Should Athletes Increase Protein Above Recommended Levels?

Many athletes will increase their protein intake in order to increase lean mass and strength.  There are many conflicting messages on whether or not this macronutrient increase actually works.  Hoffman et al ran a stratified study to determine if increasing an athlete's protein intake does improve his body composition and strength. 

In the study, the researchers took 23 collegiate strength/power athletes for a 12-week resistance training study.  The athletes were divided into three stratified groups.  BL consumed below recommended levels of protein at 1.0-1.4g/kg/day.  RL consumed the recommended levels of protein at 1.6-1.8g/kg/day.  AL consumed above the recommended protein levels at >2.0g/kg/day. (1)  The researchers noted that the total energy intake for each group was below the recommended levels. (1)

According to common marketing in supplement stores and magazines, the AL group should have seen market increases in strength and improvement in body composition.  However, the researchers discovered no changes in body composition, to include body mass, lean body mass, and percent body fat, from the PRE in all three groups.  The researchers did discover a significant increase in strength, but, again, it was in all three groups.  Also, the researchers discovered no significant hormone changes from PRE in all three groups. (1) 

Given the results from the Hoffman study, there is no benefit for an athlete to stray from the recommended protein intake levels.  It is important for an athlete to remain lean, but it is also important for the athlete to remain healthy.  Consuming a well-rounded diet with nutritionally dense foods will help an athlete, meet his goals and stay lean and strong.  Being sure to follow a balanced workout of strength and cardiovascular exercise appropriate for the sport, will help the athlete increase strength and power without the need to consume more than the recommended allowance of any one macronutrient.  Being consistent in diet and training are more important than consuming too much or too little of any particular macronutrient.

1.  Hoffman, Jay R.; Ratamess, Nicholas A.; Kang, Jie; Falvo, Michael; Faigenbaum, Avery.  Effect of Protein Intake on Strength, Body Composition, and Endocrine Changes in Strength/Power Athletes.  Journal of the International Society of Sports Nutrition 2006; 3: 12-18.

And some more about protein supplements...

Here are summaries of two more studies covering whey protein supplements.  In the first, Pasiakos et al conducted a thirteen day, randomized, crossover study to assess postexercise muscle protein synthesis (MPS), whole-body protein turnover, and anabolic intracellular signaling responses to the effect of essential amino acids in supplements (1).  The eight adult volunteers were tested on days 8 and 13.  The two groups were given two different concentrations of leucine:  Group 1, the experimental group, were given 3.5g leucine (L-EAA) and Group 2, the control group, was given 1.87g leucine (EAA) (1).  Both groups consumed their supplements during exercise.  The leucine for both groups was dissolved in 500mL of water with an artificial sweetener (1).

The volunteers were active-duty military personnel who regularly participated in both endurance and resistance exercise at least 3-4 days per week.  They were all recreationally fit with no medications, no injuries, and no abnormalities (1).  While the study was run with 9 men and 1 woman, the data used in the report was for 7 men and 1 woman (1).  The volunteers were directed to do two separate bouts of cycle for 60 minutes at 60% VO2 peak (1).

The researchers discovered that the muscle protein synthesis was 33% greater after L-EAA than EAA.  Also, the whole-body protein breakdown and synthesis was down and the oxidation was up for the L-EAA group (1).  The mammalian target of rapamycin phosphorylation was up with the L-EAA group 30 minutes after exercise (1).  The researchers concluded that L-EAA supplementation increases leucine availability and spares endogenous protein stores to a greater extent during endurance-type exercises (1).

In the second study, West et al measured the effect of whey protein on myofibrillar protein synthesis (MPS) after exercise (2).  This study observed eight men who were recreationally active, not endurance athletes.  They were randomly assigned into two groups:  Group 1 was given a single bolus of 25g (BOLUS) and Group 2 was given small, “pulsed” drinks of ten drinks of 2.5g every 20 minutes (Pulsed) (2).  The drinks were prepared in water with no additives, like artificial sweetener.  The BOLUS consisted of 12.8g EAA, 3.5g leucine, 0 carbohydrate, and 0 fat; the PULSE drinks were the same formula administered in the pulsed manner (2).

