The Oxygen Advantage

A Book Review for People with Type-1 Diabetes
by John C. A. Manley

I placed the Oxygen Advantage on order with my local bookstore. When I went to pick it up the shopkeeper scanned the cover, laughed and said: “A book arguing that oxygen is beneficial?”

Instead the book is about the advantages that come from increasing the amount of oxygen getting into our tissues, organs and brain (instead of just passing through the bloodstream). Thousands of books talk about the importance of breathing; this books shows that most breathing instructions are not boosting oxygen uptake at all. In fact, they are often reducing the amount of oxygen we actually absorb.

I’ve long been waiting for a clear and well put together book to recommend that explains the science, theory and application of the breathing retraining methods of the late Ukrainian scientist, Konstantin Buteyko. McKeown travelled to Russia in the 90s and worked directly with Buteyko to overcome his own chronic health problems. Today, he has become the most well-known teacher of Buteyko’s methods in the West. In this 339-page volume, he’s repackaged and updated the Buteyko Method with better terminology (for the most part), slightly more refined techniques, clearer instructions and newer science.

The book also has a stronger focus on the benefits of oxygen deprivation. This makes me wonder if McKeown should have given the book the complete opposite title.

The Oxygen Disadvantage

The book could of easily been titled The Oxygen Disadvantage – especially considering how many of the studies and exercises presented focus on mimicking lower oxygen levels – like we find at higher altitudes, where lifespans and health are typically better. Indeed, chapter 7 is titled: “Bring the Mountain To You.”

An even more daring and accurate title might have been: The Carbon Dioxide Advantage.  “Most people learn,” writes McKeown, “that carbon dioxide is just a waste gas that we exhale from our lungs, but it is not a waste gas. It is the key variable that allows the release of oxygen from the red blood cells to be metabolized by the body…. Most people don’t realize that the amount of carbon dioxide in the blood cells determines how much oxygen we can use…. we exhale too much carbon dioxide, leaving our bodies literally gasping for oxygen.”

I think it is fair to assume that increasing oxygenation of the body is critical key to curing type-1 diabetes. It should certainly help fend off complications. But proper breathing can help in another way: Improved circulation.

Close Your Mouth and Save Your Toes

Many diabetic complication are a result (at least in part) of poor circulation. Not enough blood gets to the toes, the kidneys, the eyes or the heart and they slowly fail.

“Nitric oxide sends a signal to blood vessels to relax and dilate.” writes McKeown. “Producing sufficient nitric oxide enables blood flow to be directed effortlessly around the body, ensuring that vital organs receive sufficient oxygenation and nutrients. As nitric oxide is produced inside the paranasal sinuses… breathing gently and calmly through the nose allows the gas to be picked up and carried to the lungs and blood.”

Thus, simply switching to nasal breathing should reduce the chances of those with type-1 diabetes being teamed up with a dialysis machine.

“Noses Are for Breathing, Mouths Are for Eating”

Nasal breathing (day and night) has always been the foundation of the Buteyko Method. The Oxygen Advantage devotes its entire fourth chapter (with the amusing title: “Noses Are for Breathing, Mouths Are for Eating”) to show the many other ways nasal breathing is essential. While nasal breathing is ideal for increasing carbon dioxide, hemoglobin and nitric oxide levels, other side benefits are highlighted, like reducing dry lips and keeping germs out of the lungs.

The book also explains how keeping the mouth closed and the tongue in the proper position prevents orthodontic problems and creates a wider head. Page 225 shares a study from the University of California showing that men with wider faces were more successful in the business. Superior facial structure among primitive cultures has often been attributed to a superior diet, but it may be more to do with their superior breathing habits.

Breathe Like Our Ancient Ancestors

Indeed, chapter 5, “Secrets of Ancient Tribes,” takes the most comprehensive examination I’ve ever read of the breathing habits of primitive cultures.

McKeown notes how the Tarahumara of Mexico keep their mouth closed while running. As a result, they have a heart rate 20-50 beats per minute lower than a London marathoner running with their mouth open.  The chapter looks at Amazonian hunters chasing animals for hours (or even days) without opening their mouth. The author makes the astute point that holding one’s breath during physical exercise was common practice among human ancestors foraging for underwater edibles.

This chapter also illustrates that activity levels of our ancestors rivaled that of today’s athletes. And while we associate fitness with athletes today, maybe we shouldn’t.

More Oxygenation: Not Just For Athletes

I was a little reluctant to read this book. The title made it sound as if it was directed towards elite athletes. Instead, the book speaks to a wider audience with chapters devoted to weight loss, asthma and heart disease awkwardly moving from the stay-at-home-mom to the Olympic medalists.

