Overbreathing can cause
numerous health  concerns, but there is a more disturbing risk  associated
with this condition that could literally make the dif ference betw een life and
death. Cardiopulmonary resuscitation (CPR) is performed during cardiac arrest
to help preserve  normal brain fu nction until further measures can be taken
to re store blood circulation and breathing. W e know that hyperventilationcauses reduced blood flow and reduced oxygenation of the heart, but
studies h ave also revealed that e xcessive ventilation during CPR is actually
detrimental to survival. Researchers inv estigated instanc es where CPR resulted in deat h due to
excessive venti lation applied by well-trained but overzeal ous rescue
personnel. Despite adequate training, these professionals hyperventilated
their patients while attempting resuscitation through higher than necessary
breathing rates. It is thought that the high airway pressure resulting from
administering more air into the patient than necessary had a detrimental—
and ultim ately f atal—ef fect on patients’ blood flow . One study concluded
with the following warning: “Additional education of CPR providers is
ur gently needed  to reduce these  newly identified and deadly co nsequences
of hyperventilation during CPR.”
Reviewing the findings above,  it is shocking to think that the very
procedure designed to help save lives might in fact be having the opposite
ef fect. I t is even more shocking when we consider that the relationship
between breathing volume and blood flow to the heart was first documented
over a century a go. Thankfully , since 2007 there has been a m onumental
change in CPR procedures involving manual ventilation. Increasingly , the
emphasis during CPR is now on  chest compressions to maintain circulation,
rather than manual ventilation. Over the  years, I have witnessed many young athletes at all l evels of
fitness b reathing too intensely for their given level of exerc ise. In this
chapter , I have attempted to j oin the dots between excessive breathing
volume, reduced oxygenation of the heart, and resultant ECG abnormalities,
heart att acks, and chronic heart disease. It is only logical to su rmise that a
poorly o xygenated heart is less able to cope with the demands of intense
physical exercise. Y et every month I see reports of children, teenagers, and
young a dults w ho were in the prime of life dying from undetected heart
conditions. Upo n hearing the ne ws I often wonder: Could this tragedy have
been av oided if the victim had been encouraged to breathe normally and
through the nose? The breathing volume of athletes and nonathl etes alike is
crying o ut for attention, and greater awareness would be wort h all of the
ef fort, if even just one young life were saved.CHAPTER 12
E l i m i n a t e  E x e r c i s e - I n d u c e d  A s t h m a
I n childhood, treatments for fort y-three-year -old Julian’ s asthma included
cough medicine , trips to the coast for the benefits of sea air , and inhaling
steam from a boiling kettle. On some nights, Julian remembers his
wheezing being so bad that he st ayed up most of the night with his head out
the w indow in an ef fort to breathe. Any individual who experien ced asthma
as a  child durin g the 1970s and  1980s can probably testify to the lengths
that similarly worried parents took to try to help their children to breathe. By the late 198 0s Julian had been prescribed various relievers and
preventative me dications, in addition to regular trips to the hospital for
nebulizer treat ment. This never -ending cycle of medication and
hospitalizations continued for many years, and although Julian tried to keep
fit, he often found he was unab le to breathe, particularly during the small
hours of the night. Fast-forward to 2006, and Julian was taking higher doses of asthma
medication while his fitness level gradually reduced, a totally u nproductive
cycle th at was beginning to s eriously af fect his health and well-being. Julian’ s story is typical of any individual with moderate to severe asthma;
although physic al exercise can be very beneficial, many persons with
asthma simply tend to avoid it for fear of having an attack. In early 2007, Julian attended one of my Dublin courses at which we
focused on breathing through the nose, breathing light, and practicing
breath h olds while walking. Julian took his last dose of reliever medication
the day after the course. W ithin s ix mon ths, Julian’ s asthma had drastically improved,  and by
Christmas 2007,  he had his last dose of preventative medication. His fitnessalso improved and he was able to swim a mile per day , five times a week. In
2008, J ulian’ s GP agreed to reclassify his medical record as “asthma
resolved.”
Over the next three years, Julian’ s exercise plan evolved to include eight
hours of  high-in tensity indoor cycling, circuits, and stretching  classes per
week, as well as  the techniques of nasal and reduced-volume breathing he
learned from my course. These changes, along with adj ustments to his eating habits, allowed
Julian to  improv e his performance and enjoy more ener gy and stamina at a
higher level of activity . At the age of forty in 2012, Julian ran five half-
marathons and covered over 750 training miles. He achieved a personal best
of 1 :46 i n his third half-maratho n; two weeks later he complete d the Berlin
full mar athon in 3:57. Following the Berlin Marathon, he ran  the Dublin
City Ma rathon in 4 hours. In six months, Julian had knocked over 8 minutes
of f his first half-marathon time. In si x ye ars, Jul ian progressed from a chance encounter with one of my
books to attending my breathing  course, improving his fitness, completely
eliminating prescription medicine for his asthma, and running h alf and full
marathons in very respectable times! The word asthma  derives from Greek and means “to pant.” While
asthma has been around for a very long time, it af fects more p eople today
than ever before. Exercise-indu ced asthma af fects an estimated 4 to 20
percent of the g eneral populati on and 11 to 50 percent of cer tain athlete
populations. Interestingly , one study showed that while 55 percent of
football athletes  and 50 perce nt of basketball players displayed airway
narrowing conducive to asthm a, athletes from the sport of water polo
showed significantly fewer asth ma symptoms. Later on in this section we
will investigate why this might be. So, what causes asthma? The  most common theories include the
hygiene hypothesis, which rests on the premise that too much cleanliness
means children are not exposed to enough germs, resulting in diminished
immune capabilities later on in life. A second commonly cited explanation
is an increase in  pollution, but while this may well be a trigger , it is not
necessarily the cause. For instan ce, the west of Ireland, where I live, has a
high asthma rate but very good air quality .Might there be another factor that plays a significant role in causing
asthma—that of  habitually breathing too much? If this were true, then
surely reducing breathing volume could result in a reversal of th e condition. By look ing at the causes and symptoms of asthma, and the p hysiological
changes resulting from the condition, we can begin to determi ne just how
important breathing exercises can be in treating asthma. Since asthma is a condition cha racterized by dif ficulty in breathing, a
logical approac h would be to  attempt to find the root cause by first
addressing poor breathing habi ts. T ackling asthma from this angle is not
new and  was employed by the ancient Greek physician Ga len and the
sixteenth-century doctor Paracelsus, who recommended breath holding and
breathing exercises for the treatment of coughing and narrowed airways. The prevalence of asthma increa ses relative to wealth. Increased wealth
leads to a chan ge in living standards: Food becomes more processed,
competitive stress increases, houses become more airtight, we perform less
physical exercise, and the majority of our jobs are sedentary . Fifty years
ago, our living and working situations were quite dif ferent, and asthma rates
were sig nificantly lower . During  that time, we ate more natural foods, had
less competitive  stress, our ho uses were drafty , and most occupations
involved physical labor . B ack then, our lifestyle was conducive to a more
normal breathing volume, and, as a result, asthma was far less common. As we have se en, normal breathing volume for a healthy adult is
generally agreed  to be 4 to 6 liters of air per minute, but adults with asthma
demonstrate a resting breathing volume of 10 to 15 liters per mi nute, two to
three times more than required. Imagine the ef fect on the respiratory system
when an  individ ual breathes twice or three times too heavily all day , every
day . Normal breathing during rest involves regular , silent, abdominal breaths
drawn in  and out through the no se. People with asthma, on the other hand,
display habitual  mouth breathing with regular sighing, snif fing, and visible
movements from the upper chest. During an exacerbation of asthma,
symptoms like wheezing and breathlessness increase along with respiratory
rate, relative to the severity of the condition. In other words, as asthma
becomes more severe, there is also an increase in breathing volume. While it  is well documented that people with asthma breathe too much,
there is a need to determine whether the increase to breathing volume is acause or ef fect of the condition. As the airways narrow a feeling of
suf focation is generated, and a normal reaction is to take more air into the
lungs to try to eliminate this sensation. Either way , it is a vi cious cycle;
narrowed airways lead to heavier breathing that causes an increase in
breathing volum e, resulting in th e narrowing of the airways and  on and on,
worsening the condition and esta blishing bad breathing habits as a matter of
necessity . The only way to  determine whether breathing too much causes asthma
is to  investigate what happens when a group of individuals with asthma
practice breathing exercises designed to bring their breathing volume
toward normal. A st udy at the Mater Hospital in Brisbane found that when the breathing
volume of adults with asthma decreased from 14 liters to 9.6 liters per
minute, their symptoms reduc ed by 70 percent, the need for rescue
medication decr eased by 90 percent, and the need for preve nter steroidmedication decr eased by 50 percent. The study found a direct relationship
between the reduction of breat hing volume and improvement to asthma. The closer breathing volume reduced toward normal, the greater was the
reduction of asthma symptoms s uch as coughing, wheezing, chest tightness,
and breathlessness. Furthermore, the trial’ s control group—who were taught
the hosp ital’ s in-house asthma management program—made zero progress. The reason for this was solely due to the fact that there was no change to
their breathing volume. Further studies reinforced these findings by
showing that people with asthma who practiced reducing their breathing
volume had far better asthma co ntrol with a significantly reduced need for
preventive steroid and rescue medication within 3 to 6 months. Since 20 02 I have taught thousands of children and adults with asthma
how to address the root cause of their condition—breathing too much. T riggers such as animal dander , dust mites, exercise, pollution, excessive
hygiene, and changes in the w eather are often cited to be the cause of
asthma symptom s, but in my experience the vast majority of suf ferers can
take back significant control of their condition, regardless of their triggers,
by s imply learning to breathe light. The fundamental cause of ongoing
asthma s ymptoms can almost always be attributed to breathing too much. As l ong as a student understands  the exercises and devotes time to changing
his or her breathing, positive results are consistent and reproducible. Based on the fact that a number of clinical trials have shown that asthma
symptoms and the need for asthma medication are significantly reduced
following the employment of reduced breathing exercises, there is no doubt
that over breathing is a significant contributor to asthma. Of cour se, it is also
normal for people prone to ast hma to increase their breathing volume to
compensate for a feeling of suf focation, but this action is simp ly part of a
feedback loop. Elements of modern living increase breathing volume,
which can activate asthma in genetically predisposed individuals. As their
asthma takes hold, the individual breathes faster and more intensely ,
worsening the condition. While  it is important to recognize this feedback
loop, th e first step to addressing asthma is to reduce excessive breathing
habits. I can relate to any child or adult with asthma because for m ore than
twenty y ears I struggled with the same symptoms; I was unable to perform
even the most basic physical exercise, my nose was constantly stuf fed, and Icontinuously breathed through a n open mouth. Y ear after year my asth ma
medication increased with no signs of my symptoms abating. My sleep,
concentration, m ood, and quality of life were all adversely af fe cted. It was
only by chance, when I learned of the work of Russian doctor Konstantin
Buteyko, that I w as able to reve rse my asthma. W ithin a few short days my
wheezing decrea sed dramaticall y , simply by learning to unblo ck my nose
and norm alize m y breathing volume. I have now been wheeze-free for the
past thirteen years, and all I did was to learn to breathe normally again. This had  such a tremendous imp act on my life that I changed careers in
2001 an d retrained under the auspices of the late Dr . Buteyko. In 2002, I
founded Asthma Care to help publicize this information to children and
adults with asthma. Our clinics are now of fered in a number of countries. The first step to  addressing chronic overbreathing is to make th e switch
from m outh to nasal breathing. While nasal breathing is important for
everyone, for people prone to asthma it is vital. When breathing volume is
greater than normal, there is a tendency to open the mouth in order to allow
more air  to enter the lungs. Peo ple diagnosed with asthma often feel they
are n ot t aking in  enough air whi le breathing through the nose, w hich causes
them to breathe through the mouth. Mouth breathing influences asthma in a number of ways:
•   Air taken in through the mouth is not filtered of airborne
particles, including germs and bacteria. •   The mouth is simply not as ef fective as the nose in conditioning
air to the correct  temperature and humidity prior to entering the
lungs. •   B ecause the m outh provides a lar ger space to breathe throug h
than the  nose, breathing volume will be higher , causing too
much carbon dioxide to be ex pelled from the lungs. Carbon
dioxide is a na tural “opener” of the smooth muscle in the
airways. The loss of carbon dioxide therefore causes asthma
airways to narrow even more.•   Unlike nasal breathing, mouth breathing does not allow us to
benefit from nasal nitric oxide, which supports the lung’ s
defensive capabilities. T aking all these factors into c onsideration, it is not surprising that
mouth breathing causes a reduction in lung function in people with mild
asthma and plays a significant role in the exacerbation of asthma symptoms. Not only  is it im portant to breathe through the nose during rest, it is also
beneficial to nasal breathe durin g physical exercise. In a paper published in
the American Review of Respiratory Disease,  res earchers studied the
beneficial ef fects of nasal breathing on exercise-induced asthma. The study
observed that most subjects wit h asthma spontaneously breathe d with their
mouths open when instructed to breathe “naturally .” The authors found that
mouth b reathing during exercise  caused the airways to narrow even further . In contrast, when subjects were asked to breathe only through their nose