The researchers found the BOLUS increased blood essential amino acid (EAA) concentrations 162% 60 minutes after exercise, and the PULSE increased EAA 53% (2).  Also, with the BOLUS, the blood EAA concentrations were greater at the 80-minute mark.  However, the EAA concentrations were greater with PULSE at 180, 200, and 240 minutes (2).  The same results were found for blood leucine concentrations.  There was no change in insulin for PULSE, but the insulin was greater for BOLUS at 20, 40, and 60 minutes (2).

The researchers concluded that muscle anabolism was better benefitted by bulk delivery of amino acids post-exercise (2).  The researchers also speculate that more fat and/or more carbohydrates would slow protein absorption (2).

Below is the information gathered from five studies thus far.  The chart includes the dosage, timing, and form of protein for each study.  A few of the studies compared different types of proteins or different ways of administering the proteins.  I did not include conclusions from the studies in this chart; however, I will be getting to those in the next few weeks.

	Protein Supplement Study Protocols
Number	Dosage	Timing	Form	Study
1	1.5g/kg	daily for 14 days	Whey or Carbohydrate	Cooke et al, 2010
2	20g	pre- or post-exercise	Whey	Tipton et al, 2007
3	237g	1 hr post workout	FF milk
	237g		Whole milk	Elliot et al, 2006
	393g		FF milk isocaloric with whole milk
4	3.5g	during exercise	leucine
	1.87g		leucine	Pasiakos et al, 2011
5	25g-single	post exercise	Whey	West et al, 2011
	25g-pulsed

1.  Pasiakos, Stefan M.; McClung, Holly L.; McChung, James P.; Margolis, Lee M.; Anderson, Nancy E.; Coutier, Gregory L.; Pikosky, Matthew A.; Rood, Jennifer C.; Fielding, Roger A.;  Young, Andrew J.  Leucine-enriched essential amino acid supplementation during moderate steady state exercise enhances postexercise muscle protein synthesis.  The American Journal of Clinical Nutrition  2011; 94: 809-818

2.  West, Daniel WD; Burd, Nicholas A.; Coffey, Vernon G; Baker, Steven K; Burke, Louise M; Hawley, John A; Moore, Daniel R; Stellingwerff, Trent; Phillips, Stuart M.  Rapid aminoacidemia enhances myofibrillar protein synthesis and anabolic intramuscular signaling responses after resistance exercise.  American Journal of Clinical Nutrition  2011; 94: 795-803

More about protein...

In last week’s discussion, the Cooke study was used to demonstrate how whey protein supplements enhance performance.  The Cooke study states that protein supplements providing “exogenous amino acids, especially within the first 4 hours after resistance exercise (as implemented in the study), increases protein synthesis, decreases protein breakdown, and produces a positive protein balance, thus providing an environment for muscle growth” (Cooke et al, 2010).  This week, the search was for studies that supported the use of milk-based protein, such as whey, for muscular anabolism. 

Tipton et al set up a study to examine the response of muscle protein balance when subjects consume whey proteins either before or after resistance exercise (Tipton et al, 2007).  There were both male and female subjects; seventeen total.  None of the subjects had done regular resistance training for at least five years prior to the study, and all were young and healthy (Tipton et al, 2007).  The volunteers were randomly assigned to two groups:  Group A consumed a 300-ml solution of 20g whey proteins before exercise (PRE); Group B consumed the same amount of whey protein post exercise (POST) (Tipton et al, 2007).  There was no placebo group.  Each group conducted ten sets of eight leg extension exercises. 

The researchers sampled the subjects before protein ingestion and four hours after to measure the amino acid uptake.  The researchers found that the timing of the protein ingestion had no effect; however, it was the combination of the free amino acids and carbohydrates that did have an effect on the measurements (Tipton et al, 2007).  Phenylalanine concentrations increased immediately after ingesting whey protein for both PRE and POST groups, but there was no significant difference between the PRE and the POST groups (Tipton et al, 2007).

Elliot et al set out to discover if whole foods would have an effect on muscular anabolism.  Again, the twenty-four subjects had not participated in regular resistance training in at least five years prior to the study (Elliot et al, 2006).  The subjects were randomly assigned to three groups:  1)  237g fat free milk (FM), 2) 237g whole milk (WM), and 3) 393g fat-free milk isocaloric with the whole milk (IM).  There was no placebo group.  Each group ingested their protein one hour after leg exercises, and researchers measured amino acid balance across the leg to determine net muscle protein balance (Elliot et al, 2006).  The groups were tested just before exercise and 55 minutes post-exercise; as well as, immediately prior to consuming their drink (Elliot et al, 2006).

