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Is Supplemental Oxygen a Performance-Enhancing Drug?

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Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 800 page views per day, and he has over 5100 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 800 page views per day, and he has over 5100 followers on Twitter.

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Have you ever wondered if it works? Does breathing a high concentration of oxygen help an athlete recover from exertion faster?
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You often see a football player on the sidelines breathing oxygen after running a long distance or having worked hard during a long series of plays.

Have you ever wondered if it works? Does breathing a high concentration of oxygen help an athlete recover from exertion faster?

The answer is a resounding “No,” and here’s why…

In healthy people, such as college and professional football players, nearly all of the oxygen in the blood is carried by hemoglobin. Only a very small percentage is dissolved in blood. Saturation defines the oxygen that is attached to hemoglobin and partial pressure of oxygen is that which is dissolved in blood.

Definitions: SaO2 = arterial oxygen saturation, Hb = hemoglobin, 1.34 mL is the amount of oxygen a fully saturated gram of hemoglobin can carry, Pa02 = partial pressure of oxygen or the amount of oxygen dissolved in blood.

If an athlete has a normal Hb level of 15 gm, a SaO2 of 100% and a PaO2 of 100 mmHg, the formula used to calculate his blood oxygen content is:

[Hb X 1.34 X (SaO2/100)] + 0.003 X PaO2 or [15 X 1.34 X 100/100] + 0.003 X 100 so 20.1 + 0.3 = 20.4 mL/100 mL of blood

Only about 1.5% of the oxygen content of blood is dissolved.

If an athlete raises his PaO2 to 400 mmHg by breathing pure oxygen the calculation is:

[Hb X 1.34 X (SaO2/100)] + 0.003 X PaO2 or [15 X 1.34 X 100/100] + 0.003 X 400

20.1 + 1.2 = 21.3 mL/100 mL of blood

Even at a PaO2 of 400 mmHg, only 5.6% of the oxygen content of blood is dissolved. Note that hemoglobin cannot be more than 100% saturated with oxygen.

Very soon after the athlete stops breathing the pure oxygen, its minimal effect disappears. It’s simply not enough to affect recovery or performance.

Possibly because the basic science is well-understood, there have not been too many papers on this subject.

A study from JAMA looked at 12 soccer players given 100% oxygen or placebo after exertion. Then they had to exercise again. “The administration of enriched oxygen during the recovery period had no effect on plasma lactate levels [an objective measure of recovery] or on performance during the second period of exercise. The subjects were unable to identify which gas they received.”

A similar study of 13 athletes from Medicine & Science in Sports & Exercise concluded: “These findings offer no support for the use of supplemental oxygen in athletic events requiring short intervals of submaximal or maximal exertion.”

Another from the European Journal of Applied Physiology found that giving athletes supplemental oxygen during the recovery periods of interval-based exercise improves the recovery time of SpO2 (equivalent to SaO2), but it did not improve post-exercise markers of reactive oxygen species or inflammatory responses because the improvement in saturation was clinically insignificant.

The situation is explained in simple terms in an excerpt from the book “Exercise Physiology: Integrating Theory and Application.” It concludes that supplemental oxygen may have a placebo effect, but there is “no real physiologic benefit.”

If you Google “supplemental oxygen and athletes,” you will find a number of websites touting the supposed benefits of inhaled oxygen. They are almost all supported by companies that sell oxygen.

Bottom line: Supplemental oxygen is not considered a performance-enhancing drug because it doesn’t work.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 800 page views per day, and he has over 5100 followers on Twitter.

23 Comments

  1. Respiratory Therapist for over 27 years. This article explains PERFECTLY the dynamic effects of oxygen therapy. These players are not hypoxic. Their oxygen saturation levels are already near 100%, so the extra oxygen they will breath will NOT dissolve in the blood. It will merely go unused. Oxygen is a drug. It can only be used by prescription of a physician. If anything, prolonged exposure to 100% FiO2 can cause lung damage. I’m not surprised the NFL is doing this though. They aren’t very smart over there.

    Reply
    • Thanks for backing me up.

      Reply
  2. I have lupus, asthma, fibromyalgia and autoimmune thyroid disease. When I’ve been hospitalized for surgery I usually get O2 through a nose cannula. I swear I feel better on the O2; is it my imagination?

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    • If it works for you, keep doing it.

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      • I have a cpap machine that I have to use every night. I have a o2 machine that helps with cluster headaches. I have started running 5 k’s. I wake up after the races or after a work out I push myself very sore. I have found that if I go to sleep with the 02 hooked to my cpap, I wake up with no sore legs. This helps me recover much faster to be able to run sooner.