during exercise, exercise-induced asthma did not occur at all. The paper
concluded that “the nasopharynx and the oropharynx play important roles in
the phenomenon  of exercise-induced bronchoconstriction.” In si mple terms,
the ef fects of breathing through the nose are integral to reducing or avoiding
exercise-induced asthma completely . The fact that el ite athletes with asthma often favor swimming above
other forms of exercise is not a coincidence. During swimming, the face is
immersed under water , reducing  the amount of air taken into th e lungs and
increasing the athlete’ s tolerance  for carbon dioxide. Although the swimmer
may dra w his or her breath in t hrough the mouth, the protective ef fects of
reduced breathin g are still evide nt. A child or adult with asthma may also
prefer swimming because the water exerts a gentle pressure on the chest
and abdomen, further restricting breathing volume and improving athletic
performance. The dif f erence b etween land-ba sed exercise and swimming in terms of
breathing pattern and volume is significant for people with asthma. On land,
your breathing pattern during exercise is not restricted the way it is in water ,
meaning that you can very easily overbreathe, resulting in constricted
airways, a reduction in the amount of CO 2  in your  blood,  and a lower
BOL T score. For an individual w ith asthma, overbreathing durin g rest leadsto overbreathing during exercise, which in turn leads to exercise-induced
asthma. However , exercising in  water naturally causes you to restrict your
breathing and lower your brea thing volume toward normal, providing a
much safer and more productiv e environment for people with asthma to
exercise. At the beginning of this chapter we looked at statistics that showed that
in a group of athletes, narrowing of the airways af fected 55 percent of
football athletes and 50 percent of basketball players, but 0 percent of water
polo pla yers. W ith such a glar ing disparity , what factors could possibly
explain the dif ference? The answ er , as you have probably guessed by now ,
is simple. W ater polo training  involves breath holding and swimming
underwater , resu lting in a high er tolerance to carbon dioxide, increased
amounts of nitric oxide, and a  reduced breathing volume. W ith a more
normal breathing volume, asthma tendencies don’ t appear . However , if you have asthma and do not wish to take up swimming,
there is a simple r way! The Oxy gen Advantage approach incorp orates all of
the ben eficial aspects of swimming and more. Although the act of
swimming has its merits, it is  well documented that spending time in
chlorinated pool s is not ideal for asthma, as the chlorine can ca use damage
to lung tissue. F urthermore, while swimming reduces breathing  volume, it
is st ill im portant to address poor breathing habits outside of the pool. Many
swimmers rema in habitual mouth breathers and continue to employ poor
breathing habits that reduce their athletic performance and maintain their
asthma. Y our success in addressing asthma will be based on your ability to
increase your BOL T score usin g the Breathe Light to Breathe  Right and
simulation of high-altitude exercises described in this book. Y ou  will find a
program specifi c to your needs  in Part IV . The general aim is to increase
your BOL T score to 40 seconds. The best time to measure your BOL T score
to tr ack your p rogress is first thing in the morning, and if your BOL T
measurement re mains less than 20 seconds, then your asthma  symptoms
will persist. However , when your early morning BOL T score is greater than
20 seconds, symptoms such as wheezing, coughing, breathlessness, and
chest tightness will disappear . It’ s important to note that you may still be
susceptible to certain symptoms even when you have achieved a BOL Tscore of 20 seco nds when exposed to a trigger; a BOL T score of 40 seconds
is needed to fully eliminate your asthma symptoms. As you work toward achieving a high BOL T score, you may continue to
experience symptoms, depending on your medical history and triggers. Y our ability to stop the ef fects of asthma using the exercise below is
dependent on two factors: how high your resting BOL T score is and how
quickly you react to the ons et of symptoms. The sooner you begin
practicing the exercise, the easier it is to prevent symptoms from taking
hold. By ignoring your symptoms and hoping they will g o away by
themselves, the ef fects of asthm a tend to get worse and can take  on a life of
their ow n. If you often experie nce asthma symptoms, you will know that
wheezing and coughing usually  worsen over time, so it is important to
intervene early on. This ex ercise can help stop a sthma symptoms, but please get your
doctor ’ s permiss ion to try it first. Then follow the instructions below during
the early  stages of chest tightness, wheezing, coughing, or a head cold. If
you aren ’ t able to stop your sy mptoms within 10 minutes, then take your
rescue m edication. If you are experiencing severe symptoms , of course,
then take rescue medication str aightaway . If your rescue medication does
not stop your sy mptoms within a couple of minutes, it is advisable to call a
medical doctor immediately . T o stop asthma symptoms before they take hold, follow these steps:•   T ake a small, silent breath in and out through your nose. •  Hold your breath and walk for 10 to 15 paces. •   Stop walking, release your no se, and resume gentle breathing in
and out of your nose.•  W ait for 30 to 60 seconds and repeat. •   Continue to walk while holding your breath for 10 to 15 paces
followed by resting with nasal breathing for 30 to 60 seconds. •   If you r symptoms are mild, yo u may hold your breath for more
than 10 to 15 paces. •  Do this exercise for at least 10 minutes. In a ddition to e mploying nasal breathing and achieving a high BOL T
score, it is also very importan t to warm up properly in order to avoid
exercise-induced asthma. The minimum time spent warming up should be
10 minu tes. A good warm-up consists of fast walking while practicing a
medium to strong breath hold every minute or so. After the 10-minute
warm-up, increa se the pace so that you’re moving as fast as you can while
maintaining nas al breathing. If y ou feel the need to open your m outh, slow
down. Following  your physical exercise, encourage your breathing to calm
toward normal. The positive results of reduced breathing exercises and nasal breathing
on the symptom s of asthma are  fast and astounding. W ith su ch a simple
method, there really is no reas on for anyone to suf fer a single day more
from the discomfort of asthma.CHAPTER 13
A t h l e t i c  E n d e a v o r — N a t u r e  o r  N u r t u r e ? I n 1704, a racing stallion by th e name of the Darley Arabian arrived in
Britain f rom Syria, and 95 perc ent of today’ s male thoroughbreds descend
from him . Gene ticist Patrick Cunningham and colleagues fro m my alma
mater , T rinity College Dublin,  traced the lineage of nearly one million
horses f rom the past two cen turies and determined that 30 percent of
variation in performance in tho roughbreds is due to genetics alone. In the
nature versus nurture debate, these results suggest that nature plays a
significant part in our athletic abilities. There is one ar ea in particular where a combination of gene tics and
behavior has considerable influe nce on athletic performance, and that is the
way the face and jaws develop during childhood. For example, take a look
at the structure of the face and jaws of past Olympic gold me dal winners
including Usain Bolt, Sanya Richards-Ross, Steve Hooker , and Roger
Federer . What is strikingly apparent for this group, and for the vast majority
of to p-class athletes, is the forward growth of the face and w idth of the
jaws. A thletic success depends on having good airways, which in turn is
dependent on normal facial stru cture. Spend a lot of time with your mouth
hanging open or sucking your thumb during childhood and the face grows
dif ferently from how nature intended. In fa ct, M ichael Phelps, the most decorated Olympian of all time, is one
of th e v ery few top-class athlet es who does not exhibit forwar d growth of
the jaws  and a w ide facial structure. Based on his facial profile, there is a
high likelihood that he was a m outh breather during childhoo d, possibly
requiring orthod ontic treatment  in his early teens. It is also possible that
Phelps chose swimming, either consciously or unconsciously , as it was theone sport that he could excel in. The very act of swimmi ng restricts
breathing to help of fset any n egative ef fects that have developed from
mouth breathing or an inef ficient breathing pattern. Although the natural order of things is to breathe through th e nose,
many children—especially those with asthma or nasal congestion—
habitually breathe through the mouth. Brazilian researchers i nvestigating
the prev alence of mouth breathing in children aged 3 to 9 fo und that 55
percent of a ra ndom selection of 370 subjects were mouth breathers. Children who regularly breathe through their mouth tend to develop
negative alterati ons to their face, jaws, and the alignment of their teeth. Mouth b reathing af fects the shape of the face in two ways. Firs t, there is a
tendency for the face to grow long and narrow . Secondly , the jaws do not
fully de velop and are set back from their ideal position, thus reducing
airway s ize. If the jaws are not positioned forward enough on th e face, they
will encroach on the airways. See for yourself: Close your mouth, jut out
your chin, and t ake a breath in and out through your nose, not ing the way
air travels down behind the jaws. Now do the same but pull your chin
inward a s far as you can—you will probably feel as if your thro at is closed
up as you try to breathe. This i s exactly the ef fect poorly developed facial
structure has on your airway siz e. It is no wonder that those wi th restricted
airways tend to favor mouth breathing. The forc es exerted by the lips and the tongue primarily influence the
growth o f a child’ s face. The lips and cheeks exert an inward pressure on
the f ace, with th e tongue providing a counteracting force. Whe n the mouth
is closed, the tongue rests against the roof of the mouth, exerting light
forces that shape the top jaw . Because the tongue is wide a nd U-shaped, it
follows that the shape of the top jaw should be wide and U-shaped also. In
other words, the shape of the top jaw reflects the shape of th e tongue. A
wide U-shaped top jaw is optimal for housing all our teeth. However , durin g mouth breathing, it is very unlikely that the  tongue
will rest  in the roof of the mouth. T ry it for yourself: Open your mouth and
place yo ur tong ue on your upp er palate. Now try to breathe through your
mouth. While it is possible to draw a wisp of air into the lungs, it will not
feel righ t. It follows therefore th at the tongue of a mouth breather will tend
to re st o n the floor of the mouth  or suspended midway . Since th e top jaw is
not t hen shaped by the normal pressures of the tongue, the end result is thedevelopment of a narrow V -sha ped top jaw . Aesthetically , this contributes
to a  narrowing of the facial structure, crooked teeth, and orthodontic
problems. It has been well docu mented that mouth-breathing children grow
longer faces. The sec ond way facial structure is af fected by the way we breathe
during childhood is the position of the jaws. The way the jaws develop has
a direct influence on the width of the upper airways. Our upper airways
comprise the nose, nasal cavity , sinuses, and throat. Strong athletic
performance req uires lar ge upper airways that enable air to flow freely to
and from the lungs. Although a  high BOL T score and ef fectiv e breathing
technique are crucial for high l evels of performance, having airways that
function with little resistance is also very advantageous. For example, a
marathon runner who has ef ficient breathing but airways that a re the width
of a narrow straw is not going to get too far . The nor mal growth of the fac e is forward. Since a mouth-b reathing
child does not rest his or her tongue in the roof of the mouth, the jaws are
unable t o be properly shaped by the tongue, and the natural forw ard growth
of the jaws is impeded. This results in jaws that are set back from their ideal
position, compro mising airflow . For the correct development o f the lower
half of the face a nd airways, it is imperative that a child habitually breathes
through his or h er nose. Breathing through the nose with the tongue resting
in th e roof of the mouth helps to establish the ideal conditions for the
normal development of the face. I sw itched from mouth to nose breathing during the late 1990s, when I
was in my early  twenties, but i t was only after I met with myofunctional
therapists Joy Moeller , Barbara  Greene, and Karen Samuel in 2006 that I
learned the correct position of the tongue. Until then, I hadn’ t given it a
moment’ s consideration, and most likely my tongue had been flopping
about without a home for the previous thirty-two years. Between them, Joy ,
Barbara, and Karen have devo ted almost a hundred years to reeducating
people on the placement of the tongue and facial muscles in order to
address a variety of detrimenta l issues that af fect the development of the
jaws and teeth. S pending thousands of dollars on orthodontic treatment can
be in vain if po or habits such as mouth breathing, tongue th rusting, and
incorrect swallo wing are not addressed. And you may be ab le to avoidorthodontic treat ment altogether if these habits are not permitted to develop
in the first place. In th e correct re sting position, three-quarters of the tongue should press
gently a gainst th e roof of the mouth with the tip of the tongue placed just
behind t he top front teeth—the s ame place we put the tongue to make the N
sound “nuh.”  Just like nasal breathing, optimal resting tongue posture is not
a recent  discove ry; for thousands of years it formed an important part of
Eastern yoga and the religion o f Buddhism. Y ogi Bhajan, who introduced
Kundalini yoga to the United States in 1968, accredited the upper palate and
the tip of the tongue as the tw o most important parts of the  body . The
ancient Buddhis t scriptures of t he Pali Canon contain passages describing
how the Buddha pressed his tongue against the roof of the mouth for the
purposes of controlling hunger and the mind. This illustration  shows the facial characteristics of a nasal brea ther and
is based on the Irish International and LA Galaxy soccer captain Robbie
Keane:
Note the  forward position of th e jaws, high cheekbones, airway size,
and wid th of the face. The jaw i s strong and positioned well forw ard so that
the chin  is nearly as far forwar d as the tip of the nose. When  cartoonists
draw illu strations of a dominant male, his strength is often conveyed by arugged and exaggerated jaw . S ocially , a wide facial structure and strong
jawline are considered healthier and more attractive than a recessed chin. And not only is  the classic squa re jawline more likely to get you a date, it
might also be beneficial to your bank balance. In a paper written by
researchers from the School of Business at the University of California at
Riverside, men with wider faces were found to be stronger negotiators,
commanding a signing bonus of nearly $2,200 more than their narrow-faced
counterparts. In  a separate stud y by the same authors it was found that
companies led by men with wider faces also achieved superior financial
performance. Throughout our evolution, social anthropologists have regarded facial
appearance as a determinant in establishing societal rank and individual
roles. Beauty is not just skin de ep, and Aristotle was right whe n he stated
that “Beauty is a far great er recommendation than any  letter of
introduction.”
