Wow, this book was a DOOZIE! I recently just put up a summary on Breath by James Nestor, and The Oxygen Advantage was an incredible journey into the more nitty-gritty science of breathing.

Specifically, breathing less. Much less.

In other words, you’re probably breathing too much – especially if you suffer from anxiety, stress, poor circulation, coldness, nasal congestion, asthma, cancer, heart disease, low energy, weight gain, and sleep apnea.

Like what?? I think those symptoms cover pretty much everyone in the Western world!

Here are some of the radical, science-backed benefits of restricted, nasal breathing:

  • Improves anxiety
  • Decreases oxidative stress, free radicals and disease-causing inflammation (caused especially by high-intensity exercise)
  • Activates the parasympathetic (relaxation) nervous system
  • Increases warmth, circulation and energy
  • Prevents disease (including heart disease and cancer)
  • Produces rapid weight loss by decreasing appetite, stress, and blood sugar levels
  • Improves athletic performance by increasing Max V02
  • Decreases asthma and sleep apnea
  • Increases the release of oxygen from red blood cells, both increasing oxygenation to the heart and body
  • Diaphragmatic breathing pushes the breath to the lower lungs, which has more blood flow and thus increases oxygenation and CO2
  • Increases nitric oxide (the Magic Molecule), which also boosts oxygen uptake, relaxes vessels further increases oxygenation, removes arterial plaque, prevents blood clots, decreases cholesterol (all preventing heart attacks and stroke)

“Another advantage of abdominal breathing is that it assists with lymphatic drainage. The lymphatic system is effectively the body’s sewer system, draining away waste materials and excess fluid. During abdominal breathing, lymph is sucked through the bloodstream, neutralizing and destroying dead cells, reducing fluid retention, and improving detoxification of the body.”

Patrick McKeown, The Oxygen Advantage

The two most important breathing exercises you’ll learn from the book:

  • Slowing down your breath volume into you feel a tolerable need for air for 3-5 minutes, twice a day (see Breathe Light to Breathe Right below)
  • Holding your breath after you exhale (no breath in your lungs) until you feel a moderate to strong air hunger, several times a day

The key is you actually want to increase carbon dioxide in your body, in order to release more oxygen from your red blood cells. The more carbon dioxide you can learn to tolerate, the more you’ll benefit. This can be done by decreasing your breathing volume during the day, and practicing breath holds during rest and exercise.

So here we go, a summary of the mind-blowing book, The Oxygen Advantage by Patrick McKeown. As usual, this summary is organized into chapter, with direct quotes from the book in bullet points, sometimes with my own paraphrased bullet points.


  • “It has been well documented that those who live at higher altitudes tend to live longer.”
  • “Research is very clear that calorie restriction extends life span. But another nutrient many of us don’t frequently consider is oxygen.”
  • Decreased breathing decrease the free radicals and inflammation caused by oxygen metabolism, which prevents damage to our cells and DNA

