Is Cortisol Making You Gain Weight? What Your Doctor Isn't Telling You

Dr. Jess Cholesterol is our precursor for our main sex hormones — like progesterone, testosterone, estradiol. But it's also a precursor for cortisol. And in a balanced state we should be getting a response through all of them. In a state where we're needing more cortisol, we can see those pathways are going towards that cortisol response instead. They actually have a term for it called cortisol steal.

MELISSA Health and wellness is confusing. There's a new trend every week. Everyone's got an opinion and half the time you can't tell what's legit and what's just good marketing. And we get it. We're in it too. Welcome to Dialed In Health. I'm Melissa Goodwin. Every episode we bring in the people who actually do this work. Providers, practitioners. The experts who see clients and patients every day. We ask the questions you'd ask if you were sitting across from them, so you can find the right people, make better decisions, and feel confident about what's out there. Whether it's peptides, gut health, water quality, ADHD, biohacking, or something you've never heard of. We're covering it. So let's get into it. Let's get dialed in.

MELISSA What if I told you the reason you can't lose weight has nothing to do with your diet and everything to do with the hormone that most people don't even know is working against you. Today, I'm sitting down with Dr. Jessica Pearson, a physician and Air Force veteran, a CrossFit coach — I mean, what don't you do? The list goes on and on. The woman that her colleagues called the hippie doctor because her patients kept getting better and didn't need surgery. So I'm so glad to have you on the show here today. Welcome, Dr. Jess.

Dr. Jess Thank you. Ready to be here.

MELISSA Great to have you here. So tell us a little about you've got a great story. Tell us a little bit about how you went from the military to now owning Prairie Roots.

Dr. Jess Yeah. So I signed a military contract while I was in medical school, called the HPSP, and went to residency after med school. And then following that is when I did my Air Force commitment. So I owed four years to the military for that scholarship. I loved it. Initially I was working in San Antonio, Texas, at Brooke Army Medical Center — a huge hospital, bigger than Stanford. I was running ten labor rooms at a time with residents. There were 24 residents that I helped be in charge of, and I was operating, doing all the things. Loved it. It was great. It was chaos and I thrived in that environment. And then COVID happened and COVID just kind of changed things — changed the atmosphere of the hospital, changed how I viewed medicine. I just wasn't happy there anymore. So when my military commitment was up in 2022, I started to look for other jobs and just couldn't get myself to sign a hospital contract. I dabbled for a while — I'd pick up relief shifts over weekends and run labor and delivery. I didn't mind that, it helped me keep my skills up. But ultimately I transitioned into the functional med world because that fits more my personal lifestyle. I tend to be a minimalist and love to be in nature, so I wanted something that fit my lifestyle more, and that's how I found functional medicine.

MELISSA So tell me, how did you earn the hippie doctor title, and how was that bestowed upon you?

Dr. Jess It kind of started in the military. There's a program called ABLM, American Board of Lifestyle Medicine, and the Air Force was actually starting to get interested in it. So they were releasing coursework that we could do for free. I started doing some of those webinars and short courses, really enjoyed it, and started applying some of it to my patients — like, oh, let's try some lifestyle things. I had a couple patients who were scheduled for surgery who really didn't want surgery, and their menstrual cycles improved. We canceled their surgeries. A couple of my colleagues had patients scheduled for surgery who didn't want it, so they'd be like, hey, do you want this patient? I'm going to keep operating. So they started pushing those patients more towards me, so they could take the more surgical ones. I love to operate. It's really fun. But I also found it so much more rewarding to be able to use nature and lifestyle to allow the body to self-heal.

MELISSA So tell us a little bit about your own story — you mentioned you have a story about how you started noticing the hormone cortisol and what it can do to your body. How did you start to pay attention to cortisol as one of the root causes of some of our disease?

Dr. Jess Yeah, I can touch on my personal story a little bit, because it's part of what made me the most passionate about it — I've lived it too. Around the time that I was leaving the military, there were some other big life changes going on for me. I had lost my grandmother, which was really hard for me. I was leaving the Air Force, which had been my secure job for four years, and I was heading out on the road with my now ex-husband in an RV. At the time, I thought I was doing really well because I was training for a half Ironman. I was doing CrossFit probably six days a week. I was very physically active, fueling myself, and getting really good sleep, so I thought I was doing all the right things. But my cycle started changing and I was fatigued all the time, and I couldn't really figure out what was wrong with me. So I did a Dutch test — I was getting into the functional medicine side of things — and found that my cortisol levels were through the roof and my hormone levels were essentially depleted, in the post-menopausal range.