In the image ab ove, the jaws are set back and the airways are smaller ,
resulting in diminished athletic performance. Had the jaws bee n in a more
forward position, the nose would be straighter and smaller . Th e eyes look
tired as the fac e sinks downward, and there is poor definition of the
cheekbones. Chronic, habitual mouth breathing is also associated withpostural changes that result in decreased muscle strength, reduced chest
expansion, and impaired breathing. Interestingly , researchers have found
that mouth breathers are more likely to be male. While the above image is exa ggerated somewhat, these features are
identifiable in thousands of children and adults who have fallen between the
cracks o f the health care system and were not encouraged  to breathe
through their nose. These same individuals often suf fer from poor health,
low ener gy , and reduced concentration. In the words of Dr . Y osh Jef ferson:
“These children do not sleep well at night due to obstructed airways; this
lack of sleep ca n adversely af fect their growth and academic p erformance. Many of these children are misdiagnosed with attention deficit disorder
(ADD) and hyperactivity .”
Dr . Egil Peter Harvold, an ex pert in orthodontics and craniofacial
anomalies, carried out extensive  research into the development of the facial
structure of monkeys in the 197 0s, discovering that the restriction of nasal
breathing over several years led to a lowering of the jaws, crooked teeth,
and other facial deformities. While today we would consider it  dreadful to
experiment on innocent anima ls in this way , hundreds of thousands of
children take part in a simil ar experiment and experience  the same
craniofacial ano malies due to the ef fects of mouth breathing. D r . Harvold’ s
studies paved the way for the treatment and prevention of th e improper
development of the jaws and fa ce and is accredited almost single-handedly
for introducing a branch of or thodontics known as functional appliance
therapy to North America. A 2012 study investigating the long-term changes to facial structure
caused by mouth breathing noted that this seemingly “benign” h abit “has in
fact immediate and/or deferred cascading ef fects on multiple physiological
and behavioral functions.” Infa nts and children who breathe through their
mouths due to n asal obstruction  are likely to develop crooked  teeth and a
longer , narrowe r face, permanently af fecting their appearan ce. Mouth
breathing also has a significant impact on the health of the chil d, including
restriction of the lower airways, poor quality of sleep, high stress levels, and
a lower  quality of life. Rese arch has suggested that habitual mouth
breathing may even be connected to sudden infant death syndrome.Hold On to Y our T eeth! Over the past few years I have been asked to give talks on nasal breathing at
dental c onferences in Europe, Australia, and the United States. Each
conference presents a wonderful opportunity to speak with international
experts in dentistry and related disciplines, including orthodontics. There
are two specific groups within  orthodontics that hold opposing views:
functional orthodontists and traditional orthodontists. A fu nctional orthodontist places  emphasis on attaining the correct facial
profile of the face as well as str aightening the teeth. Functiona l appliances
are worn by the child in order to help guide the growth of the face, jaws,
and teet h to reach their full gen etic potential. The commonly held view of
functional ortho dontists is that overcrowding of teeth is not because the
teeth are too big, but more likely because the jaw is too small as a result of
mouth breathing or thumb sucking. The course of action therefore is to
gently expand the jaws and guide them forward to make room for the teeth,
with extractions only carried out as a last resort. In c ontrast, the primary emph asis of traditional orthodontic s is to
straighten the teeth, with the facial profile and airway size receiving
secondary consideration. Crowded teeth are usually treated by extracting
four per fectly good premolars and retracting or pulling the fron t teeth back
to cl ose up the excess space created. This retraction sometimes  causes the
face, especially around the lips, to look caved in, and the nose and chin to
become more prominent. This retraction of the front teeth may  also cause
problems with the joint of the jaw if the lower jaw is forced back too far . When th e lower jaw is too far back, it encroaches on the upp er airways,
decreasing airway size and negatively af fecting athletic ability . If you are the parent of a child who may be under going orthodontic
treatment, I would like to impart some advice from i nternational
orthodontist Dr . John Mew , who has devoted his life to ensuring the normal
growth of children’ s faces:
•   F irst ask the orthodontist ho w many permanent teeth will b e
initially removed and how many more may need extracting
later . Sadly , most children who receive traditional retractive
orthodontic treatment lose 4 premolar teeth, and nearly half ofthese ch ildren will not have room for their wisdom teeth,
leaving them with 24 teeth. This  can be completely avoided by
helping to ensure normal growth of the face to accommodate
all 32 teeth. •   Ask your c linician whethe r he or she is confident about
avoiding an increase in the verti cal growth of your child’ s face. Y ou hav e the right to be inform ed of all types of treatment and
to be warned of likely problems. Knowledge is empowering. The best approach to determine the
treatment option s for you and your child is to research both fun ctional and
traditional orthodontic treatment. Selecting the correct approach will have
repercussions on  the well-being of your child; it is well worth  investing a
little tim e to determine a more noninvasive solution. Extraction s should be
a last resort. Don’t Leave It Until It’ s T oo Late
According to American research, 95 percent of head circumference growth
for the average North American  white child takes place by the age of nine. Development of  the lower jaw , however , continues until approximately the
age of eighteen. Based on these observations, for correct craniofacial growth to take
place, early intervention with  nasal breathing and tongue posture is
essential. The negative ef fects of mouth breathing on the stru cture of the
jaws and face will have the most impact when they occur before  puberty , so
there is only a  brief window of opportunity to avoid the need for
orthodontic treatment and significant changes in a child’ s facial structure. My daughter is three years old. She first began to breathe occa sionally
through her mouth at the age o f eight months during teething, and since
then I have been encouraging her to breathe through her nose. I set an
example by breathing through m y own nose all the time, and congratulate
her any time she has her mout h closed. As we live in the co untryside, Ioften comment that Charlie the  donkey breathes through his nose, as does
Snowball the cat. Such clever animals! Genetically , ther e would be a high likelihood for my daughter  to be a
mouth breather as both my wif e and I had severe respiratory complaints
while growing up. The earlier you begin to encourage your children to
breathe through their nose and e nsure the correct positioning of the tongue,
the bett er . Not only might yo u help them avoid orthodontic treatment
altogether , but the shape of their face, their general health, and their
athleticism will be significantly influenced during these fe w short  years. Even genetic predispositions can be minimized when the right action and
behavior is enshrined. A few years ago I wrote a self-help book for children, teenagers, and
parents entitled Buteyko Meets Dr . Mew: Buteyko Method for Childr en and
T eenagers  about the craniofacial changes associated with mouth breathing. I
put extensive amounts of resear ch into the subject and included  many peer -
reviewed paper s and studies to support my claims. Most parents are
shocked when they realize that crooked teeth, narrow faces, lar ge noses, and
undeveloped jaws can be avoided if a child is simply encouraged to breathe
through his or her nose. Not only is sports performance a f fected, but
lifelong health! W e cannot be dispassionate about the impac t of mouth
breathing on the development of our children. The detrimental e f fects that I
suf fered from a childhood of br eathing through my mouth needn’ t happen
to anyone else, armed with the knowledge we have about the benefits of
nasal breathing.CHAPTER 14
E x e r c i s e  a s  i f  Y o u r  L i f e  D e p e n d s  o n  I t
F or two million years we survived without supermarkets, convenience
stores, microwa ves, or McDonald’ s. In the past, in order to feed ourselves
and our families, muscle move ment was required to collect berries and
vegetation or to track down an  animal—often over several days—until it
collapsed from exhaustion. Compare that to today’ s couch  potato lifestyle—do you know many
people w ho could adequately feed themselves if there was no food available
for conv enient purchase? One thing is for sure—a major shif t of attitude
would b e required. In order to eat, we would have to perform regular and
sustained physic al exercise, something that the human body is built for and
thrives u pon. W hy should we st op it now , simply because hunti ng our own
food is no longer necessary? And while it might be too late f or many of us to become elite athletes,
we can still enj oy and derive considerable benefit from regular physical
exercise. Even if you have lived a relatively sedentary life until now , you
can dev elop your fitness slowly and steadily and bring about positive
changes to your health. There is a great feeling of self-esteem and
accomplishment when we get up of f our backsides or move away from the
computer . If you exercise for an hour per day , five times per week, for just a
few weeks, you will experience a remarkable dif ference in your sleep
quality , mood, and state of health. Despite the advances of med ical science, the diseases of modern
civilization cont inue to increase, and it could be ar gued that we  are passing
responsibility for our health to pharmaceutical companies rather than
making changes to our lifestyle and diet to prevent illness in the first place.Each year , more and more people are developing asthma, heart disease,
diabetes, high blood pressure, an d cancer . Not only that, but new “diseases”
are being invented all the time—and some might say it’ s because the market
conditions and share prices of b ig pharmaceutical companies dictate a need
for n ew markets and ever -increa sing sales. W e may be living longer , but at
the expense of consuming vast quantities of medication as soon as we
approach fifty or sixty years of age. A far better option to help prevent the
onset of diseases—and one that involves no toxicity or expense—is to take
a reg ular fast wa lk or jog. If you haven’ t exercised regularly before, please
pay a visit to your physician to get the all clear before starting. One thi ng that pretty much all health professionals agree o n is the
importance of regular physical exercise, taken within our limits. Dozens of
studies over the last few years have shown that regular physi cal exercise
provides many health benefits, including a reduced risk of cardiovascular
disease, cancer , and diabetes. Studies as far back as the 1950s have investigated the relationship
between regular physical exercise and cardiovascular health. One of the
earliest w as conducted by Dr . Jeremy Morris, who studied the incidence of
heart att acks in 31,000 transport workers. Morris found that bus conductors,
who spent most of their day climbing up and down the stairs of double-
decker buses, averaging betwee n 500 and 700 steps per day , h ad reduced
incidences of heart disease than their bus-driving counterparts, who spent
90 p ercent of t heir day sitting down. Not only this, but he art disease
developed by the bus conductors tended to present later in life and was less
likely to be fatal. The same study was replicated using over 100,000 postal workers, and
once again it was found that those who spent their day on foot or cycling
while delivering  the mail had fewer incidences of heart disease compared to
workers in sedentary occupations such as telephonists, civil service
executives, and clerks. Dr . Mor ris’ s findings are just as relevant today as
sixty years ago, and since more and more of us spend our working day
behind a desk, there is an increased need to perform regu lar physical
exercise. Even more important is that we perform this exercise within our
own personal limits. The bes t way to ensure that w e exercise within our capabilities is by
nasal breathing,  and an importa nt consideration is the length of time youcan com fortably hold your breath, or your BOL T measurement. When your
BOL T s core is less than 20 seco nds, your breathing volume will be greater
than what your body requires, resulting in a risk of overbreat hing during
physical exerci se. All breathing should be through the nose when
performing phys ical exercise so as not to increase breathing v olume even
further . When your BOL T score is grea ter than 20 seconds, it’ s fine for you to
breathe through  the mouth during exercise for brief periods of time. However , it is o nly when your BOL T score is greater than 30 seconds that
intense physical exercise can be performed without undue risk of
overbreathing. T he goal for seri ous athletes, of course, is to attain a BOL T
score of 40 seconds. Only with a high BOL T score of 40 seconds is breathing volu me at a
normal level. Anything less indicates habitual overbreathing. And while it
would b e a normal expectation f or athletes to possess a high BOL T score, in
reality this is s eldom the case. I have measured the BOL T scores of
hundreds of athletes, ranging fro m weekend warriors to elite Ol ympic-level