Introduction: Do More with Less

  • “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.”
  • Just like we binge eat, we can also binge breathe
  • “The process of breathing has been warped by chronic stress, sedentary lifestyles, unhealthy diets, overheated homes and lack of fitness. All of these contribute to poor breathing habits.”
    • “These in turn contribute to lethargy, weight gain, sleeping problems, respiratory conditions and heart disease”
  • “The biggest obstacle to your health and fitness is a rarely identified problem: chronic overbreathing.”
  • “We can breathe two to three times more air than required without knowing it.”
  • “Breathing too much air every minute, every hour, every day translates into excessive breathlessness during exercise.”
  • “Overbreathing causes the narrowing of airways, limiting your body’s ability to oxygenate, and the constriction of blood vessels, leading to reduced blood flow to the heart and other organs and muscles.”
  • “The amount of oxygen your muscles, organs, and tissues are able to use is not entirely dependent on the amount of oxygen in your blood. Our red blood cells are saturated with between 95 and 99 percent oxygen, and that’s plenty for even the most strenuous exercise. What determines how much of this oxygen your body can use is actually the amount of carbon dioxide in your blood. Most people learn 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. This is called the Bohr Effect.”
  • “Most people don’t realize that the amount of carbon dioxide present in our blood cells determines how much oxygen we can use.”
  • “At high altitude the air is thin, which results in reduced atmospheric pressure of oxygen. The body adapts to this environment by increasing the number of red blood cells.” The same effect can be produced by breathing less which increases CO2 in the body.
  • “Upping the presence of red blood cells translates into improved oxygen delivery to the muscles, a reduction of lactic acid buildup, and stronger overall performance, including longer endurance and a lower risk of inflammation and injury.”
  • Asthma has been around for thousands of years but has become more prevalent since the 1980s, which means that increase has been caused by lifestyle, not genetics.
  • “Weight loss only occurs when the amount of calories we burn is greater than those we consume, and our breathing has a direct bearing on this process. With properly oxygenated cells, our bodies operate more efficiently, even – or especially – in passive activites like sitting. A desire for more water and less processed food naturally follows.”

Chapter 1: The Oxygen Paradox

  • “Taking a large breath into the lungs during rest will not increase oxygen content. It is exactly the wrong thing to do if you seek greater endurance.”
  • “It is quite a striking example of evolutionary balance and beauty that the tress around us that give off oxygen and the trees in our lungs that absorb it share a similar structure.”
  • “It is a common misconception that breathing in a larger volume of air increases the oxygenation of the blood. It is physiologically impossible to increase the oxygen saturation of the blood in this way, because the blood is almost always already fully saturated.”
  • “The human body actually carries a surplus of oxygen in the blood – 75 percent is exhaled during rest and as much as 25 percent is exhaled during physical exercise. Increasing oxygen saturation to 100 percent has no added benefits.”
  • “For years people have been indoctrinated with the “benefits” of taking deep breaths by well-meaning stress counselors, yoga practitioners, physiotherapists, and sports coaches, not to mention the Western media. And it’s easy to see why this belief is perpetuated: Taking a large breath can actually feel good, even if it can actually be bad for you.”
  • The key to better breathing is breathing slower and less (lower volume)
  • A slower rate of breathing can still lead to overbreathing if you take in too much air with each breath
  • “Part of your body’s quotient of carbon dioxide is retained when you exhale. correct breathing both relies on and results in the right amount of carbon dioxide being retained in your lungs.”
  • “When we breathe too much over an extended period of days to weeks, a biochemical change takes place inside us that results in an increased sensitivity or lower tolerance to carbon dioxide. With this lower set point, breathing volume remains above normal as the receptors in the brain continuously stimulate breathing in order to get rid of carbon dioxide that is perceived to be in excess of the receptor’s programmed limits. The result is the habit of chronic overbreathing or chronic hyperventilation, with all its negative manifestations.”
  • “The problem is not a lack of oxygen in the blood, but that not enough oxygen is being released from the blood to tissues and organs, including the brain, resulting in feelings of lethargy and exhaustion.”
  • “Once the pattern of overbreathing is established, it is often maintained by an occasional deep breath or sigh. When such a habit becomes ingrained both mentally and physically, you will breathe in excess of what is required every minute, every hour, and every day. And it doesn’t just happen while we’re conscious; many people sleep with their mouth open, and whether they realize it or not, this drags down their physical and mental energy.”
  • “The crucial point to remember is that hemoglobin releases oxygen when in the presence of carbon dioxide. When we overbreathe, too much carbon dioxide is washed from the lungs, blood, tissues, and cells. This causes the hemoglboin to hold on to oxygen, resulting in redured oxygen release and therefore reduced oxygen delivery 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 and organs.”
  • “Breathing too much can also cause reduced blood flow. For the vast majority of people, 2 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 dioxide.”
  • “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 percent.”
  • “Many individuals who sleep with their mouths open may find it difficult to get going in the morning. However long they sleep, 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.”
  • “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 persons diagnosed with asthma.”
  • “It’s not just people with asthma 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.”
  • “It’s not just breathless exertion that leads to panting. Panting also leads to breathless exertion.”