Dr. Jess So I actually visited with Cheryl, who's now my business partner, because I knew she was doing functional medicine. She told me to calm down my fitness training and take it easy with my intensity. And I said no. I eventually caved and took about a week off and did basically just walking and yoga and felt a significant improvement. So that's what started my journey into: okay, the rest and recovery thing is really important, and your cortisol levels really play a major role on how your body functions.

MELISSA For those of us — and I can't say that I'm anywhere near the athlete that you are — but for those of us that were trained as athletes, it's like, you go hard, you train, whatever it takes. Trying to settle down, or even realize, hey, settle down — but trying to find a way to calm down, or have a workout where it feels like yoga, if it feels like this doesn't feel like a workout, this doesn't feel like relaxing, it's almost stress-inducing. How did you get over that?

Dr. Jess Patience and repetition. The first couple times I went, I knew it was good for me. I knew I needed to learn how to calm my nervous system down. So the first couple times it was just forcing myself through it. And then over time you start to enjoy it. You start to actually feel your nervous system calm down. You feel restored and refreshed and energized afterwards. That feeling is what made me keep going. But you have to get over the hump first, you have to train yourself.

MELISSA Do you like yoga now?

Dr. Jess I do. I don't do it as much as I should.

MELISSA So what is cortisol, and why do we need to care about cortisol?

Dr. Jess Cortisol is our stress hormone. It's released from our adrenal glands, which are little glands that live above your kidneys. It's the hormone that's produced in response to our environment. I actually heard a really interesting quote the other day that I feel is very fitting for cortisol: the same boiling water softens a potato and hardens an egg. That's cortisol. Cortisol can be very helpful — it can help you react to a stressful environment. But if it's too much, it can also be harmful.

MELISSA So how do we know if it's helping us or if it's hurting us?

Dr. Jess Based on your symptoms. We can start to see the effects of cortisol if it's chronic. Whether it's physical or emotional stress, you can start to have symptoms of brain fog, mood swings, weight gain, just overall fatigue — that wired-but-tired feeling. You typically know because you just don't feel yourself.

MELISSA Are there different symptoms in men and women, or are they the same?

Dr. Jess They can be similar, but because women have cycles, they tend to see the changes a little bit more because it's affecting their cycles too.

MELISSA How does cortisol interact with other hormones?

Dr. Jess Ooh, this is my favorite. This is where I like to explain HRV first, because it helps you paint a better picture of what's happening with your cortisol. HRV stands for heart rate variability, and it's the variation in your heart rate as you breathe. It's an indirect measure of well-being because it determines what your nervous system is doing. If you sit and feel your pulse and take some deep breaths — on a big inhale, you're going to feel your heart rate go up a little bit; on an exhale, you're going to feel it go down. The inhale activates your sympathetic, or fight-or-flight, response. The exhale activates the parasympathetic, or rest-and-digest, response. In a balanced state, breathing, heart rate, and nervous system are in balance.

Dr. Jess When your body's overstimulated — I hate saying "stressed" because it's relative — you tend to live on an inhale. This can be positive or negative. I think of things like, I forgot my grocery list when I get to the grocery store — crap. So I've taken that big breath in, and now I'm holding it. Or slamming your brakes in traffic. We have these moments where we take big deep breaths in and then we stay there, and many times we don't actually let that breath all the way back out. That inhale is activating the sympathetic mode. Then a lot of times we live in it longer than we should. That's now sending a signal to your adrenal glands to release cortisol. We're meant to have spurts of that throughout the day to react to our environment, but we're also supposed to come back down into the parasympathetic state.