athletes, and guess what? The v ast majority of BOL T measurements were
less than 20 seco nds. Some, in f act, have been less than 10 seconds, as low
as any person with severe asthm a. It is shocking to think of th e stress that
such overbreathing is placing on the body during intense physical exercise,
so a nyone serious about exercis e should aim to reduce their breathing and
increase their BOL T score. Like any  change  to your routine , the best way to determine the benefits
of reduc ed breat hing, nasal breathing, and a higher BOL T score is to put the
Oxygen Advant age program into practice for 2 to 3 weeks. Y ou will find a
program specific  to your BOL T score, exercise history , and state of health
in P art I V of this book. T wo or  three weeks is a relatively short period of
time in the grand scheme of th ings, and most individuals will experience
positive benefits  within a few short days. As you experience the positive
benefits, I am i n no doubt tha t you will be happy to incorporate these
principles into your life, for the rest of your life. For exam ple, wh en I first learne d to unblock my nose and switch from
mouth to nasal breathing, I imm ediately felt tension lifting from my head,
and desp ite havi ng wheezed my way through the previous twenty years, mysymptoms reduced by as much as 50 percent within the first day , simply by
breathing calmly through the nose. Even if you are unwilling to make a 100 percent change to nasal
breathing during  your peak seas on training, bear in mind that whatever you
do t o incorporate the Oxygen Advantage program into your routine will
provide a return. Ultimately , your success depends on your ability to
improve your BOL T score—each 5-second improvement will cause the
benefits to accumulate. In Part IV I have outlined a series of dif ferent programs to suit
individuals according to their current training, BOL T score, age, and overall
health. Choose the one that best matches your fitness level and abilities and
move on  when you feel you ha ve accomplished as much as po ssible from
each program. W ould Y ou Do Me a Favor? I am  ver y optimistic that if you follow the principles outlined in this book
and work toward increasing y our BOL T score, your health and sports
performance will improve in many ways. Since 2002, I ha ve observed tremendous improvements in the sporting
ability of both amateur and p rofessional athletes who have applied the
concepts of the Oxygen Adva ntage program. I have also wi tnessed the
negative ef fects on respiratory , mental, and cardiovascular health from
chronic overbre athing. It is my  aim to spread the word of t hese simple
techniques to provide an easy and ef fective way of improving the health and
well-being of readers. And you can help me to generate awareness! I w ould  appreci ate it greatly if  you would try out these practices and
then spr ead the word to your frie nds and family who are interested in health
and sports, or who suf fer from any of the problems described i n this book. Y ou could also help by writing a review of The Oxygen Advantage  on
Amazon.com. Also, please share the book with anyone you think may benefit from the
techniques within the Oxygen Advantage program.Finally , if you have any question s, or would simply like to tell me about
your personal experience with the Oxygen Advantage program, please drop
me a line. I would love to hear  from you. Y ou can contact me directly at
patrick@OxygenAdvantage.com. Best wishes and thanks again,
Patrick McKeown
Galway , IrelandP A R T  I V
Y o u r  O x y g e n  A d v a n t a g e  P r o g r a mS u m m a r y  a n d  G e n e r a l  P r o g r a m  B a s e d  o n
B O L T  S c o r e  a n d  H e a l t h
E ach time I work with a client, I design a program of breathing exercises
and lifestyle guidelines to help him or her reach goals safely and in the
shortest time possible. When de ciding on a program, it is necessary to take
into considerati on each individual’ s health and BOL T score. Having an
insight into a pe rson’ s lifestyle is also useful, as exercises can be tailored to
cause minimal disruption to work schedules and current training routines. I
fully understand the challenge of making time in a busy life to exercise,
which i s why the Oxygen Ad vantage program of fers quick, easy , and
achievable techn iques that can f it around any existing routine. There is no
doubt th at a low BOL T score can result in fatigue, reduced co ncentration,
and poor productivity , so by allocating just a half hour to one hour each day
to practice these exercises, your  BOL T score will increase alon g with your
ener gy levels, well-being, and  performance. I have seen th e proof in
thousands of clients that spendin g a little time to improve body oxygenation
is a hugely beneficial investment. The best  way to approach the O xygen Advantage program is to view it
as a lifes tyle cha nge and something to be incorporated into your way of life
as o pposed to a set of exercises practiced formally throughout the day . This
way it will become part of your daily routine rather than a regular chore or
duty .Q u i c k  R e f e r e n c e  S u m m a r y  o f  t h e  O x y g e n
A d v a n t a g e  P r o g r a m
H abitual overbreathing involves breathing more air than your body
requires during rest and exercise. Overbreathing leads to:
•  A reduction of the gas carbon dioxide in the blood
•  Mouth breathing and underutilization of the gas nitric oxide
•   Impai red rele ase of oxygen from red blood cells ( see the Bohr
Ef fect .) •   Cons triction of the smooth muscle in the blood vessels an d
airways
•  Adverse ef fects on blood pH
•   Reduced oxygenation of working muscles and or gans,
including the heart and brain
•  Increased acidity and fatigue during exercise
•  Limited sports performance
•  Negative ef fects to overall health
Benefits of practicing the Oxygen Advantage program include:•  Improved sleep and ener gy
•  Easier breathing with reduced breathlessness during exercise
•  Naturally increasing the production of EPO and red blood cells
•  Improving oxygenation of working muscles and or gans
•  Reduction of lactic acid buildup and fatigue
•  Improved running economy and VO 2  max
•  Improved aerobic performance
•  Improved anaerobic performanceO x y g e n  A d v a n t a g e  E x e r c i s e  S u m m a r y
T he fo llowing BOL T measuremen t and exercises are explained in  detail in
earlier chapters. Body Oxygen Level T est (BOL T)
1. Nose Unblocking Exercise
2. Breathe Light to Breathe Right
3. Breathe Light to Breathe Right—Jogging, Running, or Any Other
Activity
4. Breathing Recovery , Improved Concentration
5. Simulate High-Altitude T raining—W alking
6. Simulate High-Altitude T raining—Running, Cycling, Swimming
7. Advanced Simulation of High-Altitude T raining
Body Oxygen Level T est (BOL T)
Y our pr ogr ess  c an be determi ned by a reduction to breathlessness during
physical exercise, how you feel, and your BOL T scor e  as follows:1. T ake a  small, silent breath in through your nose, and allow a
small, silent breath out through your nose. 2. Hold y our nose with your fing ers to prevent air from entering
your lungs. 3. Count the num ber of seconds until you feel the first definite
desire to breathe. 4. At the  first definite desire to b reathe in, you may also feel the
first involuntary  movements of your breathing muscles. (Y our
abdomen may jerk and the a rea around your neck may
contract.) 5. Release your nose and breathe in through it. 6. Y our inhalation at the end of the breath should be calm. Y our BOL T  score is the length of time in seconds that you are able to
hold you r breath  until you feel the first physical signals to take a breath. T o
increase your BOL T score, it is necessary to:
•   N ose-breathe at all times, in cluding during physical exercise
and sleep. •  A void taking lar ge breaths while sighing, yawning, and talking. •   Practice Oxygen Advantage exercises appropriate to your
health and fitness.By incorporating the Oxygen Advantage exercises into your routine,
your BOL T score should increase by 3 to 4 seconds during the first week. After co ntinued practice for a n umber of weeks, you may find your BOL T
score remains stubbornly at ab out 20 seconds. Continue to p ractice and
incorporate breath holds into your physical exercise to increase your BOL T
score above 20 seconds. It can take 6 months for an individual to reach a
BOL T s core of 40 seconds, but  by then your health and fitness levels will
be at a totally dif ferent place than before. Enjoy the journey! 1. Nose Unblocking Exer cise
( Please do not practice this exe r cise if your BOL T scor e is less than 10
seconds, or if yo u ar e pr egnant or have high blood pr essur e, car diovascular
issues, diabetes, or any serious health concerns. ) T o unblock the nose, perform the following:
1. T ake a small , silent breath in  and a small, silent breath out
through your nose. 2. Pinch your nose with your fingers to hold your breath.3. W alk as many paces as possible with your breath held. T ry to
build up a strong air shortage, without overdoing it, of course! 4. When you resume breathing, do so only through your nose;
your breathing must be calmed immediately . 5. After resumin g your breathing, your first breath will usually
be bigg er than  normal. Make sure that you calm your
breathing as soon as possible by  suppressing your second and
third breaths. 6. Y ou should be able to reco ver your breath within 2 to 3
breaths. If you cannot, you have held your breath for too long. 7. W ait for about a minute or so and then repeat. 8. Repeat this exercise 5 or 6 times until the nose is decongested. 2. Br eathe Light to Br eathe Right
1. P lace one han d on your ches t and the other just above your
navel to help you to follow your breathing. 2. Breathe in and gently guide your abdomen outward.3. Breathe out and gently guide your abdomen inward. 4. Observe your  breathing pattern, noting the size and depth of
each breath. 5. Apply gentle pressure with yo ur hands to slightly reduce your
breathing movements. It should feel as if you are breathing
against your hands. 6. Encourage the depth of each breath to reduce. 7. T ake in a smaller or shorter breath than you would like. 8. A llow a relaxed breath out, exhaling gently , slowly , and
easily . 9. Bring a feeling of relaxation to your breathing. 10. Do  not tense your body , hold your breath, or pause your
breathing. Continue to breathe smoothly but take in less air
than before. 11. The obje ctive of this exercise i s to create a tolerable hunger
for a ir . T ry to sustain this for 3 to 5 minutes at a time. If your
breathing rhythm becomes chaotic or if your breathing
muscles contrac t, then the air shortage you have created is too
much. If these s igns occur , stop the exercise and return to it
when breathing is back to normal. 3. Br ea the Light to Br eathe Right— Jogging, Run ning, or Any
Other Activity
No matt er what  type of exercis e you prefer , make sure that you observe
your breath and become awar e of your inner body . Bring your entire
attention from your mind into your body . Move with every cell of your
body , from the top of your head to the tips of your toes.Allow your body to find its perfect work rate by breathing through your
nose in a steady and regular fas hion. Continue to increase your pace to the
point wh ere you can maintain s teady and regular nasal breathing. If your
breathing rhythm becomes chaotic and it is necessary to open your mouth to
breathe, you will know that the intensity is too much. If nece ssary , slow
your pace to a walk for 2 to 3 minutes before resuming your jog. As you run, fe el each gentle connection between your feet and the
ground as you p ropel yourself forward. A void pounding the pavement as
this will  lead to sore hips and joints and other possible injuries. Instead,
bring a feeling of lightness to  your body and visualize yourself barely
touching the ground as your run. Imagine yourself running over thin twigs,
treading so softly that they do n ot break. The mantra to follow is: light foot
strikes, a relaxed body , and regular , steady breathing. If you keep your  mouth closed t hroughout your exercise, your breathing
will recover quickly . 4. Br eathing Recovery , Impr oved Concentration
T o recover from physical exercise and to help calm your breathing or mind,
practice the following exercise for 3 to 5 minutes:
1. Exhale as normal through the nose. 2. Pinch your nose with your fingers to hold the breath for 2 to 5
seconds. 3. Breathe normally through the nose for 10 seconds. 4. Repeat the first three steps. Important Note Regarding the “Simulate High-Altitude
T raining” Exer cises That Follow
Please do not practice any exer cise that simulates high-
altitude training if your BOL T scor e is less than 20 seconds (or
less than 30 seconds for advanced simulation of high-altitude
training) or if you ar e pr egnan t, have high blood pr essur e or
other car diovascular issues, have diabetes, or have any serious
health c oncerns. While these exer cises involve the cr eation of a
medium to str ong air hunger , th er e is no point in over doing it. Upon co mpletion of each br eath hold, you should be able to
r ecover your br eathing within 2 to 3 br eaths. If while practicing
these exer cises, you experience dizziness or any other negative
side effect, then please stop immediately . 5. Simulate High-Altitude T raining—W alking
If you have a p ulse oximeter , you might find it motivating to observe the
decrease to your oxygen saturation as you do this. Continue walking
throughout the exercise and hold your breath only until you feel a medium
hunger for air for the first 2 to  3 breath holds. For the remaining breathholds, it is bene ficial to hold the breath until you feel a relat ively strong
hunger for air . 1. W alk for 1 minute or so while breathing through your nose. 2. Gently exhale and hold your br eath, followed by minimal