Chapter 2: How Fit Are You Really?

The Body Oxygen Level Test (BOLT)

  • “When breathing receptors are less sensitive to carbon dioxide levels, you will experience a reduction in breathlessness as your body is able to work harder with far less effort; breathing will be lighter during both rest and physical exercise.”
  • “Efficient breathing means that fewer free radicals are produced, reducing the risk of inflammation, tissue damage, and injury.”
  • Breathing less increases our tolerance for CO2, which increases our Max V02, which is the primary indicator of athletic performance and oxygen utilization
  • “When the breath is held [on the exhale], oxygen saturation in the blood decreases, leading to increased production of red blood cells to offset the drop, which leads to an increase in aerobic capacity and V02 Max.”
  • “Remember that changing your breathing volume toward normal improves blood flow and oxygenation of all tissues and organs. With better-functioning organs and systems, waste products are expelled more readily.”
  • Typical detox symptoms:
    • Increased demand for water
    • Loss of appetite
    • Bad taste in the mouth
    • Increased moodiness
    • Short-term headache
    • Increased secretions of mucus from the lungs by people with asthma
    • Head cold with runny nose, especially during physical exercise
    • Diarrhea

The BOLT Test:

  • Take a normal breath in through your nose and allow a normal breath out through your nose.
  • Hold your breath after exhaling.
  • 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 (need to swallow, constriction of airways, contractions of the abdomen or throat)
  • Breathe in through your nose and resume normal breathing.
  • “If your BOLT score is below 20 seconds, you will probably find you experience a blocked nose, coughing, wheezing, disrupted sleep, snoring, fatigue, and excessive breathlessness during physical exercise.”
  • “Each time that your BOLT score increases by 5 seconds, you will feel better, with more energy and reduced breathlessness during physical exercise. The aim of the Oxygen Advantage program is to increase your BOLT score to 40 seconds, and this can be realistically achieved.”
  • The most accurate time to test is first thing in the morning
  • “The length of time of a comfortable breath hold served as a simple test to determine relative breathing volume during rest and breathlessness during physical exercise. The BOLT test is a very useful and accurate tool for determining this relative breathing volume.”
  • The BOLT test measures how long you can hold your breath on the exhale until your first natural desire to breathe (in seconds)
  • “The lower the BOLT score [the less time you can hold your breath], the greater the breathing volume, and the greater your breathing volume, the more breathlessness you will experience during exercise.” Meaning, the lower your BOLT score, the more you overbreathe on a regular basis.
  • “To obtain an accurate measurement, it’s best to rest for 10 minutes before measuring your BOLT score.”

3 Steps to Increase Your BOLT Score:

  1. Stop Losses of Carbon Dioxide
    • Breathe through your nose, day and night (tape your mouth at night)
    • Stop sighing; instead, swallow or suppress the sigh. One sigh taken every few minutes is enough to maintain chronic overbreathing, so it is necessary to counteract the sigh by swallowing or holding the breath. If you notice your sighs only after they have taken place, then hold your breath for 10 to 15 seconds to help compensate for the loss of carbon dioxide.
    • Avoid taking big breaths when yawning or talking.
    • Observe your breathing throughout the day. Good breathing during rest should not be seen or heard (breathe less and slower).
  2. Improve Tolerance of Carbon Dioxide
    • “This is where you practice exercises designed to reduce your breathing volume toward normal. They will bring a feeling of relaxation to your body and encourage your breathing to slow down and become calmer.”
    • “The objective is to create a tolerable need or hunger for air. A sustained need for air over the course of 10 to 12 minutes resets the receptors in the brain to tolerate a higher concentration of carbon dioxide.”
    • The main two exercises for improving CO2 tolerance is through slow, low-volume breathing (creating a tolerable air hunger) and breath holds during rest and exercise
  3. Simulate High-Altitude Training
    • “Breathing less than you feel you need to during physical training is an excellent method of conditioning the body to tolerate a higher concentration of carbon dioxide, while at the same time subjecting the body to a reduced concentration of oxygen.”
    • “The benefit of implementing Oxygen Advantage breathing techniques during physical exercise is that a stronger air shortage can be created than at rest. A strong air shortage is necessary to increase your BOLT score from 20 to 40 seconds.”