Athlete or not, the second section of the book, “The Secrets of Fitness,” presents fascinating information applicable to all forms of exercise. In fact, the recreational runner or those playing sports for fun, can reap even more health benefits from these methods than your typical athlete (who push themselves to the edge of endurance). For example, as McKeown points out in chapter 14 (“Exercise Like Your Life Depends On It”), nitric oxide levels rise during moderate exercise, but actually drop with intense exercise.

Nonetheless, McKeown suggests that many famous athletes are using many of the breathing techniques in this book, but purposely keeping it a secret to maintain an advantage over their competitors. For example he points out that Bear Grylls prepared for is 1998 climb up Mt Everest by swimming underwater. Czech athlete, Emil Zaopek, one of the greatest long distance runners, used breath holds while walking to work (even once pushing himself so far he passed out).

McKeown also says that certain sports lead to better breathing by unintentionally using the concepts in The Oxygen Advantage. On page 217, por ejemplo, states that narrowing of airways is seen amongst 55% of football players, 50% of basketball players and 0% of water polo players. (He even talks about underwater hockey – a sport I never would have imagined existed.)

The book shares many other insights that can help anybody get started with or increase their enjoyment of daily physical exercise. On page 9, McKeown points out that most people often need to build respiratory stamina more so than physical stamina. Page 189 provides evidence showing that we can handle oxidative stress better if we did a less intense exercise program every single day instead of a intense workout three times a week.

Is a Little Mouth Breathing Okay?

The only part I didn’t like about the fitness chapters: Once breathing reaches a specific and measurable level of efficiency McKeown allows for brief periods of mouth breathing during intense exercise.

On page 131, for instance, the book makes the oddly non-committal statement: “Breathing through the mouth is probably the best option during swimming, as nasal breathing may result in water inhalation.” May result? Probably the best? It almost sounds like a politician trying to please too many people, while offending none. After reading this I decided to trade my running wear for a swim suit and head down to a nearby salt-water pool. I found absolutely no problem swimming with nasal breathing (having adapted to nasal breathing after two years of daily runs).

The mixed messages about nasal breathing feels a bit like convincing a heroine addict of the dangers of his addiction, putting him through rehab, and then saying: “Now that you’re clean… a little dope, once in a while, when life gets too intense, is okay.”

Now, on page 86 McKeown does say: “Recreational athletes who are not taking part in competitions or high-intensity exercise, however, are far better off maintaining nasal breathing all the time.” Again, the book suffers from trying to speak to diverse audiences at the same time.

The book also mentions little to nothing about maintaining nasal inhalation while talking and singing. Yet it makes up for this by its warning about sighing.

Stopping a Rapid Heart Rate When All Else Failed

McKeown shares a case study of a slim thirtysomething woman who suffered from a rapid heart rate. (This is a condition I see among many people with type-1 diabetes.) Cardiovascular specialists could not find the cause and determined her condition was incurable.

“She seemed to be a nose breather, but the one thing that caught my eye was that she would sigh every few minutes, lifting her shoulders and taking a large breath,” writes McKeown. “I’d seen the effects of regular sighing many times over the years, often in individuals prone to anxiety, and just like mouth breathing, it is a habit that usually gets unnoticed.”

McKeown then gave her specific instructions (p. 199) on how to retrain herself to stop sighing. Within a few weeks her pulse had reduced by 30 beats per minute – into normal range.

“Live Unhindered By Thought”

Where the fitness section of the book lacks in hard-core nasal breathing, it makes up with an unexpected gem of a chapter with the moribund title: “Finding the Zone.” While written for elite athletic endeavours, the content is applicable to any lifestyle, whether we are washing dishes, writing a book, running a restaurant or changing a diaper.

“When the mind is still and the thoughts are no longer a distraction,” McKeown writes, “you are able to give an activity your complete and undivided attention. Being able to focus without distracting thoughts defines concentration, a vital attribute for the proper execution of any action, the achievement of any goal.”

The chapter makes unique observations about the struggle for mindfulness in our modern world.  For example, McKeown points out the Internet has shortened most people’s attention span to that of a goldfish (9 seconds). Yet one of the men behind this technological rise in instant distractions, Steve Jobs, would not let his own children use an iPad.

What really makes McKeown’s chapter unique is how he combines the science of the proper breathing with the mindfulness exercises of the East. Many mindfulness gurus appear to have very poor breathing patterns, undermining their own progress. McKeown writes that “a still mind can be attained through a high BOLT [Body Oxygen Level Test] score, using meditation and developing awareness of the mind – nothing else.”

McKeown goes on to point out that mediation has been shown to shrink the part of the brain that produces fear; while improving the area of the brain that makes us happy and calm. Such is the life “unhindered by thought”; while “overthinking every action creates gigantic mental hurdles.”