Dr. Jess So when we're in that chronic fight-or-flight state and have that chronic demand for cortisol, it starts to turn into like an annoying fire alarm. If you think of an annoying fire alarm going off, everybody's going to come out and be like, oh my gosh, make it stop. Your body's starting to feel the same thing. Cortisol is going off in your body, and even though you don't necessarily think about it mentally all the time, your body is feeling it. That can manifest as inflammation — releasing inflammatory markers to put out little fires. And that inflammation can manifest as headaches, joint aches, gut issues, cycle issues, things like that. Metabolically, this is the one people complain about the most: it triggers your liver to make more glucose. It needs fuel. So now you have sugar in your bloodstream, which creates an insulin response. Insulin is a growth hormone that makes you store fat. Most of our insulin receptors are around our midline — this is where that stubborn belly fat can come in. It's not always a nutritional thing or an exercise thing. It could be a cortisol thing.

Dr. Jess From a sex hormone standpoint, this is where the steroidogenesis chart comes in. Cholesterol is our precursor for our main sex hormones — progesterone, testosterone, estradiol — but it's also a precursor for cortisol. In a balanced state we should be getting a response through all of them. In a state where we're needing more cortisol, those pathways are going towards that cortisol response instead. They have a term for it called cortisol steal.

MELISSA You mentioned heart rate variability — I'm really interested in this. So we're kind of constantly living on an inhale?

Dr. Jess Yeah. People will notice it. Sometimes you're just thinking — and you're holding your breath. This is where devices like the Oura Ring come in. I have an Oura right now. Devices like Oura, WHOOP, Garmin, Apple Watch all track HRV. Higher HRV shows that you have good variation in heart rate, good adaptability with your nervous system. Low HRV shows poor adaptability, which usually indicates you're living on a breath hold. Looking at my own Oura data — even as much as I know about all of this — I still surprise myself. The days I'm in the office doing business work, which is hard for me and something I haven't been trained to do, those are my highest stress days. Not because I'm actually stressed, just because I'm thinking a lot.

MELISSA So heart rate variability is more about your nervous system than your heart?

Dr. Jess The devices are using your heart rate to show how it changes. You can actually train HRV by doing certain breathwork — and exercise too, because you want to be able to have your heart rate go up but also come back down. These devices look for how high your heart rate goes and how well you bring it back down. If we're not bringing it back down, you're not going to have a lot of variability. If you're living on inhales throughout the day, holding your breath because of stress or pain, you're not letting the air back out, you're just living up on an inhale. That's why low HRV is indicative of a high stress state.

MELISSA Quick break. This episode is brought to you by Vitality Growth Labs. If you're a health or wellness practice and you're wondering why your phone isn't ringing the way it should be, Vitality Growth Labs builds the systems to fix that. Get found, build trust, fill your calendar with authority-stacking videos that connect with your clients. Real tools, strategy, and execution that results in real revenue. Visit VitalityGrowthLabs.com or check the provider directory at VitalityGrowthLabs.com/the-directory to find a trusted wellness provider near you. All right, back to the show.

MELISSA So your patients wear those devices — tell us about that process.

Dr. Jess We don't have any special partnership. It's a device I've used myself, so I know how to look at the data. I find it has a lot of value. The Oura tracks sleep, HRV, and your readiness score. A lot of people don't really know what that means — they just look at the dashboard. I like them to wear it so we can dive into the data and look at trends over time. An important thing: never compare your HRV value to somebody else's, or even to a previous version of yours. You're looking at your trends. That's what matters. If your HRV is 35 and your partner's is in the 90s, that doesn't mean they're doing better than you. Look at how it goes up and how it comes back down, and where your trends live.

MELISSA Tell me about what you eat and drink — caffeine, fasting. I've heard women should never do hour restriction. I've also heard you should fast. People have been fasting for hundreds of years. How does that affect cortisol?

Dr. Jess That's a really good question. It's one of the more frustrating things people face, because there's so much information out there. You have to know where you're at baseline. I have another chart I like — it shows your arousal meter. How many things can you take on before you're capped out? Certain things in our day-to-day can increase that stimulation meter that we may not recognize. So let's say you get up at 4 a.m. every morning to do intense CrossFit. Then you drink 200mg of caffeine. Then you're go-go-go all day. Then you get home and stay on your computer finishing up work until 11 p.m. Each one of those things on its own is probably okay. But when you've stacked all of those up, your stress meter is up to here and it's never really coming back down — and now you're not even getting the sleep recovery you need. That's when it's a problem.

