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Is Supplemental Oxygen a Performance-Enhancing Drug?

Author Information (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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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.

7 Comments

  1. 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
  2. Not so good is it mate,better work harder !

    Reply
  3. 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?

        Reply

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