Breathwork Meets Supplements: My Oxygenation Protocol for Athletes

I'll be honest—for years, I treated breathwork like it was yoga studio fluff. I'd tell my athletes, "Look, just breathe normally and focus on your lifts." Then I had a college swimmer come in with terrible performance anxiety. We tried some basic diaphragmatic breathing as a stress management tool, and her 100m freestyle time dropped by 1.2 seconds in three weeks. That got my attention.

So I dug into the research—and I was wrong. Proper breathing isn't just about calming nerves. It's about optimizing your body's oxygen delivery system. And when you combine specific breathing protocols with the right supplements? That's where you see real performance changes.

What the Research Actually Shows

Here's the thing—your body doesn't read studies, but I do. And the data on this combination is surprisingly solid.

A 2023 study published in the Journal of Applied Physiology (124(2): 345-356) followed 68 trained cyclists for 8 weeks. Half did diaphragmatic breathing exercises 10 minutes daily, the other half didn't. The breathing group improved their time to exhaustion by 14% (p=0.002) and increased their VO2 max by 6.2%. The researchers measured better oxygen extraction at the muscle level—literally more efficient use of what was already there.

But here's where supplements come in. A 2024 randomized controlled trial (PMID: 38512345) with 312 endurance athletes looked at iron supplementation combined with breathing retraining. Athletes with ferritin levels below 50 ng/mL who took 100mg of iron bisglycinate daily and did CO2 tolerance exercises improved their running economy by 8.7% compared to just 3.1% for iron alone. That's the synergy effect.

Dr. Andrew Huberman's lab at Stanford has been publishing on this too—their 2022 paper in Cell Reports (39(7): 110847) showed how nasal breathing specifically increases nitric oxide production by 15-20%. Nitric oxide dilates blood vessels, which means better oxygen delivery. And you know what else boosts nitric oxide? Beetroot powder.

So we've got breathing improving oxygen extraction, supplements improving oxygen transport, and the combination being greater than the sum of its parts. That's the sweet spot.

The Protocol: What to Do and What to Take

Look, I'm not going to give you some complicated 45-minute breathing routine. Athletes don't have time for that. Here's what actually works in the real world:

Breathwork (10 minutes total daily)

Morning (5 min): Box breathing—4 seconds in, 4 second hold, 4 seconds out, 4 second hold. Do this through your nose. This isn't just calming—it trains CO2 tolerance, which helps your body offload oxygen more efficiently at the tissue level.

Pre-workout (5 min): Diaphragmatic breathing lying on your back. One hand on chest, one on belly. Breathe in for 3 seconds, out for 6. The goal is belly rising, chest still. This activates the diaphragm properly so it doesn't steal energy from other muscles during exercise.

Supplements (the targeted approach)

I'm not a fan of throwing everything at the wall. These three have the best evidence for oxygenation:

1. Iron (if you need it)
Form: Ferrous bisglycinate (gentler on stomach)
Dose: 50-100mg elemental iron daily (with vitamin C for absorption)
Timing: Morning, empty stomach if tolerated
My pick: Thorne Research Iron Bisglycinate
Important: Get your ferritin checked first. Don't supplement blindly. Women, endurance athletes, and vegetarians are most likely to be deficient.

2. Beetroot powder
Form: Standardized to 400-500mg nitrate per serving
Dose: 5-6g powder mixed in water
Timing: 90-120 minutes before training
My pick: NOW Foods Beet Root Powder
Why it works: Converts to nitric oxide, improving blood flow and oxygen delivery. A 2021 meta-analysis (doi: 10.1007/s00394-021-02658-1) of 27 studies found consistent improvements in time trial performance (2.1-3.5% faster) with beetroot supplementation.

3. Vitamin B12 (methylcobalamin)
Form: Methylcobalamin or adenosylcobalamin
Dose: 1,000-2,000mcg sublingual
Timing: Morning
Why: Essential for red blood cell production. Even mild deficiency impairs oxygen transport. Vegetarians/vegans absolutely need this.

I had a 28-year-old triathlete last year—ferritin at 32 ng/mL, always fatigued in the second half of runs. We got him on 100mg iron bisglycinate, beetroot before long sessions, and the box breathing protocol. Eight weeks later, his ferritin was 68, and he PR'd his half marathon by 4 minutes. "I just don't hit the wall anymore," he said. That's oxygenation working.

Who Should Be Careful

This isn't for everyone. A few contraindications:

Iron supplementation: Don't take if you have hemochromatosis or iron overload. Men over 40 should get ferritin checked first—men's stores tend to accumulate.

Breath-holding exercises: Avoid if you have uncontrolled hypertension, glaucoma, or are pregnant. The Valsalva-like effect can spike blood pressure.

Beetroot: Can interact with PDE5 inhibitors (like Viagra)—both lower blood pressure. Also, if you have kidney stones, the oxalates might be problematic.

And honestly? If you're a healthy recreational athlete without deficiencies, you might get 90% of the benefit from just the breathing work. Supplements are the icing, not the cake.

FAQs

Q: How long until I see results?
A: Breathing improvements show in 2-3 weeks—you'll feel less "winded" at given intensities. Supplement effects (especially iron) take 4-8 weeks as you rebuild red blood cells.

Q: Can I overdo the breathing exercises?
A: Yes—especially CO2 tolerance work. Start with just 2-3 minutes daily. I had a client who did 20 minutes of breath-holds daily and gave himself constant headaches. More isn't better here.

Q: What about those "oxygen supplement" pills?
A: Most are garbage. They're usually just herbs with minimal evidence. The only supplements with solid oxygenation research are iron (for deficiency), beetroot/nitrate, and B12. Save your money.

Q: Should I breathe through nose or mouth during exercise?
A: Nose for easy efforts, mouth for hard efforts. Nasal breathing filters and humidifies air, but during high intensity, you need volume. Don't force nasal breathing during sprints—you'll just limit performance.

Bottom Line

• Breathwork isn't just stress relief—it improves oxygen extraction at the muscle level. The data's clear on this now.
• Combine diaphragmatic breathing + CO2 tolerance work (10 min daily total) with targeted supplements if deficient.
• Get tested before iron supplementation. Beetroot powder has the best evidence for performance enhancement.
• This works for endurance athletes first, but strength athletes benefit too—better recovery between sets, less fatigue.

Disclaimer: This is educational content, not medical advice. Talk to your doctor before starting any new supplement regimen, especially with iron.