is supplemental oxygen considered a performance-enhancing drug for atheletes?

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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, but is it actually doing anything? In athletic performance oxygen controls many things and a lack of it causes loss of muscle control, poor stamina and an inability to concentrate. At its very worse it can cause complete and literal collapse. Many athletes try to extend their stamina and performance by using oxygen supplementation but does it work?
Kenyan nationals have become next to unbeatable in marathon running and one supposed reason for this performance was oxygen surplus. Kenyans are born and train in an atmosphere with lower oxygen and when they compete in marathons they are usually doing so in countries at lower altitudes and therefore they experience a natural oxygen surplus. Some believe this allows them to have higher stamina and a faster, stronger performance than people who train in more oxygen-rich atmospheres. It also boosts the idea that supplemental oxygen increases performance. Even if this theory is true, the question still remains as to whether artificial sources of oxygen can help you achieve Kenyan stamina.~

There have been a few studies that have shown that when pure oxygen is used prior to an athlete’s performance that they can lift weights quicker and cover short distances quicker. However during these few studies the participants knew that they were breathing pure oxygen and raises the question that perhaps the result was due to a placebo effect.

If there was significant proof that oxygen could enhance performance then there would have been an immediate debate as to whether breathing pure oxygen was deemed a performance-enhancing drug and whether it should be regulated or banned.

The science of oxygen consumption and the studies that have been carried out answers the question with a resounding no.
In healthy athletic people, such as professional football players, nearly all of the oxygen in the blood is carried by haemoglobin and only a very small percentage (1.5%) is dissolved in blood.  Even if an athlete breathes pure oxygen, haemoglobin cannot be more than 100% saturated and therefore does not change and the amount that is dissolved in the blood only raises to 5.6%. This minimal affect will nearly instantly disappear after you have stopped breathing the pure oxygen and is not enough to affect recovery or performance.

One study looked at football players given 100% oxygen or a placebo after exertion before they had to exercise again. There was no increase in performance during the second bout of exercise. Another study also concluded that supplemental oxygen may have a placebo effect, but there is “no real physiologic benefit.”

Supplemental oxygen is therefore not considered a performance-enhancing drug because it doesn’t work, the science and studies cannot provide supporting evidence and at best it may just have a placebo effect, which has a similar result that lucky socks do.

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Supplemental oxygen can potentially improve eyesight



Diabetes can cause many health problems for sufferers and one of these is macular oedema. This is a fluid build-up in the part of the eye that is responsible for central vision. Diabetic macular oedema affects up to 10 percent of all patients with diabetes. It is caused when high blood sugar eventually causes damage in blood vessels of the retina and a decrease in the supply of oxygen and nutrients. When the retina experiences low oxygen levels it releases vascular endothelial growth factor (VEGF) and other substances that cause the retinal blood vessels to become leaky and stimulates the growth of new blood vessels. The leakage of fluid into the macular causes it to become thickened and results in vision loss. Many patients have laser treatment to try and correct it, however many patients find that they still suffer persistent oedema.
A pilot study has monitored diabetic patients breathing supplemental oxygen through a nasal cannula and found that it helped to reduce fluid build-up and swelling and in some cases improved their visual acuity fairly dramatically. Patients were given 4 litres per minute of oxygen via a nasal cannula and asked to use it continuously for three months day and night.
After the three months it was found that there was an average 50% decreases in the excess thickness of the macular, the excess thickness of the fovea (responsible for sharpness of vision) and in the macular volume. Also a third had improved visual acuity with the ability to read two lines higher on an eye chart.
In addition it was noted that when the supplemental oxygen therapy was discontinued the subject’s vision slowly worsened. However in those where their eyes had returned to within the normal range whilst on supplemental oxygen, their eyesight did not worsen but remained within the normal ranges once the supplemental oxygen was stopped.
It appears that supplemental oxygen reduces the production of VEGF, which reduces the amount of leaking in retinal vessels and therefore lessens the severity of macular oedema.