The researchers discovered that the amino acid uptake was higher for the WM group (Elliot et al, 2006).  The threonine exchange was present in all three groups; this was measured in arterial concentrations.  The phenylalanine in muscular concentrations was present in all three groups; this was measured via biopsy of the muscular tissue (Elliot et al, 2006).  The researchers concluded that the milk ingestion stimulates phenylalanine and threonine net uptake and promotes muscular anabolism.

Both the Elliot and Tipton studies determined free amino acid concentration via GCMS and used muscle biopsies to analyze for intracellular amino acid concentrations.  All three studies used non-athletes as their subjects.  All three studies demonstrate that it is best to combine the carbohydrate with the amino acid source to stimulate net muscle protein synthesis and muscle growth, which is why the whey protein and whole milk are useful to athletic performance.

Cooke, Matthew; Rybalka, Emma; Stathis, Christos; Cribb, Paul; Hayes, Alan. Whey protein isolate attenuates strength decline after eccentrically-induced muscle damage in healthy individuals.  Journal of the International Society of Sports Nutrition 2010; 7:30

Elliot, Tabatha A; Cree, Melanie G; Sanford, Arthur P; Wolfe, Robert R.; Tipton, Kevin D.  Milk Ingestion Stimulates Net Muscle Protein Synthesis Following Resistance Exercise.  Medicine and Science in Sports and Exercise  2002; 38: 667-674

Tipton, Kevin D; Elliot, Tabatha A.; Cree, Melanie G; Aarsland, Asle A; Sanford, Arthur P; Wolfe, Robert R.  Stimulation of net muscle protein synthesis by whey protein ingestion before and after exercise.  American Journal of Physiology-Endocrinology and Metabolism  2007; 292: E71-E76

Protein Supplements as an Ergogentic Aid: Do They Really Work?

An ergogenetic aid is “any training technique, mechanical device, nutritional practice, pharmacological method, or psychological technique that can improve exercise performance capacity and/or enhance training adaptations” (Kreider et al, 2010).  Protein supplements are an ergogentic aid that have been heavily advertised to the general public and athletes as a great way to build muscle and enhance abilities.  However, there are three important questions to ask when evaluating these supplements:  1)  Is the theory plausible?  In other words, can protein supplements enhance performance and reduce muscle breakdown?  2) Is there scientific evidence to support the theory?  3)  Is the supplement safe and legal?  (Kreider et al, 2010)   

Most sources agree that an athlete should strive to get adequate protein from whole foods before turning to a supplemental form.  However, protein supplements may be a more convenient way for the athlete to consume his or her protein requirements, especially for vegetarian athletes (Dunford & Doyle, 2012).  A high-quality protein supplement is considered safe and effective at the recommended doses (Dunford & Doyle, 2012).

It has been found that whey, casein, or soy supplements are effective for the maintenance, repair, and synthesis of skeletal muscle proteins and can enhance maintenance and net gains in skeletal muscle (ADA, 2009).   Cooke et al conducted a study on whey protein isolate and found that adding whey protein supplements to their subjects’ diets increased isometric strength in the knees of those subjects (Cooke et al, 2010).   This study took seventeen untrained males and randomly selected them into two categories:  whey protein and carbohydrate.  The subjects were given 1.5g/kgbw/d for 14 days.   The study was run with a 95% confidence interval.  The subjects were tested with the leg press, leg extension, leg flexion, and checked for muscle damage (Cooke et al, 2010). 

The Cooke study supports the theory that a high-quality protein supplement enhances performance for athletes when additional protein is needed.  Athletes commonly go above the RDA of 0.8g/kgbw for protein, and endurance and ultra-endurance athletes should consume more protein due to an increase in protein oxidation (ADA, 2009).   Protein supplements providing “exogenous amino acids, especially within the first 4 hours after resistance exercise (as implemented in the [Cooke] study), increases protein synthesis, decreases protein breakdown, and produces a positive protein balance, thus providing an environment for muscle growth” (Cooke et al, 2010).  It is the use of a high-quality protein with appropriate amino acids that aids in the rebuilding, repairing, and endurance of the muscle.