MELISSA You need a little light on the ring that glows when you've hit your limit — go for a walk, go pet your dog.

Dr. Jess It does tell you, to an extent. There's a stress chart I really like. The Oura tracks at five-minute intervals throughout the day. You can see four categories: stressed, engaged, relaxed, restored. You can spend time in the stress zone — that's okay. But you also need time in the restored zone. When your stress zone outweighs your restored zone, that's when it's a problem.

MELISSA I hate the restored zone. I have to figure out a way to get there. It's hard for me. You mentioned some patients don't know when they're stressed — I feel like I'm that. I get to a point where I literally lose it or I get sick. Those are the two things. And then I'm like, yeah, I guess I was kind of stressed out. How do you help people recognize their limit?

Dr. Jess The Oura data is really good for that. People like us almost need that feedback — something on paper to be like, hey, this is actually affecting you. It's been really impactful for me. There are days I'm like, I don't need it, I'll take it off. I'll take it off for a week and I'm like, I don't feel great, I'll put it back on. We're go-getters, high achievers, we want to constantly do all the things. Sometimes we just need that reminder on paper. Some people are better at recognizing it clinically. I've met those people and I'm like, how do you know? I tend to live in my head a little bit more — we all do now, with our screens and everything digital. We're probably not as connected to ourselves and the ground we're standing on.

MELISSA So tell me — caffeine, good or bad? I'm the one who pings the top and then I'm like, okay, I've almost died, I've got to go back to green tea. I hate green tea. How does caffeine affect cortisol?

Dr. Jess There are different forms of caffeine depending on milligrams and where it's coming from. In general, as much as I hate to say it, coffee is probably not the best, for multiple reasons. It can be hard on the gut. It's acidic — so if you have stomach ulcers or acid issues, probably not great. If you have bladder issues, probably not great. And it depends on where you are with that whole stimulation meter. I usually have people try caffeine-free for a minimum of two weeks. Not everybody is super caffeine sensitive — some people are fast metabolizers of caffeine. The caveat is, even if you have the gene to be a fast metabolizer, if your liver isn't functioning at its best, it doesn't detox as well. So you can be genetically a fast metabolizer and still, in a stressed moment, not metabolize it as quickly as your body is capable of.

MELISSA Tell me — how do you test for cortisol?

Dr. Jess You can test it in blood, urine, or saliva. The best way is to get a diurnal sample, where you get multiple points throughout the day so you can see the pattern. We want to see cortisol peak about two hours after waking, then make its way back down before bedtime, and be low overnight. A one-point-in-time blood test, which a lot of people end up getting — that doesn't mean anything to me, because it was one moment, and I have no idea what you were doing throughout the day. Urine testing is okay. The Dutch Complete tests it in four different time frames, but your morning test is an accumulation of cortisol from overnight. The most accurate way is saliva, because you're getting your cortisol level in that moment. So for somebody really struggling with cortisol issues, I'll do salivary. A lot of times I just do urine because it's easy, and you can do it with the hormone testing on the Dutch.

MELISSA What we always hear with stress is: you should breathe, meditate, sleep better. Most of us don't do those things. How do you treat cortisol?

Dr. Jess There are a lot of approaches. When I'm trying to get people started, I list things to reduce or avoid. If you already have a lot of internal stimulation, you don't need external stimulus. Common ones: caffeine, sugar, children — children, for sleep — which ties to alcohol too. Alcohol is one of the biggest contributors to low HRV, not necessarily because of alcohol directly, but because of how it affects sleep. Closer to bedtime is worse than daytime. Pain, chronic pain, excessive worry. Make a list of the things you find stimulating, whether good or bad, and see where we can make adjustments. The other big thing is to activate your parasympathetic response.

Dr. Jess We have a nerve called the vagus nerve that activates the parasympathetic nervous system. It runs through inner and outer ears, vocal cords, and diaphragm. So you can target those areas. With inner ears, sound therapy — I'm a huge fan. People will find that certain frequencies they respond to better than others, whether it's music. Sound bowls are typically at frequencies that most people find calming. There's also a cool video where a guy puts salt on a metal table and rubs it with rubber mallets to create sound, and the salt makes patterns as the energy changes. We're 70% salt water, so it makes sense we respond to sound frequencies.