        Reply
        • In science, what you describe is known as an anecdote. The way to find out if oxygen really prevents leg soreness is to find a group of people whose legs are sore after working out or running and randomly give some of them oxygen and some of them air through the same mechanism as the ones who received the oxygen. The subjects would not know whether they are receiving oxygen or not nor with the investigators who would be analyzing the data. If you know any physiologists, maybe you could get them to perform that experiment.

          Reply
    • It stims your peripheral chemo receptors (carotid bodies) that let your body know when to exhale CO2, so essentially its numbing your chemoreceptors, allowing for you to feel better. You hemoglobin isn’t transporting more 02 because hemoglobin can’t be more than 100% saturated.

      Reply
      • I had not ever heard that, but I’m willing to learn. Do you have a reference for your statement? Thanks.

        Reply
        • Proven physiological science and My Kinesiology 605 professor Dr. Poole, a world renown respiratory physiologist. That’s my reference. You can look him up, and I’m sure you’ll find one of his publications.

          Reply
          • That’s not the way it works. You made the statement. You need to provide the evidence to back it up. Dr. Poole? How many Drs. Poole do you suppose there are?

          • Thanks for the PDF, but I don’t have time to read a 500-page document. Did you have a specific point you wanted to make?

        • You asked Andrew for reference and said you were willing to learn he gave you the name dr.poole You weren’t satisfied so I gave you a 550 page pdf referencing what he was referring to. I Don’t see the issue I simply gave you what you asked for.

          Reply
          • Andrew did not give a first name for Dr. Poole. If you search the word “Poole” on Pubmed, you get 7772 hits. The words “carotid bodies” appear in the PDF you linked to exactly once. This is what is it says on page 133: “On the other hand, the cardiovascular system also affects the rhythm control of respiration, via right ventricular strain, via pulmonary J receptor, and via aortic and carotid bodies.” I searched the PDF you sent for the words exhale and exhalation and found only one mention which did not say that oxygen stimulates “your peripheral chemo receptors (carotid bodies) that let your body know when to exhale CO2, so essentially its numbing your chemoreceptors, allowing for you to feel better.” That statement is not true. Even if increasing the supply of oxygen did stimulate your carotid bodies to exhale CO2 (which it does not), how would stimulating the carotid bodies make you feel better? The carotid bodies cause the respiratory rate to increase when they sense a DECREASE in the availability of oxygen, not an increase.

  3. As I have played football from Georgia to Boston Mass, I have never seen nor heard what I do now in Las Vegas in 100 to 110 degrees. These so-called coaches are punishing 8 & 10 year olds for not having their mouthpieces in at all times. They are forced to keep them in all during practice and even during coaches talk time. NFL, NBA, Boxing, College Sports, they all take them out after every play to get proper air supply.
    With a growing rate of players dying today in sports, mainly football, I would like to know if all levels of sports who have athletes using mouthpieces, is it dangerous for breathing purposes to have it in at all times, mainly during 2 hours of practice, and does not the brain need much oxygen intake to perform greater?

    Reply
    • I don’t know if mouthpieces hamper breathing but it certainly seems possible. I don’t know if anyone has investigated it. Some youth coaches are sadists who apparently enjoy making little kids suffer. There is an even better question which is–should 8- and 10-year-olds be playing tackle football at all or practicing in 100 degree heat?

      Reply
  4. Not so good is it mate,better work harder !

    Reply
  5. I am a respiratory physiologist and have recently arrived in the USA to teach optimal posture and breathing programs.

    I could not agree with your comments more – as the general population totally believes the myth that breathing is all about oxygen.

    As you will see from the short intro videos on our website – it is well explained that functional breathing is in fact all about CO2.

    Happy to explain what we do in more detail if this is of interest to you.

    Kind regards
    Roger Price

    Reply
    • I’d like to talk to you more about this my email is Tnkringle02@gmail.com best regards Chris

      Reply
    • Where can I find your information on breathing programs?

      Reply
      • I would like to help you, but I do not understand your question. What sort of breathing programs are you looking for?

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    • Hi I have been recently diagnosed with fibromyalgia. Taking a huge list of pills one of them was lyrica. I recently quit the lyrica because the side affects were worse than the minimal relief it has given me. I have been reading tons on ewot therapy. I recently purchased a o2 concentrator but it only produces max 5liters. I ride a recumbent bike and practice yoga and qigong. I feel I have gotten some results from just even using a non rebreather mask. I feel rested as before I started name ewot program I had to nap every day. Even before bed I lay with a canula for an hour or so. I also have severe insomnia and anxiety. It may all be in my head but I do feel more at ease. Any thoughts on all of this?

      Reply
      • If you feel better, go ahead and use it. I do not understand how it is any different than football players using supplemental oxygen on the sidelines. The physiologic principles are no different.

        Reply

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