While protein supplements may be beneficial to strength and muscle repair, it is still important to look for quality sources.  The best sources of protein supplements are casein, whey, mild and egg proteins, and colostrum (Kreider et al, 2010).  When choosing a protein supplement, it is also important to consider the amino acids in the supplement for maximum benefits and health (Dunford & Doyle, 2012).  It is also important to use a high-quality protein as was used in the Cooke study.  It is also important to remember that although protein supplements are considered safe and effective, they may not be necessary for the general public but are beneficial to the strength and endurance athlete.

ADA (2009)  Nutrition and Athletic Performance.  Journal of American Dietetic Association 2009; 109:509-527.

Cooke, Matthew; Rybalka, Emma; Stathis, Christos; Cribb, Paul; Hayes, Alan (2010)  Whey protein isolate attenuates strength decline after eccentrically-induced muscle damage in healthy individuals.  Journal of the International Society of Sports Nutrition 2101, 7:30

Dunford, Marie & Doyle, J. Andrew (2012)  Nutrition for Sport and Exercise, 2^nd ed.  Wadsworth Cengage Learning:  California

Kreider, Richard B.; Wilborn, Colin D.; Taylor, Lem; Campbell, Bill; Almada, Anthony; Collins, Rick; Cooke, Matthew; Earnest, Conrad; Greenwood, Mike; Kalman, Douglas; Kerksick, Chad; Kleiner, Susan; Leutholtz, Brian; Lopez, Hector; Lowrey, Lonnie; Mendel, Ron; Smith, Abbie; Spano, Marie; Wildman, Robert; Willoughby, Darryn; Ziegenfuss, Tim; Anfonio, Jose (2010).  ISSN exercise and sport nutrition review:  research and recommendations.  Journal of the International Society of Sports Nutrition 2010, 7:7

Fetal alcohol syndrome

Fetal alcohol syndrome is caused when alcohol consumed by the mother crosses the placental barrier into the fetus.  This causes the fetus’s blood alcohol levels to rise approximately to the level of the mother’s; however, some babies of mothers who drink are born normal (Nadakavukaren, 2011).   Health care professionals are not sure why this happens, but they do know there is a direct link between drinking alcohol while pregnant and fetal alcohol syndrome.  As fetal alcohol syndrome affects 1-3 out of every 1000 pregnancies, it is the top known leading cause of intellectual disabilities (Nadakavukaren, 2011). 

Diagnostic criteria have remained fairly broad and include selected facial malformations, central nervous system abnormalities, and mental retardation (CDC, 2004).  A fourth diagnostic criterion is the mother’s alcohol consumption during pregnancy.  As these criteria may differ from child to child in severity, it is sometimes difficult for the health care provider to diagnose fetal alcohol syndrome.  Also, some of the criteria may have other causes; for example, ADHD may be triggered by a food allergy or short stature may be genetic.  Diagnosis will remain difficult until there is a standard set of criteria for fetal alcohol syndrome.

Fetal alcohol syndrome is different from other birth defects in that it is directly related to the alcohol consumed by the mother during pregnancy.  No level of alcohol is deemed safe for women who are planning a pregnancy or who are already pregnant as any level of alcohol can cause fetal alcohol syndrome to one degree or another (Nadakavukaren, 2011).  In 1989, labels on alcoholic beverages began listing a warning to pregnant women.  Even though the dangers are known, approximately one in eight women admit to drinking during pregnancy, which means the warnings are not being taken seriously (Nadakavukaren, 2011).

The effects of fetal alcohol syndrome are irreversible; this is a life-long condition.  However, it is avoidable if the mother abstains from alcohol during pregnancy.  Also, the effects will vary in degree and type depending on when the mother is drinking alcohol, and even as little as one drink could cause some degree of fetal alcohol syndrome.  For this reason, it is important that women who may become pregnant abstain from drinking alcohol as well.

A public health official who wishes to reduce the incidences of fetal alcohol syndrome could begin by educating women that even one drink is dangerous.   Many women are under the assumption that one or two drinks will not harm the fetus; however, findings show that any amount of alcohol could be dangerous.  This needs to become common knowledge for women who are pregnant or who may become pregnant, and it needs to be given the same urgency as bug spray or toxic household cleaners. 