br eathing for 15 seconds:  G ently exhale,  pinch your nos e,
and walk while holding the bre ath until you feel a medium
hunger f or air , then release you r nose, inhale through it, and
minimize your breathing for 15 seconds by taking short
breaths. After 30 seconds of continued walking and nose
breathing, repeat the breath hold until you feel a medium
hunger f or air . Minimize your breathing for 15 seconds, then
allow your breathing to return to normal and through the nose. 3. Continue walk ing for 30 seco nds and r epeat:  Continue
walking for around 30 seconds while breathing through your
nose, then gently exhale and pinch your nose with your
fingers. W alk while holding your breath until you feel amedium to strong hunger for air . Release your nose and
minimize your breathing by tak ing short breaths for about 15
seconds. Then resume breathing through your nose. 4. Repeat br eath holds 8 to 10 times:  While continuing to
walk, perform a breath hold ev ery minute or so in order to
create a medium to strong n eed for air . Minimize your
breathing for 15 seconds following each breath hold. Repeat
for a total of 8 to 10 breath holds during your walk. A typical increase in the number of paces per breath hold might look
like this: 20, 20, 30, 35, 42, 47, 53, 60, 60, 55. 6. Simulate High-Altitude T raining—Running, Cycling ,
Swimming
Br eath Holding During RunningBreath holding can also be incorporated into more intense exercise, such
as running:
1. 10 to 15 minute s into your run,  gently exhale and hold your
breath until a str ong air shortage is reached. The length of the
breath hold may range from 10  to 40 paces and will depend
on your running speed and BOL T score. 2. Following the breath hold, continue to jog with nose breathing
for about 1 minute, until your breathing has partially
recovered. 3. Repeat the bre ath hold 8 to 10 times for the duration of your
run. The breath hold should be a challenge and, at the same
time, should allow breathing to  recover to normal within a
couple of breaths. Br eath Holding During Cycling
A similar practice can be employed during cycling:
•   A fter your bo dy has warmed up, exhale and hold your breath
for 5 to 15 pedal rotations. •   Resume nose breathing while continuing to cycle for about 1
minute. •  Repeat this exercise 8 to 10 times throughout your ride. Br eath Holding During Swimming
During s wimming, increase the number of strokes between breaths. Y ou
can do this in gradual increment s, increasing the number of stro kes between
breaths from 3 to 5 to 7 over a series of lengths. 7. Advanced Simulation of High-Altitude T rainingFor this exercise, it is necessar y to monitor your blood oxyge n saturation
with a pulse ox imeter , ensuring  that your SpO 2  d oes not drop below 80
percent. 1. W alk  for a m inute or so. Ex hale and hold your breath for
approximately 4 0 paces, then ta ke a sip of air into the lungs. A “sip” is a tiny  breath—just enough to reduce tension. Hold
the breath for a further 10 paces. 2. No w take a sip  of air in or out  of the lungs. Hold for 10 paces
or so. 3. Continue taki ng sips of air and repeating short breath holds
until you feel a fairly strong air shortage. 4. If the air shortage is too strong , then reduce the hold to 5
paces or less. W ith each successive breath hold, oxygensaturation will continue to decrease. 5. Challenge but do not stress yourself. 6. C ontinue to  monitor pulse oxygen saturation. Do not go
below 80 percent SpO 2 . 7. Perform this exercise for 1 to 2 minutes.B r e a t h e  L i g h t  t o  B r e a t h e  R i g h t  ( A d v a n c e d
M e t h o d )
T he a dvanced version of Breathe Light to Breathe Right is best practiced
after yo u have mastered the basic exercise as described on page 74. The
following will teach you how to  combine reduced breathing with abdominal
breathing to increase your BOL T score. Please note that just like any fo rm of physical exercise, it is easier and
more beneficial if you practice reduced breathing exercises at least an hour
or more after eating a meal. This exercise involves three simple stages:
1. Activating and strengthening the diaphragm
2. Mer ging your breathing with the movements of your abdomen
3. Reducing your breathing to create an air shortage
By p racticing abdominal breath ing, you will allow it to become your
natural breathing method. This exercise is split into three parts to ensure
that you learn the technique correctly and to gradually incorporate
abdominal breathing into your normal breathing habits. First you must learn
to re lax the diaphragm muscle s o that it can be activated during breathing. Second, you must learn to match the movements of the abdomen with the
breath to  engag e the diaphragm. And finally , you will be able to practice
breathing lightly with abdominal breathing to maximize body oxygenationduring rest. Remember that to im prove your breathing during exercise, you
must first learn how to breathe ef ficiently at rest. Stage 1: Relaxing and Activating the Diaphragm
•   S it up straight but do not force yourself into a rigid upright
position, as doing so will only  increase the tension in your
body . Instead, try to lengthen th e distance between your navel
and sternum (chest); imagine a piece of string gently lifting you
up from the top of the back of your head.•   A s you guide your body upw ard, imagine the space between
your ribs becoming wider .
_OceanofPDF.com_The_Oxygen_Advantage_-_Patrick_McKeown.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        Overbreathing can cause
numerous health  concerns, but there is a more disturbing risk  associated
with this condition that could literally make the dif ference betw een life and
death. Cardiopulmonary resuscitation (CPR) is performed during cardiac arrest
to help preserve  normal brain fu nction until further measures can be taken
to re store blood circulation and breathing. W e know that hyperventilationcauses reduced blood flow and reduced oxygenation of the heart, but
studies h ave also revealed that e xcessive ventilation during CPR is actually
detrimental to survival. Researchers inv estigated instanc es where CPR resulted in deat h due to
excessive venti lation applied by well-trained but overzeal ous rescue
personnel. Despite adequate training, these professionals hyperventilated
their patients while attempting resuscitation through higher than necessary
breathing rates. It is thought that the high airway pressure resulting from
administering more air into the patient than necessary had a detrimental—
and ultim ately f atal—ef fect on patients’ blood flow. One study concluded
with the following warning: “Additional education of CPR providers is
ur gently needed  to reduce these  newly identified and deadly co nsequences
of hyperventilation during CPR. ”
Reviewing the findings above,  it is shocking to think that the very
procedure designed to help save lives might in fact be having the opposite
ef fect. I t is even more shocking when we consider that the relationship
between breathing volume and blood flow to the heart was first documented
over a century a go. Thankfully, since 2007 there has been a m onumental
change in CPR procedures involving manual ventilation. Increasingly, the
emphasis during CPR is now on  chest compressions to maintain circulation,
rather than manual ventilation. Over the  years, I have witnessed many young athletes at all l evels of
fitness b reathing too intensely for their given level of exerc ise. In this
chapter, I have attempted to j oin the dots between excessive breathing
volume, reduced oxygenation of the heart, and resultant ECG abnormalities,
heart att acks, and chronic heart disease. It is only logical to su rmise that a
poorly o xygenated heart is less able to cope with the demands of intense
physical exercise. Y et every month I see reports of children, teenagers, and
young a dults w ho were in the prime of life dying from undetected heart
conditions. Upo n hearing the ne ws I often wonder: Could this tragedy have
been av oided if the victim had been encouraged to breathe normally and
through the nose. The breathing volume of athletes and nonathl etes alike is
crying o ut for attention, and greater awareness would be wort h all of the
ef fort, if even just one young life were saved. CHAPTER 12
E l i m i n a t e  E x e r c i s e - I n d u c e d  A s t h m a
I n childhood, treatments for fort y-three-year -old Julian’ s asthma included
cough medicine, trips to the coast for the benefits of sea air, and inhaling
steam from a boiling kettle. On some nights, Julian remembers his
wheezing being so bad that he st ayed up most of the night with his head out
the w indow in an ef fort to breathe. Any individual who experien ced asthma
as a  child durin g the 1970s and  1980s can probably testify to the lengths
that similarly worried parents took to try to help their children to breathe. By the late 198 0s Julian had been prescribed various relievers and
preventative me dications, in addition to regular trips to the hospital for
nebulizer treat ment. This never -ending cycle of medication and
hospitalizations continued for many years, and although Julian tried to keep
fit, he often found he was unab le to breathe, particularly during the small
hours of the night. Fast-forward to 2006, and Julian was taking higher doses of asthma
medication while his fitness level gradually reduced, a totally u nproductive
cycle th at was beginning to s eriously af fect his health and well-being. Julian’ s story is typical of any individual with moderate to severe asthma;
although physic al exercise can be very beneficial, many persons with
asthma simply tend to avoid it for fear of having an attack. In early 2007, Julian attended one of my Dublin courses at which we
focused on breathing through the nose, breathing light, and practicing
breath h olds while walking. Julian took his last dose of reliever medication
the day after the course. W ithin s ix mon ths, Julian’ s asthma had drastically improved,  and by
Christmas 2007,  he had his last dose of preventative medication. His fitnessalso improved and he was able to swim a mile per day, five times a week. In
2008, J ulian’ s GP agreed to reclassify his medical record as “asthma
resolved. ”
Over the next three years, Julian’ s exercise plan evolved to include eight
hours of  high-in tensity indoor cycling, circuits, and stretching  classes per
week, as well as  the techniques of nasal and reduced-volume breathing he
learned from my course. These changes, along with adj ustments to his eating habits, allowed
Julian to  improv e his performance and enjoy more ener gy and stamina at a
higher level of activity. At the age of forty in 2012, Julian ran five half-
marathons and covered over 750 training miles. He achieved a personal best
of 1 :46 i n his third half-maratho n; two weeks later he complete d the Berlin
full mar athon in 3:57. Following the Berlin Marathon, he ran  the Dublin
City Ma rathon in 4 hours. In six months, Julian had knocked over 8 minutes
of f his first half-marathon time. In si x ye ars, Jul ian progressed from a chance encounter with one of my
books to attending my breathing  course, improving his fitness, completely
eliminating prescription medicine for his asthma, and running h alf and full
marathons in very respectable times. The word asthma  derives from Greek and means “to pant. ” While
asthma has been around for a very long time, it af fects more p eople today
than ever before. Exercise-indu ced asthma af fects an estimated 4 to 20
percent of the g eneral populati on and 11 to 50 percent of cer tain athlete
populations. Interestingly, one study showed that while 55 percent of
football athletes  and 50 perce nt of basketball players displayed airway
narrowing conducive to asthm a, athletes from the sport of water polo
showed significantly fewer asth ma symptoms. Later on in this section we
will investigate why this might be. So, what causes asthma. The  most common theories include the
hygiene hypothesis, which rests on the premise that too much cleanliness
means children are not exposed to enough germs, resulting in diminished
immune capabilities later on in life. A second commonly cited explanation
is an increase in  pollution, but while this may well be a trigger, it is not
necessarily the cause. For instan ce, the west of Ireland, where I live, has a
high asthma rate but very good air quality. Might there be another factor that plays a significant role in causing
asthma—that of  habitually breathing too much. If this were true, then
surely reducing breathing volume could result in a reversal of th e condition. By look ing at the causes and symptoms of asthma, and the p hysiological
changes resulting from the condition, we can begin to determi ne just how
important breathing exercises can be in treating asthma. Since asthma is a condition cha racterized by dif ficulty in breathing, a
logical approac h would be to  attempt to find the root cause by first
addressing poor breathing habi ts. T ackling asthma from this angle is not
new and  was employed by the ancient Greek physician Ga len and the
sixteenth-century doctor Paracelsus, who recommended breath holding and
breathing exercises for the treatment of coughing and narrowed airways. The prevalence of asthma increa ses relative to wealth. Increased wealth
leads to a chan ge in living standards: Food becomes more processed,
competitive stress increases, houses become more airtight, we perform less
physical exercise, and the majority of our jobs are sedentary. Fifty years
ago, our living and working situations were quite dif ferent, and asthma rates
were sig nificantly lower. During  that time, we ate more natural foods, had
less competitive  stress, our ho uses were drafty, and most occupations
involved physical labor. B ack then, our lifestyle was conducive to a more
normal breathing volume, and, as a result, asthma was far less common. As we have se en, normal breathing volume for a healthy adult is