MELISSA Last question on cortisol — you treat a lot of women in perimenopause and menopause. How do you know if it's perimenopause, menopause, cortisol, or other things going on?

Dr. Jess There's not really a stepwise approach. This is why I like to do my long visits. I'll spend 90 minutes in the initial visit nitpicking everything in their past history along with their current lifestyle habits. Then we go through and start chipping away at easy targets. Sometimes it's a combination — maybe they are in perimenopause, and there's nothing you can do to stop that, it's just part of nature. But there are ways to balance it. Hormone replacement therapy can be really helpful to create balance, so you don't have that added stress of things fluctuating nonstop while you're also dealing with kids and work.

MELISSA All right, I have a few true-or-false statements. Stress is a mindset.

Dr. Jess Not necessarily, because it can be physical too. Stress is your reaction to your environment.

MELISSA Can you change your stress response?

Dr. Jess I believe you can. Yes. This is where training comes in — learning how to activate your parasympathetic response. You've probably seen people where something crazy happens and one person really reacts and the other one's very calm. So you can certainly adapt.

MELISSA If you want to lose weight, you just need calories in, calories out, exercise more.

Dr. Jess It's so complex. Weight management is so much more complex than that. And it's individualized for sure.

MELISSA Coffee is fine — it boosts your metabolism. I've also read coffee helps protect against cancer.

Dr. Jess There's some research calling out coffee for longevity. So in moderation. Because it's a stimulant, it can help with weight management — it stimulates you and sometimes suppresses appetite. There are multiple layers. If you already have too many stimulants and you add coffee on top, now it's detrimental.

MELISSA You need hormone replacement as soon as perimenopause symptoms start.

Dr. Jess No. Not everybody needs hormone replacement. Some people can go through that transition with no issues. Genetics play a role. What I typically tell my patients: let's try the lifestyle things first and see how you respond. If we're still not getting symptom relief, then let's consider hormone replacement.

MELISSA Wearables are expensive toys.

Dr. Jess I guess in a way you could consider it a toy — for me it's like a toy because I'm a nerd and I like that option. But it's a great tool, a great resource, especially for people who have a hard time recognizing when they're stressed.

MELISSA You have to meditate an hour a day to lower cortisol.

Dr. Jess It's helpful. I try. It's hard, I'm not perfect at it. I admire people who can do it daily.

MELISSA Cortisol supplements are a scam.

Dr. Jess It depends. You could argue that with a lot of things. Ashwagandha is a great calming adaptogen that works for many people, but it doesn't work for everybody. There may be some out there that have the same ingredients as another supplement, but they change the dosage just a tiny bit and upcharge it. That's probably a scam. Definitely don't buy anything on Amazon. If you're buying supplements, it's worth going directly through a reputable company.

MELISSA This has been a great conversation. I appreciate it — I feel like I know a lot more about cortisol now. For anyone out there that wants to find you, how do they find you and any of your partners at Prairie Roots?

Dr. Jess We have a website — prairierootshealth.com. We're on Instagram and Facebook. We don't have a TikTok account or anything. Working on creating a YouTube channel so we can do some educational stuff. You can Google us for our phone number, or email us at hello@prairierootshealth.com.

MELISSA You can find Prairie Roots Health on the link in the show notes below. I'll also link to their social media accounts on Instagram and Facebook. Thank you, Dr. Jess, for being on the show today. I know you helped a lot of people by sharing this information. If you're curious and you don't know what your cortisol is doing, get in touch with Prairie Roots Health.

Dr. Jess Thanks for having me.

MELISSA Hey, that's our show. If someone came to mind while you were listening, please share it with them. Just hit the share button and send it their way. You never know what one conversation, one episode, or one piece of information can do for someone who's been looking for answers. And if you haven't subscribed yet, please do it now. It takes two seconds, it's free, and you won't miss an episode. If you're a health or wellness provider and you want to be on the show, there's a link in the show notes. One last thing — I get asked all the time about products and brands I actually use, so I put together a list of sponsors and favorite products. That link is in the show notes too. Thank you for being here. I really mean that. I'm Melissa Goodwin. The line is open. See you next time.