Chapter 3: Noses Are for Breathing, Mouths Are for Eating

  • “From the perspective of breathing physiology, mouth breathing activates use of the upper chest, while nasal breathing results in abdominal breathing.” Activating the upper chest by mouth breathing activates the sympathetic (stress) nervous system. Abdominal / diaphragmatic breathing activates the parasympathetic (relaxation) system.
  • Mouth breathing can also cause reduced oxygen uptake in the blood
  • “The common misconception of taking a “deep” breath is to puff out the chest and raise the shoulders, but this is neither deep nor beneficial to oxygenating the body.”
  • “Processed foods are mucus and acid forming. Acid-forming foods – such as processed products, dairy, meat, bread, sugar, coffee, and tea – stimulate breathing.”
  • “On the other hand, alkaline-forming foods such as fruit and vegetables, along with plain water, are easy for the body to process; they are “breathing-friendly” foods. But while these types of foods are highly beneficial, I’m not saying you need to become a vegetarian. Protein is an essential part of a healthy diet, and meat provides a natural, nutrient-rich source. The most important change is to get rid of processed foods.”

Benefits of Nasal Breathing:

  • “Nose breathing imposes approximately 50 percent more resistance to the airstream in normal individuals than does mouth breathing, resulting in 10 to 20 percent more O2 uptake.”
  • “Nasal breathing warms and humidifies incoming air. (Air entering the nose at 42.8 degrees F will be warmed to 86 degrees F by the time it touches the back of the throat, and 98.6 degrees F when it reaches the lungs)”
  • “Removes a significant amount of germs and bacteria from the air you breathe in.”
  • “The nose is a reservoir for nitric oxide, an essential gas for the maintenance of good health.”

The Effects of Mouth Breathing:

  • “Mouth-breathing children are at greater risk of developing forward head posture, and reduced respiratory strength.”
  • “Breathing through the mouth contributes to general dehydration mouth breathing during sleep results in waking up with a dry mouth).”
  • “A dry mouth also increase acidification of the mouth and results in more dental cavities and gum disease.”
  • “Mouth breathing causes bad breath due to altered bacterial flora.” (personal note: this could also decrease nitric oxide production)
  • “Breathing through the mouth has been proven to significantly increase the number of occurrences of snoring and obstructive sleep apnea.”
  • Mouth breathing can also decrease oxygen uptake

Nitric Oxide (NO):

  • “When it comes to nasal breathing and breath-hold exercises, nitric oxide plays an important role. Nitric oxide is produced inside the nasal cavity and the lining of the thousands of miles of blood vessels throughout the body.”
  • Nitric oxide influences all major systems and organs, keeps us free from disease including cancer, promotes a longer life, and helps us perform better in bed.
  • “This short-lived gas dilates the air passages in your lungs and does the same to the blood vessels.”
  • “Nasal breathing is imperative for harnessing the benefits of nitric oxide, working hand in hand with abdominal breathing and helping to maximize body oxygenation.”
  • “Think of the nose as a [nitric oxide] reservoir. Each time we breathe gently and slowly through the nose, we carry this mighty molecule in to the lungs and blood, where it can do its work throughout the body.”
  • “Mouth breathing bypasses this special gas…”
  • “Nitric oxide plays an important role in vasoregulation (the opening and closing of blood vessels), homeostasis (the way in which the body maintains a state of stable physiological balance in order to stay alive), neurotransmission (the messaging system within the brain), immune defense, and respiration. It helps to prevent high blood pressure, lower cholesterol, keep the arteries young and flexible, and prevent the clogging of arteries with plaque and clots. All these benefits reduce your risk of heart attack and stroke – two of the top three killers in America.”
  • “Plays a significant role in erection of the penis.” (Viagra contains NO)
  • “The production of nitric oxide in the nasal sinuses can be increased by simply humming. Humming can increase nitric oxide up to fifteenfold in comparison with quiet exhalation.” This is why meditation techniques that use humming or chanting are so effective.