There are very few advertisements in print or on television that outline the dangers of alcohol on a developing fetus.  Most of the information is given by health care providers who may not be fully educated on the subject (CDC, 2004).  While these health care providers are becoming more educated as more information on the subject is discovered, there are still many misconceptions about alcohol and pregnancy.  Most pregnant women understand that they are to be out of the house when the exterminator is around or that they should not be changing the kitty litter during the pregnancy, but many of these same women will have a glass of wine with supper without thinking about the risk to the fetus.  Perhaps if there were a more public campaign on the dangers of even one drink while pregnant, fewer pregnant women would drink.

CDC (2004)  Fetal Alcohol Syndrome:  Guidelines for Referral and Diagnosis.  Retrieved on May 9, 2013, from http://www.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf

Nadakavudaren, Anne (2011) Our Global Environment: A Health Perspective, 7^th edition  Waveland Press, Inc:  Illinois

Mercury in Fish

Mercury safety is a topic that floats in and out of the nightly news.  Generally, when there is a need to do a segment on healthy eating, the report will give a brief statement on how seafood is important to health, but that one should be careful to limit the amounts consumed each week.  What is not talked about it how industrialization and evaporation of paints have cased mercury concentrations to increase three-fold in modern times (Nadakavukaren, 2011).  The question then is why we should be concerned about mercury when it is such a footnote in our daily information.

Methylmercury, the type of mercury found in fish, binds to the red blood cells and destroys the cells that control coordination, affecting speech, walking, and other cognitive abilities (Nadakaukaren, 2011).  This property makes methylmercury harmful to the developing brains of fetuses, infants, and young children.  However, the FDA does not recommend avoiding seafood altogether.

There are many benefits to consuming seafood.  Seafood is high in Omega-3 fatty acids, is low in saturated fat, and is a good source of protein, which means seafood is beneficial to heart health (FDA, 2013).  The main con to seafood is it contains mercury to varying degrees.  

The FDA provides a short list of fish to avoid due to high mercury levels.  The NRDC goes more in-depth and divides seafood into four categories:  least mercury, moderate mercury, high mercury, and highest mercury.  Low mercury is less than 0.09 parts per million, moderate mercury is 0.09-0.29 parts per million, high mercury is 0.3-0.49 parts per million, and highest mercury is above 0.5 parts per million (NRDC, n.d.).  Essentially, the older and bigger the fish, the higher the concentration of mercury. 

The FDA recommends no more than 12-oz per week of low-level fish such as shrimp, canned light tuna, salmon, pollock, and catfish (FDA, 2013).  The fish to avoid include shark, swordfish, king mackerel, and tilefish (FDA, 2013).  Since these recommendations are based on 130lb woman, the portion sizes would need to be adjusted for smaller adults and children (NRDC, n.d.).

Grocery stores are beginning to list information on mercury in seafood to educate consumers and to steer consumers toward lower-mercury fish.  Whole Foods, for example, now have signs on their fish counters for each type of fish they sell.  These signs are color-coded for sustainability and risk factors.  The website also lists which seafood to avoid and advises consumers to focus on low-mercury fish or take Omega-3 supplements (Whole Foods, 2013).

There is a great deal of information about methylmercury in seafood and the dangers it poses; however, the consumer must be diligent about educating himself.  The FDA and other sources provide basic guidelines for safety, which, when followed, are helpful.  What is not addressed is how the public can help reduce mercury levels in the environment.  Congress has passed laws and created regulations like the 1995 EPA’s Clean Mercury Rule and the Mercury Export Ban of 2008, but there should be more education on how the average person can reduce mercury levels.  One suggestion would be for the FDA, Whole Foods, NRDC, and other organizations to include this information with the listing of mercury-safe seafood.  Perhaps this kind of awareness would help keep the mercury-safe seafood safe so future generations can enjoy the benefits of seafood.

FDA (2013) What You Need to Know About Mercury in Fish and Shellfish.  Retrieved on May 4, 2013, from www.fda.gov/Food/ResourcesForYou/Consumers/ucm110591.htm

Nadakavukaren, Anne (2011)  Our Global Environment:  A Health Perspective, 7^th edition  Waveland Press, Inc:  Illinois

NRDC (n.d.) Mercury Contamination in Fish.  Retrieved on May 4, 2013, from www.nrdc.org/health/effects/mercury/guide.asp

Whole Foods Market (2013) Methylmercury in Seafood.  Retrieved on May 4, 2013, from www.wholefoodmarket.com/about-our-products/food-safety/methylmercury-seafood

Five Steps to a Healthier You: No More Excuses!

