally for 30 seconds, and repeat this eight to 10 times. Over the course of the exercise, increase the amount of time you hold your breath, waiting until you feel a powerful need to breathe to release. Once you’ve worked up to this exercise, do it once a day, McKeown recommends.

McKeown’s Breath-Hold Training vs. Wim Hof Breathing

Another popular breathing exercise that involves holding your breath is the Wim Hof method (detailed in the book of the same name). Despite being similar exercises on the surface, the Wim Hof method and McKeown’s breath-hold training have some different effects on the body.

Wim Hof breathing is the practice of training your body by temporarily reducing oxygen in the blood. According to this exercise’s creator and namesake, Wim Hof, this short-term stress strengthens your body’s ability to cope with future stress, like training a muscle. He asserts that this results in less anxiety and stress, faster recovery from exercise, and a stronger immune system.

Unlike McKeown’s exercise, Wim Hof breathing doesn’t actively improve your carbon dioxide tolerance, as it doesn’t involve increasing the amount of carbon dioxide in your blood over the long term. However, despite the two methods’ differences, McKeown acknowledges on his website that the Wim Hof method intends to accomplish many of the same goals as his exercises, including reducing stress and chronic inflammation. Some practitioners recommend using both methods.

Unlike McKeown’s breath-hold training during movement, Wim Hof breathing is practiced seated or lying down. To use this method, take 30 to 40 deep breaths, in through the nose and out through the mouth. You’ll exhale a significant amount of the carbon dioxide in your body. Then, inhale as deeply as you can and hold your breath until you feel the need to breathe. You’ll be able to hold your breath for longer than normal because you’ll have less carbon dioxide in your body. Finally, inhale one “recovery breath” and hold it for about 15 seconds. Repeat this process three or four times in a row. Like McKeown, Hof recommends practicing this once a day.