Researchers believe that this could be used in conjunction with eye laser treatment to improve oxygenation to the retina to provide long-term eye stability. The oxygen treatment could reduce the thickness of the retina prior to laser treatment in order to make the laser treatment more effective and long-lasting, for when supplemental oxygen is ceased. There are also oral drugs being developed that block receptors for VEGF and could be used in conjunction with supplemental oxygen to help improve results.

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What the consumer wants from their concentrator

A recent research study by DeVilbiss Healthcare has looked into what consumers believe to be the most important attributes of an Oxygen Concentrator.
According to the study, failure rate is the most important factor at 36% followed by price (26%), warranty (19%) and energy savings (11%).

The study was carried out in order to understand the needs of customers that use the concentrators and to identify which attributes are the most important. It was clear from the results that customers see the long-term value of the product to be the most important factor. They want a product that is built to last to reduce the costs of customers having to keep repurchasing every few years as the machines wear out.

Consumers such as the NHS and other healthcare providers are now looking at long-term saving rather than the initial short-term saving of a cheap product to purchase. They want to be able to focus their efforts on delivering excellent oxygen therapy services rather than being distracted by repairing equipment they have supplied and the costs that are involved in repairing and replacing equipment.

The business landscape of the oxygen supply industry has changed over recent years as increased failure rates have meant higher operational costs for the suppliers and they have struggled to keep prices down for the consumer.

“Increased failure rates were driving up our operational costs,” said the National Procurement Manager for RHS Canada, “and with lower reimbursement, we really have to work closely with manufacturers to attain effective, safe and reliable equipment at a price point that works for all individuals in the industry. Reliable equipment in the field is crucial to the success of our business and to providing quality patient care.”

Hopefully the industry will respond to reflect the findings of the study and it would be financially sound for them to do so. Manufacturers can spend more money making  oxygen equipment that is durable and long-lasting with less fear that it may drive the initial cost up slightly as many oxygen provider companies will not mind paying slightly more in the short-term if it reduces their long-term costs.

This will mean that the patient will be using more reliable and efficient equipment in the future, which is of obvious benefit to reduce the stress of when products break and need to be repaired or replaced. But more importantly also to prevent emergency situations from occurring when the product breaks down. If you are constantly reliant upon the product to breathe and it breaks down then there is a chance of fatality.

At the moment however until these changes make their way down through the chain in the years to come, the advice is to always ensure that you have a back-up concentrator to hand in case of emergencies, whether at home or travelling on holiday. Even if product failure rates decrease, there is always unfortunately a chance that technology can break down and it can save your life to have a back-up concentrator ready for emergencies. If your normal provider cannot arrange one then there are national and global private companies such as oxygenworldwide that you can purchase them from, and it would be a sound and wise investment, as it could save your life.


Biology meets technology to produce oxygen

London’s ecoLogicStudio has designed a prototype of its urban algae canopy. It is the “world’s first bio-digital canopy that integrates micro-algal cultures and real time digital cultivation protocols on a unique architectural system” with flows of water and energy regulated by weather patterns and visitor usage.


This is a ‘bio-digital’ structure that combines biology with technology. In the structure there is fluid filled with micro-algae organisms that are pumped around a transparent canopy which provides shade to the space underneath the canopy. It also produces energy in the form of biomass and produces a large amount of oxygen. An additional feature is that the structure can respond to the presence of visitors by producing interesting visual effects.

In the presence of sunlight the micro-algae will photosynthesise naturally and grow in numbers and volume which turns the almost transparent fluid into a deeper shade of green to provide shade to anyone standing underneath the structure. This means that the structure is weather=pattern dependent and will produce more in the presence of high levels of sunlight.

The interactive parts works by electro valves in the structure being triggered by the presence of someone walking into each different area of the canopy. The valves alter the speed at which the fluid flows through the canopy creating different colour shades and effects.

The prototype will hopefully be scaled up to a larger installation that will be able to provide the same amount of oxygen as four hectares of woodland and also produce 150kg of biomass.
Using micro-algae colonies rather than relying on woodland photosynthesis also results in a massive reduction in the amount of CO2 produced which benefits the atmosphere.

