A registered dietitian addresses calories, protein, fiber and supplements. A trainer works with the dietitian to fuel performance or recover from injury. A health and wellness coach acts as a guide, or “Sherpa,” through the whole process. Every piece is connected. Poor sleep affects eating and training; stress raises cortisol and slows recovery. Clients check in weekly or monthly, by app, phone or Zoom, depending on their needs. Most are in their 40s or their 70s and going through a transition. Others are already active but stuck, which Porges says is just as common. “It's hard to diagnose yourself,” he says. “If they could see it, they would have solved it before.”
GLP-1s: A Powerful Tool, Not the Whole Answer
Porges, who reads research every week and works alongside physicians and dietitians, calls GLP-1 medications such as semaglutide and tirzepatide “extraordinarily powerful.” They quiet hunger and cravings and help people lose weight at a pace that's hard to match otherwise. But he is clear that they are not a complete solution. The biggest risk he sees is behavioral: losing weight quickly also strips away muscle and bone density. “That is a protein and exercise problem,” he says, and sleep matters too. For women in perimenopause and menopause, protecting bone density is the priority. For men in their 40s through 60s, it's keeping muscle. He also warns people on blood pressure medication that doses are tied to body weight. When weight drops fast, medication, water and fiber all need adjusting, under a doctor's guidance. His bottom line: patients should demand this kind of support. “The pilot of this is you.”
Why Muscle Matters After 40
Muscle is far more than strength. It acts like an organ, pulling sugar out of the bloodstream and helping regulate metabolism. That ties it directly to heart health, type 2 diabetes and even brain health over time. Because we lose muscle with every decade after 40, Porges says the fight to keep it is essential. His formula: strength training to build size and strength, followed by enough protein to rebuild. “The exercise is the blueprint,” he explains. Protein is the workers and materials. You need both.
The pilot of this is you. AMI PORGES
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