generally agreed  to be 4 to 6 liters of air per minute, but adults with asthma
demonstrate a resting breathing volume of 10 to 15 liters per mi nute, two to
three times more than required. Imagine the ef fect on the respiratory system
when an  individ ual breathes twice or three times too heavily all day, every
day. Normal breathing during rest involves regular, silent, abdominal breaths
drawn in  and out through the no se. People with asthma, on the other hand,
display habitual  mouth breathing with regular sighing, snif fing, and visible
movements from the upper chest. During an exacerbation of asthma,
symptoms like wheezing and breathlessness increase along with respiratory
rate, relative to the severity of the condition. In other words, as asthma
becomes more severe, there is also an increase in breathing volume. While it  is well documented that people with asthma breathe too much,
there is a need to determine whether the increase to breathing volume is acause or ef fect of the condition. As the airways narrow a feeling of
suf focation is generated, and a normal reaction is to take more air into the
lungs to try to eliminate this sensation. Either way, it is a vi cious cycle;
narrowed airways lead to heavier breathing that causes an increase in
breathing volum e, resulting in th e narrowing of the airways and  on and on,
worsening the condition and esta blishing bad breathing habits as a matter of
necessity. The only way to  determine whether breathing too much causes asthma
is to  investigate what happens when a group of individuals with asthma
practice breathing exercises designed to bring their breathing volume
toward normal. A st udy at the Mater Hospital in Brisbane found that when the breathing
volume of adults with asthma decreased from 14 liters to 9. 6 liters per
minute, their symptoms reduc ed by 70 percent, the need for rescue
medication decr eased by 90 percent, and the need for preve nter steroidmedication decr eased by 50 percent. The study found a direct relationship
between the reduction of breat hing volume and improvement to asthma. The closer breathing volume reduced toward normal, the greater was the
reduction of asthma symptoms s uch as coughing, wheezing, chest tightness,
and breathlessness. Furthermore, the trial’ s control group—who were taught
the hosp ital’ s in-house asthma management program—made zero progress. The reason for this was solely due to the fact that there was no change to
their breathing volume. Further studies reinforced these findings by
showing that people with asthma who practiced reducing their breathing
volume had far better asthma co ntrol with a significantly reduced need for
preventive steroid and rescue medication within 3 to 6 months. Since 20 02 I have taught thousands of children and adults with asthma
how to address the root cause of their condition—breathing too much. T riggers such as animal dander, dust mites, exercise, pollution, excessive
hygiene, and changes in the w eather are often cited to be the cause of
asthma symptom s, but in my experience the vast majority of suf ferers can
take back significant control of their condition, regardless of their triggers,
by s imply learning to breathe light. The fundamental cause of ongoing
asthma s ymptoms can almost always be attributed to breathing too much. As l ong as a student understands  the exercises and devotes time to changing
his or her breathing, positive results are consistent and reproducible. Based on the fact that a number of clinical trials have shown that asthma
symptoms and the need for asthma medication are significantly reduced
following the employment of reduced breathing exercises, there is no doubt
that over breathing is a significant contributor to asthma. Of cour se, it is also
normal for people prone to ast hma to increase their breathing volume to
compensate for a feeling of suf focation, but this action is simp ly part of a
feedback loop. Elements of modern living increase breathing volume,
which can activate asthma in genetically predisposed individuals. As their
asthma takes hold, the individual breathes faster and more intensely,
worsening the condition. While  it is important to recognize this feedback
loop, th e first step to addressing asthma is to reduce excessive breathing
habits. I can relate to any child or adult with asthma because for m ore than
twenty y ears I struggled with the same symptoms; I was unable to perform
even the most basic physical exercise, my nose was constantly stuf fed, and Icontinuously breathed through a n open mouth. Y ear after year my asth ma
medication increased with no signs of my symptoms abating. My sleep,
concentration, m ood, and quality of life were all adversely af fe cted. It was
only by chance, when I learned of the work of Russian doctor Konstantin
Buteyko, that I w as able to reve rse my asthma. W ithin a few short days my
wheezing decrea sed dramaticall y, simply by learning to unblo ck my nose
and norm alize m y breathing volume. I have now been wheeze-free for the
past thirteen years, and all I did was to learn to breathe normally again. This had  such a tremendous imp act on my life that I changed careers in
2001 an d retrained under the auspices of the late Dr. Buteyko. In 2002, I
founded Asthma Care to help publicize this information to children and
adults with asthma. Our clinics are now of fered in a number of countries. The first step to  addressing chronic overbreathing is to make th e switch
from m outh to nasal breathing. While nasal breathing is important for
everyone, for people prone to asthma it is vital. When breathing volume is
greater than normal, there is a tendency to open the mouth in order to allow
more air  to enter the lungs. Peo ple diagnosed with asthma often feel they
are n ot t aking in  enough air whi le breathing through the nose, w hich causes
them to breathe through the mouth. Mouth breathing influences asthma in a number of ways:
•   Air taken in through the mouth is not filtered of airborne
particles, including germs and bacteria. •   The mouth is simply not as ef fective as the nose in conditioning
air to the correct  temperature and humidity prior to entering the
lungs. •   B ecause the m outh provides a lar ger space to breathe throug h
than the  nose, breathing volume will be higher, causing too
much carbon dioxide to be ex pelled from the lungs. Carbon
dioxide is a na tural “opener” of the smooth muscle in the
airways. The loss of carbon dioxide therefore causes asthma
airways to narrow even more. •   Unlike nasal breathing, mouth breathing does not allow us to
benefit from nasal nitric oxide, which supports the lung’ s
defensive capabilities. T aking all these factors into c onsideration, it is not surprising that
mouth breathing causes a reduction in lung function in people with mild
asthma and plays a significant role in the exacerbation of asthma symptoms. Not only  is it im portant to breathe through the nose during rest, it is also
beneficial to nasal breathe durin g physical exercise. In a paper published in
the American Review of Respiratory Disease,  res earchers studied the
beneficial ef fects of nasal breathing on exercise-induced asthma. The study
observed that most subjects wit h asthma spontaneously breathe d with their
mouths open when instructed to breathe “naturally. ” The authors found that
mouth b reathing during exercise  caused the airways to narrow even further. In contrast, when subjects were asked to breathe only through their nose
during exercise, exercise-induced asthma did not occur at all. The paper
concluded that “the nasopharynx and the oropharynx play important roles in
the phenomenon  of exercise-induced bronchoconstriction. ” In si mple terms,
the ef fects of breathing through the nose are integral to reducing or avoiding
exercise-induced asthma completely. The fact that el ite athletes with asthma often favor swimming above
other forms of exercise is not a coincidence. During swimming, the face is
immersed under water, reducing  the amount of air taken into th e lungs and
increasing the athlete’ s tolerance  for carbon dioxide. Although the swimmer
may dra w his or her breath in t hrough the mouth, the protective ef fects of
reduced breathin g are still evide nt. A child or adult with asthma may also
prefer swimming because the water exerts a gentle pressure on the chest
and abdomen, further restricting breathing volume and improving athletic
performance. The dif f erence b etween land-ba sed exercise and swimming in terms of
breathing pattern and volume is significant for people with asthma. On land,
your breathing pattern during exercise is not restricted the way it is in water,
meaning that you can very easily overbreathe, resulting in constricted
airways, a reduction in the amount of CO 2  in your  blood,  and a lower
BOL T score. For an individual w ith asthma, overbreathing durin g rest leadsto overbreathing during exercise, which in turn leads to exercise-induced
asthma. However, exercising in  water naturally causes you to restrict your
breathing and lower your brea thing volume toward normal, providing a
much safer and more productiv e environment for people with asthma to
exercise. At the beginning of this chapter we looked at statistics that showed that
in a group of athletes, narrowing of the airways af fected 55 percent of
football athletes and 50 percent of basketball players, but 0 percent of water
polo pla yers. W ith such a glar ing disparity, what factors could possibly
explain the dif ference. The answ er, as you have probably guessed by now,
is simple. W ater polo training  involves breath holding and swimming
underwater, resu lting in a high er tolerance to carbon dioxide, increased
amounts of nitric oxide, and a  reduced breathing volume. W ith a more
normal breathing volume, asthma tendencies don’ t appear. However, if you have asthma and do not wish to take up swimming,
there is a simple r way. The Oxy gen Advantage approach incorp orates all of
the ben eficial aspects of swimming and more. Although the act of
swimming has its merits, it is  well documented that spending time in
chlorinated pool s is not ideal for asthma, as the chlorine can ca use damage
to lung tissue. F urthermore, while swimming reduces breathing  volume, it
is st ill im portant to address poor breathing habits outside of the pool. Many
swimmers rema in habitual mouth breathers and continue to employ poor
breathing habits that reduce their athletic performance and maintain their
asthma. Y our success in addressing asthma will be based on your ability to
increase your BOL T score usin g the Breathe Light to Breathe  Right and
simulation of high-altitude exercises described in this book. Y ou  will find a
program specifi c to your needs  in Part IV. The general aim is to increase
your BOL T score to 40 seconds. The best time to measure your BOL T score
to tr ack your p rogress is first thing in the morning, and if your BOL T
measurement re mains less than 20 seconds, then your asthma  symptoms
will persist. However, when your early morning BOL T score is greater than
20 seconds, symptoms such as wheezing, coughing, breathlessness, and
chest tightness will disappear. It’ s important to note that you may still be
susceptible to certain symptoms even when you have achieved a BOL Tscore of 20 seco nds when exposed to a trigger; a BOL T score of 40 seconds
is needed to fully eliminate your asthma symptoms. As you work toward achieving a high BOL T score, you may continue to
experience symptoms, depending on your medical history and triggers. Y our ability to stop the ef fects of asthma using the exercise below is
dependent on two factors: how high your resting BOL T score is and how
quickly you react to the ons et of symptoms. The sooner you begin
practicing the exercise, the easier it is to prevent symptoms from taking
hold. By ignoring your symptoms and hoping they will g o away by
themselves, the ef fects of asthm a tend to get worse and can take  on a life of
their ow n. If you often experie nce asthma symptoms, you will know that
wheezing and coughing usually  worsen over time, so it is important to
intervene early on. This ex ercise can help stop a sthma symptoms, but please get your
doctor ’ s permiss ion to try it first. Then follow the instructions below during
the early  stages of chest tightness, wheezing, coughing, or a head cold. If
you aren ’ t able to stop your sy mptoms within 10 minutes, then take your
rescue m edication. If you are experiencing severe symptoms, of course,
then take rescue medication str aightaway. If your rescue medication does
not stop your sy mptoms within a couple of minutes, it is advisable to call a
medical doctor immediately. T o stop asthma symptoms before they take hold, follow these steps:•   T ake a small, silent breath in and out through your nose. •  Hold your breath and walk for 10 to 15 paces. •   Stop walking, release your no se, and resume gentle breathing in
and out of your nose. •  W ait for 30 to 60 seconds and repeat. •   Continue to walk while holding your breath for 10 to 15 paces
followed by resting with nasal breathing for 30 to 60 seconds. •   If you r symptoms are mild, yo u may hold your breath for more
than 10 to 15 paces. •  Do this exercise for at least 10 minutes. In a ddition to e mploying nasal breathing and achieving a high BOL T
score, it is also very importan t to warm up properly in order to avoid
exercise-induced asthma. The minimum time spent warming up should be
10 minu tes. A good warm-up consists of fast walking while practicing a
medium to strong breath hold every minute or so. After the 10-minute
warm-up, increa se the pace so that you’re moving as fast as you can while
maintaining nas al breathing. If y ou feel the need to open your m outh, slow
down. Following  your physical exercise, encourage your breathing to calm
toward normal. The positive results of reduced breathing exercises and nasal breathing