Integrating organic systems with artificial ones opens up possibilities for everything from temperature control to power generation methods using the advantages of both natural and digital parts. There are even designs being put forward for smog-eating algae street lamps among many other fascinating ideas.

As ecoLogicStudio puts it: “We believe that it is now time to overcome the segregation between technology and nature typical of the mechanical age, to embrace a systemic understanding of architecture. In this prototype the boundaries between the material, spatial and technological dimensions have been carefully articulated to achieve efficiency, resilience and beauty.”

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You can sometimes feel short of breath even when on oxygen

Many patients with advanced lung cancer can sometimes feel short of breath even when they are on oxygen and showing that they have an acceptable oxygen level of over 90%. There are a few reasons why this can happen.

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If your oxygen level drops below 88% this signals to the brain that you need more oxygen and initiates dyspnea (shortness of breath) and a sense of air hunger. This signal is also triggered when other pulmonary test levels are low. The Vital Capacity is how much air there is from the beginning to the end of a breath and the FEV1 is a measure of how much air you can forcefully exhale in one second. Even when your oxygen levels are good at 90% if any of the other values are low then the body can sense dyspnea.

The use of an inhaler can be very effective in improving the Vital Capacity and FEV1 and can immediately improve breathing symptoms and stop the feeling of shortness of breath due to the effect the inhalers have on widening the airways.

Also many patients can be not very physically fit due to a combination of the medical illness, age and obesity. Introducing more exercise into daily life can help to improve cardio/respiratory fitness thereby improving the Vital Capacity and FEV1 and helping to reduce the frequency of periods where you feel short of breath.

Low blood counts (anaemia), heart disease and advanced kidney disease are conditions that can also cause dyspnea even if your lungs are working effectively.

Vital capacity and FEV1 are pulmonary tests that your doctor can perform to see how effectively your lungs are working so regular check-ups are important and your doctor can help ensure that if you suffer from these situations that they are treated to help improve your breathing. Some patients find that when these other factors are dealt with that they are less reliant upon their oxygen.

If you suffer from bouts of breathlessness then there are things you can do to help yourself:
•    If you smoke, get help to quit.
•    Try some breathing techniques. If you practise these and use them every day, they will help you when you are active and getting breathless. They will also help you manage if you get short of breath suddenly.

– Blow as you go: breathe out when you are making a big effort, such as standing up, stretching or bending.

– Pursed-lips breathing: breathe out with your lips pursed as if you were whistling.
•    Be more physically active. Physical activity could be walking, gardening, walking the dog, housework or swimming as well as going to a gym. If you have a lung condition, you can be referred to a pulmonary rehabilitation (PR) programme by your doctor, and if you have a heart problem there are cardiac rehabilitation services too. These classes help you to get control over your breathlessness, get you fitter and are also lots of fun.
•    Drink and eat healthily and manage your weight.  If you are carrying excess weight you will require more effort to breathe and move around, and it will be more difficult to get control over your feelings of breathlessness.
•    Get treatment if you feel stressed or anxious.
•    Use the right medication in the right way. If you use inhalers, tablets or liquids to control your breathing ensure you know how and when to take them correctly.
•    Ensure your oxygen flow rate is correct. Another reason why regular check-ups are important so your doctor can monitor your oxygen requirements and adjust your oxygen flow rate accordingly for your oxygen concentrator.

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Your eyes and oxygen


The cornea is one of the few parts of your body that doesn’t have blood vessels supplying oxygen to it, along with tooth enamel, hair and nails.

The cornea needs to be transparent so that light can pass through so there can be no blood vessels there, otherwise the light would be obscured. Without blood vessels the cornea must get it’s oxygen directly from the air. The oxygen first dissolves in the tears and then diffuses throughout the cornea to keep it healthy. Carbon dioxide is released via the same process back out to the atmosphere. Some oxygen can diffuse through the aqueous humour within the eye but this is slow and limited. The main pathway is through the front of the eye so if this is restricted by your eyes being closed for extreme periods of time or via the use of the wrong type of contact lenses, then the cornea can become oxygen deprived.