Nose Unblocking Exercise:

  • You can get a 70% reduction in symptoms of nasal stuffiness, poor smell, snoring, trouble breathing through the nose, trouble sleeping, and having to breathe through the mouth, simply by holding your breath
  • This is done simply by extending the BOLT test to get a medium to strong air shortage (exhale, hold until medium-strong air hunger, resume calm nasal breathing), then repeating 6 times
  • “Generally, this exercise will unblock the nose, even if you have a head cold.”
  • Patrick also shares another nose-unblocking exercise (which I have had good results with), which simply consists of holding your breath on the exhale, and nodding your head back and forth several times while holding your breath. I was able to clear nasal decongestion in just one breath hold with this exercise.
  • A big reason these breath holds work so well for nasal congestion is because they “sharply increase the concentration of NO in your nasal cavity, resulting in dilation of the nasal passages and smooth, easy nasal breathing”.

Pretty cool, huh?

Mouth Taping for Nasal Breathing at Night:

  • Mouth taping has become quite the TikTok trend, but there is excellent research around its effectiveness.
  • “Taping the mouth at night ensures the benefits of good breathing during sleep, allowing you to fall asleep more quickly, stay asleep longer, and wake feeling energized.”

Patrick suggests:

  • 3M Micropore tape (known as Nexcare in stores)
  • To help make the tape easier to remove in the morning, gently press the tape against the back of your hand a couple of times to remove some of the glue before applying to your face
  • Tear off 4 in. of tape, fold a tab over at both ends to make removal easier in the morning, dry your lips, close your mouth, and gently place the tape horizontally over the lips

Now, it should be noted that James Nestor recommends a much smaller piece of tape – a small square piece in the center of the mouth, not touching your lips on both sides of the tape. James recommends this because:

  1. The purpose of mouth taping is not to hermetically seal your mouth shut. It’s to train your mouth to stay shut at night. A small piece of tape is all that’s necessary to do this.
  2. When you do not cover your entire mouth with tape, it makes it easier to pop the tape open with your mouth if for any reason you need to breath through your mouth at night. Some people are concerned about not being able to breathe through mouth in case you need it, and this solves that problem.

Chapter 4: Breathe Light to Breathe Right

  • Stress counselors, yoga practitioners, and sports coaches often instruct people to take deep breaths, but “this is often done through an open mouth while activating the upper chest”. “Such breathing is both big and shallow, but not deep. This type of breathing is entirely the wrong thing to do if your objective is to deliver more oxygen through the body.”
  • “A deep breath means to breathe down into the full depth of the lungs. It also means using the diaphragm.”
  • “To bring air down into the depths of the lungs, it is not actually necessary to take a big breath, as even the quietest of breaths will activate the diaphragm.”
  • “Abdominal breathing is more efficient simply because of the shape of the lungs. Since they are narrow at the top and wider at the bottom, the amount of blood flow in the lower lobes of the lungs is greater than in the upper lobes.”
  • “The fast upper-chest breathing of people who chronically hyperventilate does not take advantage of the lower parts of the lungs, limiting the amount of oxygen that can be transferred to the blood and resulting in a greater loss of CO2. Upper-chest breathing also activates the fight-or-flight response, which raises stress levels and produces even heavier breathing.”
  • “Stressed breathing is faster than normal, audible, produces visible movements, and often involves sighs. Many people habitually breathe in this manner every minute of every hour of every day, holding them in a perpetual state of fight-or-flight with adrenaline levels high.”
  • “The work of even the best stress counselors, psychologists, or psychotherapists will be limited unless they first help their patients to address their dysfunctional breathing.”
  • “Another advantage of abdominal breathing is that it assists with lymphatic drainage. The lymphatic system is effectively the body’s sewer system, draining away waste materials and excess fluid. During abdominal breathing, lymph is sucked through the bloodstream, neutralizing and destroying dead cells, reducing fluid retention, and improving detoxification of the body.”