on the symptom s of asthma are  fast and astounding. W ith su ch a simple
method, there really is no reas on for anyone to suf fer a single day more
from the discomfort of asthma. CHAPTER 13
A t h l e t i c  E n d e a v o r — N a t u r e  o r  N u r t u r e. I n 1704, a racing stallion by th e name of the Darley Arabian arrived in
Britain f rom Syria, and 95 perc ent of today’ s male thoroughbreds descend
from him. Gene ticist Patrick Cunningham and colleagues fro m my alma
mater, T rinity College Dublin,  traced the lineage of nearly one million
horses f rom the past two cen turies and determined that 30 percent of
variation in performance in tho roughbreds is due to genetics alone. In the
nature versus nurture debate, these results suggest that nature plays a
significant part in our athletic abilities. There is one ar ea in particular where a combination of gene tics and
behavior has considerable influe nce on athletic performance, and that is the
way the face and jaws develop during childhood. For example, take a look
at the structure of the face and jaws of past Olympic gold me dal winners
including Usain Bolt, Sanya Richards-Ross, Steve Hooker, and Roger
Federer. What is strikingly apparent for this group, and for the vast majority
of to p-class athletes, is the forward growth of the face and w idth of the
jaws. A thletic success depends on having good airways, which in turn is
dependent on normal facial stru cture. Spend a lot of time with your mouth
hanging open or sucking your thumb during childhood and the face grows
dif ferently from how nature intended. In fa ct, M ichael Phelps, the most decorated Olympian of all time, is one
of th e v ery few top-class athlet es who does not exhibit forwar d growth of
the jaws  and a w ide facial structure. Based on his facial profile, there is a
high likelihood that he was a m outh breather during childhoo d, possibly
requiring orthod ontic treatment  in his early teens. It is also possible that
Phelps chose swimming, either consciously or unconsciously, as it was theone sport that he could excel in. The very act of swimmi ng restricts
breathing to help of fset any n egative ef fects that have developed from
mouth breathing or an inef ficient breathing pattern. Although the natural order of things is to breathe through th e nose,
many children—especially those with asthma or nasal congestion—
habitually breathe through the mouth. Brazilian researchers i nvestigating
the prev alence of mouth breathing in children aged 3 to 9 fo und that 55
percent of a ra ndom selection of 370 subjects were mouth breathers. Children who regularly breathe through their mouth tend to develop
negative alterati ons to their face, jaws, and the alignment of their teeth. Mouth b reathing af fects the shape of the face in two ways. Firs t, there is a
tendency for the face to grow long and narrow. Secondly, the jaws do not
fully de velop and are set back from their ideal position, thus reducing
airway s ize. If the jaws are not positioned forward enough on th e face, they
will encroach on the airways. See for yourself: Close your mouth, jut out
your chin, and t ake a breath in and out through your nose, not ing the way
air travels down behind the jaws. Now do the same but pull your chin
inward a s far as you can—you will probably feel as if your thro at is closed
up as you try to breathe. This i s exactly the ef fect poorly developed facial
structure has on your airway siz e. It is no wonder that those wi th restricted
airways tend to favor mouth breathing. The forc es exerted by the lips and the tongue primarily influence the
growth o f a child’ s face. The lips and cheeks exert an inward pressure on
the f ace, with th e tongue providing a counteracting force. Whe n the mouth
is closed, the tongue rests against the roof of the mouth, exerting light
forces that shape the top jaw. Because the tongue is wide a nd U-shaped, it
follows that the shape of the top jaw should be wide and U-shaped also. In
other words, the shape of the top jaw reflects the shape of th e tongue. A
wide U-shaped top jaw is optimal for housing all our teeth. However, durin g mouth breathing, it is very unlikely that the  tongue
will rest  in the roof of the mouth. T ry it for yourself: Open your mouth and
place yo ur tong ue on your upp er palate. Now try to breathe through your
mouth. While it is possible to draw a wisp of air into the lungs, it will not
feel righ t. It follows therefore th at the tongue of a mouth breather will tend
to re st o n the floor of the mouth  or suspended midway. Since th e top jaw is
not t hen shaped by the normal pressures of the tongue, the end result is thedevelopment of a narrow V -sha ped top jaw. Aesthetically, this contributes
to a  narrowing of the facial structure, crooked teeth, and orthodontic
problems. It has been well docu mented that mouth-breathing children grow
longer faces. The sec ond way facial structure is af fected by the way we breathe
during childhood is the position of the jaws. The way the jaws develop has
a direct influence on the width of the upper airways. Our upper airways
comprise the nose, nasal cavity, sinuses, and throat. Strong athletic
performance req uires lar ge upper airways that enable air to flow freely to
and from the lungs. Although a  high BOL T score and ef fectiv e breathing
technique are crucial for high l evels of performance, having airways that
function with little resistance is also very advantageous. For example, a
marathon runner who has ef ficient breathing but airways that a re the width
of a narrow straw is not going to get too far. The nor mal growth of the fac e is forward. Since a mouth-b reathing
child does not rest his or her tongue in the roof of the mouth, the jaws are
unable t o be properly shaped by the tongue, and the natural forw ard growth
of the jaws is impeded. This results in jaws that are set back from their ideal
position, compro mising airflow. For the correct development o f the lower
half of the face a nd airways, it is imperative that a child habitually breathes
through his or h er nose. Breathing through the nose with the tongue resting
in th e roof of the mouth helps to establish the ideal conditions for the
normal development of the face. I sw itched from mouth to nose breathing during the late 1990s, when I
was in my early  twenties, but i t was only after I met with myofunctional
therapists Joy Moeller, Barbara  Greene, and Karen Samuel in 2006 that I
learned the correct position of the tongue. Until then, I hadn’ t given it a
moment’ s consideration, and most likely my tongue had been flopping
about without a home for the previous thirty-two years. Between them, Joy,
Barbara, and Karen have devo ted almost a hundred years to reeducating
people on the placement of the tongue and facial muscles in order to
address a variety of detrimenta l issues that af fect the development of the
jaws and teeth. S pending thousands of dollars on orthodontic treatment can
be in vain if po or habits such as mouth breathing, tongue th rusting, and
incorrect swallo wing are not addressed. And you may be ab le to avoidorthodontic treat ment altogether if these habits are not permitted to develop
in the first place. In th e correct re sting position, three-quarters of the tongue should press
gently a gainst th e roof of the mouth with the tip of the tongue placed just
behind t he top front teeth—the s ame place we put the tongue to make the N
sound “nuh. ”  Just like nasal breathing, optimal resting tongue posture is not
a recent  discove ry; for thousands of years it formed an important part of
Eastern yoga and the religion o f Buddhism. Y ogi Bhajan, who introduced
Kundalini yoga to the United States in 1968, accredited the upper palate and
the tip of the tongue as the tw o most important parts of the  body. The
ancient Buddhis t scriptures of t he Pali Canon contain passages describing
how the Buddha pressed his tongue against the roof of the mouth for the
purposes of controlling hunger and the mind. This illustration  shows the facial characteristics of a nasal brea ther and
is based on the Irish International and LA Galaxy soccer captain Robbie
Keane:
Note the  forward position of th e jaws, high cheekbones, airway size,
and wid th of the face. The jaw i s strong and positioned well forw ard so that
the chin  is nearly as far forwar d as the tip of the nose. When  cartoonists
draw illu strations of a dominant male, his strength is often conveyed by arugged and exaggerated jaw. S ocially, a wide facial structure and strong
jawline are considered healthier and more attractive than a recessed chin. And not only is  the classic squa re jawline more likely to get you a date, it
might also be beneficial to your bank balance. In a paper written by
researchers from the School of Business at the University of California at
Riverside, men with wider faces were found to be stronger negotiators,
commanding a signing bonus of nearly $2,200 more than their narrow-faced
counterparts. In  a separate stud y by the same authors it was found that
companies led by men with wider faces also achieved superior financial
performance. Throughout our evolution, social anthropologists have regarded facial
appearance as a determinant in establishing societal rank and individual
roles. Beauty is not just skin de ep, and Aristotle was right whe n he stated
that “Beauty is a far great er recommendation than any  letter of
introduction. ”
In the image ab ove, the jaws are set back and the airways are smaller,
resulting in diminished athletic performance. Had the jaws bee n in a more
forward position, the nose would be straighter and smaller. Th e eyes look
tired as the fac e sinks downward, and there is poor definition of the
cheekbones. Chronic, habitual mouth breathing is also associated withpostural changes that result in decreased muscle strength, reduced chest
expansion, and impaired breathing. Interestingly, researchers have found
that mouth breathers are more likely to be male. While the above image is exa ggerated somewhat, these features are
identifiable in thousands of children and adults who have fallen between the
cracks o f the health care system and were not encouraged  to breathe
through their nose. These same individuals often suf fer from poor health,
low ener gy, and reduced concentration. In the words of Dr. Y osh Jef ferson:
“These children do not sleep well at night due to obstructed airways; this
lack of sleep ca n adversely af fect their growth and academic p erformance. Many of these children are misdiagnosed with attention deficit disorder
(ADD) and hyperactivity. ”
Dr. Egil Peter Harvold, an ex pert in orthodontics and craniofacial
anomalies, carried out extensive  research into the development of the facial
structure of monkeys in the 197 0s, discovering that the restriction of nasal
breathing over several years led to a lowering of the jaws, crooked teeth,
and other facial deformities. While today we would consider it  dreadful to
experiment on innocent anima ls in this way, hundreds of thousands of
children take part in a simil ar experiment and experience  the same
craniofacial ano malies due to the ef fects of mouth breathing. D r. Harvold’ s
studies paved the way for the treatment and prevention of th e improper
development of the jaws and fa ce and is accredited almost single-handedly
for introducing a branch of or thodontics known as functional appliance
therapy to North America. A 2012 study investigating the long-term changes to facial structure
caused by mouth breathing noted that this seemingly “benign” h abit “has in
fact immediate and/or deferred cascading ef fects on multiple physiological
and behavioral functions. ” Infa nts and children who breathe through their
mouths due to n asal obstruction  are likely to develop crooked  teeth and a
longer, narrowe r face, permanently af fecting their appearan ce. Mouth
breathing also has a significant impact on the health of the chil d, including
restriction of the lower airways, poor quality of sleep, high stress levels, and
a lower  quality of life. Rese arch has suggested that habitual mouth
breathing may even be connected to sudden infant death syndrome. Hold On to Y our T eeth. Over the past few years I have been asked to give talks on nasal breathing at
dental c onferences in Europe, Australia, and the United States. Each
conference presents a wonderful opportunity to speak with international
experts in dentistry and related disciplines, including orthodontics. There
are two specific groups within  orthodontics that hold opposing views:
functional orthodontists and traditional orthodontists. A fu nctional orthodontist places  emphasis on attaining the correct facial
profile of the face as well as str aightening the teeth. Functiona l appliances
are worn by the child in order to help guide the growth of the face, jaws,
and teet h to reach their full gen etic potential. The commonly held view of
functional ortho dontists is that overcrowding of teeth is not because the
teeth are too big, but more likely because the jaw is too small as a result of
mouth breathing or thumb sucking. The course of action therefore is to
gently expand the jaws and guide them forward to make room for the teeth,
with extractions only carried out as a last resort. In c ontrast, the primary emph asis of traditional orthodontic s is to
straighten the teeth, with the facial profile and airway size receiving
secondary consideration. Crowded teeth are usually treated by extracting
four per fectly good premolars and retracting or pulling the fron t teeth back
to cl ose up the excess space created. This retraction sometimes  causes the
face, especially around the lips, to look caved in, and the nose and chin to
become more prominent. This retraction of the front teeth may  also cause
problems with the joint of the jaw if the lower jaw is forced back too far. When th e lower jaw is too far back, it encroaches on the upp er airways,