Chapter eight’s overall focus is metaphorically summed in McKeown’s advice to “run without a head.”  Simply replace “run” with whatever “thing” you’re life has you doing and I think you will find this chapter worth the price of the entire book.

From Mind Control to Appetite Control

Chapter 9 (“Rapid Weight Loss Without Dieting”) contains other unexpected insights – this time in regards to weight loss and food addiction.

McKeown says that by using the breathing reduction exercises in this book you can “kick-start” oxygen levels in the blood. More oxygen equals less appetite. He reports seeing clients lose anywhere from 2 to 6 pounds a week, simply changing how they breathe while watching TV.

The rise in carbon dioxide that proper breathing brings, also creates a desire for lower-calorie alkaline foods, says McKeown. “These individuals, when shown how to address their poor breathing habits, automatically find their diet changing to healthy foods over processed foods.”

This falls back to Dr. Buteyko’s maxim that he would only talk to patients about diet once for every 99 times he talked to them about breathing. Still, translations of Buteyko’s training manual contained warnings about processed foods negatively impacted breathing. Buteyko and McKeown’s dietary advice, however, differs in other areas.

Do Animal Foods Mess Up Our Breathing?

Buteyko found that a diet absent of all animal products produced the healthiest breathing patterns; with a particular focus on whole grains and vegetables. McKeown’s book, whether to  appeal to a larger audience or because of different findings, recommends a small amount of animal products. Personally, I’ve tested both approaches and can definitely say that a low-fat, whole plant-food diet minimized respiration while running (without causing protein deficiency).

Regardless of which diet might be best for breathing, it is good to see that both the vegetarian and the paleotarian will both benefit from breathing retraining.

An Oxygen Buffet: 6 Programs to Choose From

Using a simple DIY test (p. 36) you can determine your BOLT score (Body Oxygen Level Test). This is exactly the same as Dr. Buteyko’s Control Pause test with a more attractive acronym. Once you know your current score – zero you’re dead, 1-39 you’ve got work to do, 40+ you’re healthy, 60+ you’re a superman) – you can flip to part four of the book, titled “Your Oxygen Advantage Program” (which mercifully doesn’t use the word “secret” again).

This final section consists of four different daily routines incorporating lifestyle changes and specific breathing exercises. The book also includes two variations, one for children and one for people needing to lose weight. There’s also additional special instructions for people with breathing disorders like chronic coughing. The breathing retraining exercises require 60-90 minutes a day of focused time. Some of them, however, can be done while walking or running, which we should be doing anyway. The techniques also may reduce the amount of time you spend sleeping (or trying to fall asleep) as they allow the body to relax more fully – so no time lost.

In the first two programs, McKeown makes a recommendation I’d never seen before: Those with a BOLT score below 15 were to hold off on Buteyko’s key breathing exercise and, instead, focus on a  simpler exercise until there breathing had improved. This made perfect sense to me as I’ve seen many people make slow progress with the more advanced exercise.

Lacks the “Journey of Discovery”

My last bit of constructive criticism, however, is that the book reads too much like a thesis at times. I’d much more preferred it use the story-telling style of another writer with an Irish surname, Christopher McDougall (author of Born to Run). I would have liked to have seen how McKeown’s learning unfolded going from a stressed-out asthmatic to helping thousands of people around the world learn how to breathe. In particular I would enjoy a more detailed account of his time in Russia, being trained under the legendary Konstantine Buteyko.

Likewise, the book is full of many examples from athletes and clients, yet each is a told in a rather anorexic style. They lack details about the struggle and emotional rigour that such stories of personal transformation entail.  I much prefer, for example, how an author such as Malcolm Gladwell can frame whatever he is trying to teach in a series of fleshed out anecdotes that seamlessly merge the human experience with the technical how-to.

Notwithstanding, The Oxygen Advantage was a riveting read, even for someone like myself who has been studying breathing methods since 1996 and the Buteyko Method for the last two years.

Those With T1D Be Cautious But Not Afraid

The book opens with some overly cautious warning for those with type-1 diabetes. Like physical exercise, breathing exercise will cause blood sugar to drop if you are taking injected insulin. It is important that you have good blood sugar control before trying the more difficult techniques.

Regardless, I know many people with type-1 diabetes who have found these breathing methods, whether practiced intensely or cautiously, invaluable for reducing insulin needs, improving energy and mood and increasing blood circulation. The Oxygen Advantage offers anyone with type-1 diabetes several great advantages to counter the grave disadvantages of life without beta cells.

ORDER ONLINE: The Oxygen Advantage: The Simple, Scientifically Proven Breathing Technique That Will Revolutionise Your Health and Fitness by Patrick McKeown available at, and You can also order a copy from The Buteyko Clinic in Ireland.