Exercise: Breathe Light to Breathe Right

  • “You are practicing this exercise correctly when you slow down and reduce your breathing sufficiently to create a tolerable need for air. The need for air signifies an accumulation of arterial carbon dioxide, the goal of which is to reset the respiratory center’s tolerance to this gas.”
  • “To assist with this it is very helpful to exert gentle pressure against your chest and abdomen with your hands.”
  • “Try to maintain the need for air for the duration of 4 to 5 minutes.”
  • The Exercise:
    1. Place one hand on your chest and one hand just above your navel.
    2. Feel your abdomen gently moving outward as you inhale and gently moving inward as you exhale.
    3. As you breathe, exert gentle pressure with your hands against your abdomen and chest. This should create resistance to your breathing.
    4. Breathe against your hands, concentrating on making the size of each breath smaller.
    5. With each breath, take in less air than you would like to. Make the in-breath smaller or shorter.
    6. Gently slow down and reduce your breathing movements until you feel a tolerable hunger for air.
    7. Breathe out with a relaxed exhalation.
  • “If your stomach muscles start to contract or jerk or feel tense, or if your breathing rhythm becomes disrupted or out of control, then the air shortage is too intense.”
  • “Practicing 2 sets of 5-minute exercises is enough to hel pyou reset your breathing center and improve your body’s tolerance for carbon dioxide.”
  • “The accumulation of carbon dioxide in the blood will result in certain physiological changes in the body. These include:
    • A feeling of increased warmth resulting from the dilation of blood vessels
    • A rosy red color coming into the face
    • Increased production of watery saliva in the mouth, which is an indication that your body is going into relaxation mode and activating the parasympathetic nervous system”

Chapter 5: Secrets of Ancient Tribes

  • “Recreational athletes who are not taking part in competition or high-intensity exercise are far better off maintaining nasal breathing at all times.”
    • This helps you stay hydrated, maintains healthy airways, increase CO2 and O2 levels, increase nitric oxide, and increase V02 Max

Chapter 6: Gaining the Edge – Naturally

  • “Performing just 3 to 5 breath holds of maximum duration can lead to a 2 to 4 percent increase in hemoglobin.” (which increases red blood cells and thus the oxygenation of the body, and increasing aerobic performance)

Chapter 7: Bring the Mountain to You

Chapter 8: Finding the Zone

  • “When stressed, hold your breath!”
  • “Having a BOLT score of less than 20 seconds during rest indicates chronic overbreathing.”
  • “The results of a study investigating unexplainable aircraft accidents showed that mental performance deteriorated by 15 to 30 percent when the concentration of carbon dioxide in the blood was significantly reduced.”
  • “The symptoms of hyperventilation and anxiety are similar and have been found to be linked in some cases.”
  • “A study at the University at Albany in New York found that students with high anxiety had lower levels of carbon dioxide and a faster respiration frequency than students with low anxiety.”

Chapter 9: Rapid Weight Loss Without Dieting

  • “For over a decade I have witnessed hundreds of people achieve a safe method of appetite suppression leading to steady, effective weight loss using breath reduction techniques.”
  • Breath reduction produces rapid weight loss by decreasing appetite, stress, and blood sugar levels.
  • It is well known that humans and animals lose weight when living at high altitude. Breath restriction replicates those effects.
  • When exposing yourself to lower O2 saturation via high altitude and breath restriction, this puts you in an anaerobic (without oxygen) state, which forces the body to burn calories from fat stores to produce energy

There are 5 more chapters, but those weren’t as important in my opinion.

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