decreasing airway size and negatively af fecting athletic ability. If you are the parent of a child who may be under going orthodontic
treatment, I would like to impart some advice from i nternational
orthodontist Dr. John Mew, who has devoted his life to ensuring the normal
growth of children’ s faces:
•   F irst ask the orthodontist ho w many permanent teeth will b e
initially removed and how many more may need extracting
later. Sadly, most children who receive traditional retractive
orthodontic treatment lose 4 premolar teeth, and nearly half ofthese ch ildren will not have room for their wisdom teeth,
leaving them with 24 teeth. This  can be completely avoided by
helping to ensure normal growth of the face to accommodate
all 32 teeth. •   Ask your c linician whethe r he or she is confident about
avoiding an increase in the verti cal growth of your child’ s face. Y ou hav e the right to be inform ed of all types of treatment and
to be warned of likely problems. Knowledge is empowering. The best approach to determine the
treatment option s for you and your child is to research both fun ctional and
traditional orthodontic treatment. Selecting the correct approach will have
repercussions on  the well-being of your child; it is well worth  investing a
little tim e to determine a more noninvasive solution. Extraction s should be
a last resort. Don’t Leave It Until It’ s T oo Late
According to American research, 95 percent of head circumference growth
for the average North American  white child takes place by the age of nine. Development of  the lower jaw, however, continues until approximately the
age of eighteen. Based on these observations, for correct craniofacial growth to take
place, early intervention with  nasal breathing and tongue posture is
essential. The negative ef fects of mouth breathing on the stru cture of the
jaws and face will have the most impact when they occur before  puberty, so
there is only a  brief window of opportunity to avoid the need for
orthodontic treatment and significant changes in a child’ s facial structure. My daughter is three years old. She first began to breathe occa sionally
through her mouth at the age o f eight months during teething, and since
then I have been encouraging her to breathe through her nose. I set an
example by breathing through m y own nose all the time, and congratulate
her any time she has her mout h closed. As we live in the co untryside, Ioften comment that Charlie the  donkey breathes through his nose, as does
Snowball the cat. Such clever animals. Genetically, ther e would be a high likelihood for my daughter  to be a
mouth breather as both my wif e and I had severe respiratory complaints
while growing up. The earlier you begin to encourage your children to
breathe through their nose and e nsure the correct positioning of the tongue,
the bett er. Not only might yo u help them avoid orthodontic treatment
altogether, but the shape of their face, their general health, and their
athleticism will be significantly influenced during these fe w short  years. Even genetic predispositions can be minimized when the right action and
behavior is enshrined. A few years ago I wrote a self-help book for children, teenagers, and
parents entitled Buteyko Meets Dr. Mew: Buteyko Method for Childr en and
T eenagers  about the craniofacial changes associated with mouth breathing. I
put extensive amounts of resear ch into the subject and included  many peer -
reviewed paper s and studies to support my claims. Most parents are
shocked when they realize that crooked teeth, narrow faces, lar ge noses, and
undeveloped jaws can be avoided if a child is simply encouraged to breathe
through his or her nose. Not only is sports performance a f fected, but
lifelong health. W e cannot be dispassionate about the impac t of mouth
breathing on the development of our children. The detrimental e f fects that I
suf fered from a childhood of br eathing through my mouth needn’ t happen
to anyone else, armed with the knowledge we have about the benefits of
nasal breathing. CHAPTER 14
E x e r c i s e  a s  i f  Y o u r  L i f e  D e p e n d s  o n  I t
F or two million years we survived without supermarkets, convenience
stores, microwa ves, or McDonald’ s. In the past, in order to feed ourselves
and our families, muscle move ment was required to collect berries and
vegetation or to track down an  animal—often over several days—until it
collapsed from exhaustion. Compare that to today’ s couch  potato lifestyle—do you know many
people w ho could adequately feed themselves if there was no food available
for conv enient purchase. One thing is for sure—a major shif t of attitude
would b e required. In order to eat, we would have to perform regular and
sustained physic al exercise, something that the human body is built for and
thrives u pon. W hy should we st op it now, simply because hunti ng our own
food is no longer necessary. And while it might be too late f or many of us to become elite athletes,
we can still enj oy and derive considerable benefit from regular physical
exercise. Even if you have lived a relatively sedentary life until now, you
can dev elop your fitness slowly and steadily and bring about positive
changes to your health. There is a great feeling of self-esteem and
accomplishment when we get up of f our backsides or move away from the
computer. If you exercise for an hour per day, five times per week, for just a
few weeks, you will experience a remarkable dif ference in your sleep
quality, mood, and state of health. Despite the advances of med ical science, the diseases of modern
civilization cont inue to increase, and it could be ar gued that we  are passing
responsibility for our health to pharmaceutical companies rather than
making changes to our lifestyle and diet to prevent illness in the first place. Each year, more and more people are developing asthma, heart disease,
diabetes, high blood pressure, an d cancer. Not only that, but new “diseases”
are being invented all the time—and some might say it’ s because the market
conditions and share prices of b ig pharmaceutical companies dictate a need
for n ew markets and ever -increa sing sales. W e may be living longer, but at
the expense of consuming vast quantities of medication as soon as we
approach fifty or sixty years of age. A far better option to help prevent the
onset of diseases—and one that involves no toxicity or expense—is to take
a reg ular fast wa lk or jog. If you haven’ t exercised regularly before, please
pay a visit to your physician to get the all clear before starting. One thi ng that pretty much all health professionals agree o n is the
importance of regular physical exercise, taken within our limits. Dozens of
studies over the last few years have shown that regular physi cal exercise
provides many health benefits, including a reduced risk of cardiovascular
disease, cancer, and diabetes. Studies as far back as the 1950s have investigated the relationship
between regular physical exercise and cardiovascular health. One of the
earliest w as conducted by Dr. Jeremy Morris, who studied the incidence of
heart att acks in 31,000 transport workers. Morris found that bus conductors,
who spent most of their day climbing up and down the stairs of double-
decker buses, averaging betwee n 500 and 700 steps per day, h ad reduced
incidences of heart disease than their bus-driving counterparts, who spent
90 p ercent of t heir day sitting down. Not only this, but he art disease
developed by the bus conductors tended to present later in life and was less
likely to be fatal. The same study was replicated using over 100,000 postal workers, and
once again it was found that those who spent their day on foot or cycling
while delivering  the mail had fewer incidences of heart disease compared to
workers in sedentary occupations such as telephonists, civil service
executives, and clerks. Dr. Mor ris’ s findings are just as relevant today as
sixty years ago, and since more and more of us spend our working day
behind a desk, there is an increased need to perform regu lar physical
exercise. Even more important is that we perform this exercise within our
own personal limits. The bes t way to ensure that w e exercise within our capabilities is by
nasal breathing,  and an importa nt consideration is the length of time youcan com fortably hold your breath, or your BOL T measurement. When your
BOL T s core is less than 20 seco nds, your breathing volume will be greater
than what your body requires, resulting in a risk of overbreat hing during
physical exerci se. All breathing should be through the nose when
performing phys ical exercise so as not to increase breathing v olume even
further. When your BOL T score is grea ter than 20 seconds, it’ s fine for you to
breathe through  the mouth during exercise for brief periods of time. However, it is o nly when your BOL T score is greater than 30 seconds that
intense physical exercise can be performed without undue risk of
overbreathing. T he goal for seri ous athletes, of course, is to attain a BOL T
score of 40 seconds. Only with a high BOL T score of 40 seconds is breathing volu me at a
normal level. Anything less indicates habitual overbreathing. And while it
would b e a normal expectation f or athletes to possess a high BOL T score, in
reality this is s eldom the case. I have measured the BOL T scores of
hundreds of athletes, ranging fro m weekend warriors to elite Ol ympic-level
athletes, and guess what. The v ast majority of BOL T measurements were
less than 20 seco nds. Some, in f act, have been less than 10 seconds, as low
as any person with severe asthm a. It is shocking to think of th e stress that
such overbreathing is placing on the body during intense physical exercise,
so a nyone serious about exercis e should aim to reduce their breathing and
increase their BOL T score. Like any  change  to your routine, the best way to determine the benefits
of reduc ed breat hing, nasal breathing, and a higher BOL T score is to put the
Oxygen Advant age program into practice for 2 to 3 weeks. Y ou will find a
program specific  to your BOL T score, exercise history, and state of health
in P art I V of this book. T wo or  three weeks is a relatively short period of
time in the grand scheme of th ings, and most individuals will experience
positive benefits  within a few short days. As you experience the positive
benefits, I am i n no doubt tha t you will be happy to incorporate these
principles into your life, for the rest of your life. For exam ple, wh en I first learne d to unblock my nose and switch from
mouth to nasal breathing, I imm ediately felt tension lifting from my head,
and desp ite havi ng wheezed my way through the previous twenty years, mysymptoms reduced by as much as 50 percent within the first day, simply by
breathing calmly through the nose. Even if you are unwilling to make a 100 percent change to nasal
breathing during  your peak seas on training, bear in mind that whatever you
do t o incorporate the Oxygen Advantage program into your routine will
provide a return. Ultimately, your success depends on your ability to
improve your BOL T score—each 5-second improvement will cause the
benefits to accumulate. In Part IV I have outlined a series of dif ferent programs to suit
individuals according to their current training, BOL T score, age, and overall
health. Choose the one that best matches your fitness level and abilities and
move on  when you feel you ha ve accomplished as much as po ssible from
each program. W ould Y ou Do Me a Favor. I am  ver y optimistic that if you follow the principles outlined in this book
and work toward increasing y our BOL T score, your health and sports
performance will improve in many ways. Since 2002, I ha ve observed tremendous improvements in the sporting
ability of both amateur and p rofessional athletes who have applied the
concepts of the Oxygen Adva ntage program. I have also wi tnessed the
negative ef fects on respiratory, mental, and cardiovascular health from
chronic overbre athing. It is my  aim to spread the word of t hese simple
techniques to provide an easy and ef fective way of improving the health and
well-being of readers. And you can help me to generate awareness. I w ould  appreci ate it greatly if  you would try out these practices and
then spr ead the word to your frie nds and family who are interested in health
and sports, or who suf fer from any of the problems described i n this book. Y ou could also help by writing a review of The Oxygen Advantage  on
Amazon. com. Also, please share the book with anyone you think may benefit from the
techniques within the Oxygen Advantage program. Finally, if you have any question s, or would simply like to tell me about
your personal experience with the Oxygen Advantage program, please drop
me a line. I would love to hear  from you. Y ou can contact me directly at
patrick@OxygenAdvantage.
Reduced blood flow and reduced oxygenation of the heart.
What is the potential risk associated with overbreathing during CPR?
The study showed that a reduction in breathing volume led to a 70% reduction in symptoms, a 90% reduction in the need for rescue medication, and a 50% reduction in the need for preventative medication.
What is the relationship between the reduction of breathing volume and improvement in asthma symptoms?
Overbreathing, which can lead to a vicious cycle of increased breathing, worsening of the condition, and decreased athletic performance.
What is the primary cause of asthma, according to the author?
The author recommends practicing nasal breathing during exercise, as it helps to reduce breathing volume and prevent overbreathing.
What is the recommended approach to nasal breathing during exercise?
To increase the BOL T score and improve overall health, fitness, and sports performance by reducing overbreathing and promoting nasal breathing.
What is the main goal of the Oxygen Advantage program?