Developing a healthy lifestyle is not easy; however, there are five simple steps that will help you on your way.   Developing a plan a following through with the plan is easy if you just focus on each step.

Step one:  Whatever you focus on gets BIG.  We have a tendency to get stuck in what is wrong instead of how to fix it.  Change your focus; stop focusing on the problem and start focusing on the solution.  Envision your goal in all its glory—smell it, feel it, see it, make it real.          Schedule in positive rewards, keeping them inline with your goals.  Try keeping a goal sheet that breaks down your goal into bite-sized pieces.

Step two:  Think Lifestyle, Not Diet.   A “diet” is temporary; however, “lifestyle” is permanent.  A “diet” is doomed to fail; a “lifestyle” is blessed to succeed.  Be realistic for permanent change and avoid media pitfalls as to how you should look/feel/eat.  A good way to stay focused on reality is to hire a qualified personal trainer.  Sport and Health has many, highly qualified personal trainers on staff.  Members have the ability to take advantage of a free Smart Start; take advantage of this free personalized assessment and goal-creating session.

Be consistent in creating a lifestyle change to find the balance that works for you.  Try enlisting a “partner in crime” to help hold you accountable.   Also, and most importantly, focus on conscious eating.  Turn off the TV.  Turn off the computer.  Put down the book.  Enjoy your meal fully.  You will feel satiated sooner and you will be in a much better mood.

Part of creating a lifestyle change is to create a positive habit.  This takes work.  It takes 30-40 repetitions to form the neurological pathways that create a habit.  These repetitions must be performed properly with no cheating.  Each time you are tempted to cheat, remember that you will be bringing yourself back to square one.

Step three:  Manage Stress and Hydration.  The solution to pollution is dilution.  Make sure you are drinking enough water that you do not feel thirsty and your urine is clear.  You will eat less, feel more alert, and sleep better. 

Get more exercise by adding steps into your day.  This helps release the “happy hormones”:  endorphins, serotonin, and dopamine.  Work strength training into your day, especially women.  This helps build lean mass, which increases metabolism.  It also aids in prevention or maintenance of osteoporosis.  Importantly, strength training reduces cortisol and stress, which means you sleep better.

Work stretching into your routine.  This helps your body and mind reduce stress through breathing.  MELT, meditation, and yoga are three wonderful stress-reduction techniques offered through Sport and Health.  A healthy fascia means a healthy mind.  A healthy mind means better sleep and productivity.

All of these items—hydration, movement, strength training, MELT, meditation, yoga—are meant to balance your hormones, elevate your mood, and improve your sleep.

Step four:  Eat Real Food!  The closer to the source, the better the food.  An apple is better than applesauce, which is better than apple juice.  Learn to say no to processed foods.  Processed foods are full of sodium, hidden sugars, and watered-down nutrients.  A processed food is any food that has been altered from its original state.

Instead, try for 7-9 servings of vegetables and 2-3 servings of a fruit each day.  Not only will you lose weight, but you will also be increasing the nutrients needed to combat depression and the fiber needed to keep regular.  When you are in the grocery store or at the farmer’s market, aim for in-season fruits and vegetables, and opt for a variety of colors to include a variety of phytochemicals for health.

Avoid added sugar.  Americans consume approximately 150-200 pounds of sugar per person each year.  That is approximately 22-28 teaspoons of sugar each day, or 350-400 empty calories each day.  The American Heart Association recommends we consume no more than 9 teaspoons of sugar each day.  That is how much sugar is found in non-processed, natural foods.

Learn to read labels.  Check labels for items like brown sugar, sucrose, sugar, confectioner’s sugar, HFCS, maltodextrin, turbinado sugar, glucose, dextrose, lactose, date sugar, fruit sugar, honey, corn syrup, molasses, caramel, brown rice syrup, maple syrup, maple sugar, dextrin, fructose, or any “-ose”.  We have no control over how much sugar a manufacturer adds to the food.  If we start taking responsibility and eat whole foods, we can regain control of our sugar intake.

Step five:  You Get Out of It What You Put Into It.  If you are willing to put in 100%, you will get 100% out of it.  If you are only willing to put in 80%, you will only get 80% out of it.  If you are only willing to put in 60%, you will only 60% out of it.  If you put 0% into it, you will get 0% out of it. 

How invested are you in change?