Without enough Oxygen the cornea will warp, become less transparent, less able to detect pain and can develop scars. Additionally, new blood vessels from the sclera (the white part of the eye) can grow into the cornea and cause further damage and scarring. A blood shot eye happens in response to the cornea looking for another way to get more oxygen. Since the cornea is without blood vessels, the retina pumps up its veins in attempt to absorb more oxygen. This response can lead to other problems over time like corneal neovascularization and macular degeneration disease.

The oxygen supply to the cornea is slightly less absorbed when contact lenses cover the cornea. Contact lenses nowadays are a lot more permeable in order to allow more oxygen to pass through to the eye and some are designed to be in for long periods of time. Check with your optician to make sure you have the correct type to avoid damaging your eyes. Early symptoms of a lack of oxygen include dryness and irritation as well as blood shot eye. Solutions and moisturisers are available to help keep your eyes healthy and oxygenated.

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Air travel with a lung condition

For those people who suffer with any type of lung condition they may have difficulties when travelling by air. This is due to the reduced air pressure in the aircraft cabins as well as the lack of mobility for long periods of time. Air pressure in an aircraft cabin is lower than air pressure at ground level and feels like being at 6000 to 8000 feet on a mountain. At high altitudes blood oxygen levels fall in everyone, and some people may feel a little breathless. In most people this has no health effect, but if you already have low blood oxygen levels because of your lung condition, then the extra dip that happens while you are in the plane can cause breathlessness and discomfort for you.

As long as you meet a minimal fitness criteria agreed with your doctor then it is still possible to fly, even if you require constant oxygen therapy.

Before departure :
If you are able to walk 100 metres on ground level without needing oxygen, at a steady pace without feeling breathless or needing to stop, then you are not likely to be troubled by the reduced pressure in aircraft cabins.

If you cannot do this then you will need to talk to your doctor about whether you should travel by air. You may need to have some breathing tests to show if a fall in your blood oxygen level is likely to be a problem to you while travelling.

You should also check your travel insurance policy to make sure you are fully covered for any medical costs that may arise in connection with your lung condition. It is important that your travel medical insurance includes the cost of return by air ambulance if you were to become too ill to return on a commercial flight.

Many policies will not cover you for costs from your lung condition unless you have a written note from your doctor that he or she feels you are fit to fly.

Oxygen and air travel :
If tests show that your usual blood oxygen levels are so low that air travel may be a problem for you, you may still be able to travel by air, if oxygen is provided for you. Airlines can arrange extra oxygen, but remember that most will charge for providing oxygen. Different airlines have different charges; check with each one before you arrange your flight. Don’t trust to luck that planes will have oxygen on board. They carry emergency supplies but not enough for several hours.
You will also need permission from the airline to take on board and use any electrical equipment you need for your treatment. Equipment must be battery driven, and you will not be allowed to use it during take off or landing. Using an inhaler with a spacer is just as effective as using a nebuliser.
You may find it easier to organise your oxygen needs via a company that can arrange oxygen for both the plane and the entirety of the holiday, just in case you need oxygen throughout your trip or if you just want to arrange to have a ‘back-up’ supply just in case. It’s easier to have dealings with just one company rather than multiple, especially if you’re travelling to more than one place during your trip.
Essential Tips from the NHS website to remember before flying:
1.    Ask your doctor well in advance for a letter to take in your hand luggage with details of your condition and medication.
2.    Be sure to take your inhalers in your carry-on bags. One of the most common problems is that people pack their inhalers in the luggage that goes into the hold.
3.    If you get breathless when walking, make sure you have help at airports. Distances to departure gates can be long. Disabled assistance at airports can be arranged before you travel.
4.    When you are in the aeroplane try to move about every hour or so and exercise your legs. Sitting for too long can lead to blood clots in the legs.
5.    Drink plenty of water and non-alcoholic drinks during the flight.
6.    Remember the golden rule: If in doubt about travelling, check with your doctor.