Category "Danielle Cook"

Are you sometimes so bloated that you feel like you are pregnant? Or even had people ask you if you are pregnant? Do you have an extra set of clothes set aside for those times when you are so bloated that it’s time for a wardrobe switch? Maybe you are like Samantha, a woman just trying to deal with this painfully inconvenient, embarrassing physical disruption, along with all of the other frustrating and painful effects of Endometriosis.

We met Samantha in a forum recently, and she agreed to share her story and photo. She says: “I now only go out to doctors/hospitals or dentist as I cannot cope with people thinking and staring at me thinking I am pregnant. Every doctor blames the bloating on something else, but no one has investigated or tried to do anything about it. I would be so grateful for any help, as I feel totally alone.”

The severe bloating that goes hand-in-hand with endometriosis is too often dismissed by doctors as a minor symptom. For the patient, however, this symptom can be emotionally and physically devastating.

Endo Belly is also an example of the wide array of symptoms endometriosis patients experience and one of the very common misunderstandings about this disease. Physicians, patients, and even endometriosis specialists often misunderstand the root cause of many “endo symptoms”.  Are they always a result of endo, or could there be other causes?

Good progress has been made on increasing awareness of endometriosis and optimal treatment. Proper surgical treatment of endometriosis requires wide excision of the endometriotic implants rather than just burning or cautery. Surgery that simply burns the surface of the implants leaving underlying disease behind is often associated with either continued symptoms or recurrence of symptoms soon after surgery.

This is not the full story, however, and to truly understand this condition, we need to raise awareness of the missing pieces in the puzzle. In my 25 years of practice specializing in endometriosis, I have come to appreciate the complexity of the pattern of symptoms many of my patients deal with. While approximately half of my patients are primarily affected by endometriosis, which is effectively resolved by excision surgery, the other half have other conditions or health problems that co-exist with their endometriosis. In this latter group of patients, while excision surgery provides the foundation of their treatment, complete resolution of their symptoms requires that we address additional health problems, including multi-systemic dysfunction. In these patients, it is a mistake to automatically assume that continued symptoms after surgery are due to persistent or recurrent endometriosis. The real problem may well extend beyond this diagnosis and often encapsulates other often-related health conditions that may masquerade or be overshadowed by the initial diagnosis of endometriosis.

“Endo Belly” can be the result of endometriosis implants and may get better after surgical removal of the disease. Endometriosis implants, however,
are not the only cause of “Endo Belly”.

One such example is the infamous “Endo Belly”. While “Endo Belly” can be the result of endometriotic implants, and may resolve after complete excision of all endometriosis, this is certainly not always the case and other health problems can also cause or contribute to those all-too-familiar flares of extreme bloating and distention. At our center, we therefore approach endometriosis and its associated health problems from a multi-disciplinary paradigm including traditional medicine (e.g., excision surgery), as well as a variety of integrative and holistic modalities.

Our approach is based upon the most recent scientific information. We treat the whole patient, not simply surgical removal of the endometriosis implants. One example of this is the role of the bowel, including the human microbiome (the bacteria that live in our bowel), in causing pelvic pain and other health problems. We will discuss below the importance of gut bacteria as a contributing causal factor in bloating and “Endo Belly”. This is a very brief overview and covers just a few of the important facts about the critical impact of our intestinal health on our overall health.

Best wishes,

Dr. Andrew Cook

Gut Bacteria & Endo Belly ~
Why You Look & Feel So Bloated

What does your gut bacteria have to do with that annoying bloating and gastrointestinal discomfort? A lot!

We have more bacteria living in our guts than we do human cells in our body. We have a balance of beneficial (commensal) bacteria and potentially pathogenic bacteria (disease causing unfriendly bacteria). This is actually one of the most complex ecosystems in nature. It is important to maintain a healthy balance of bacteria in the gut.

These beneficial bacteria are not simply along for the ride, but rather, they play a critical role in our health. For example, they are involved in digesting food that we eat, producing vitamins such as vitamin K2 and biotin, converting thyroid hormone into its active form, detoxification, reducing inflammation, reducing pathogenic forms of bacteria, and energy production. These are only a few of their important jobs! We also have yeasts and viruses in our guts. It’s important to keep a healthy balance of these microorganisms in our guts too.

Gastrointestinal problems can be a result of bacterial problems in the small and/or large bowel. Most of the bacteria are in the large bowel. A little is in the small bowel, but not nearly as much as in the large bowel. Dysbiosis is a condition where an imbalance in beneficial and potentially disease producing pathogenic bacteria occur in the bowel. SIBO (Small Bowel Intestinal Overgrowth) is a condition where the bacteria from the large bowel migrate up into the small bowel. With SIBO, the over abundance of bacteria in the wrong location is exposed to undigested food, which it eats and turns into a large amount of gas (bloating, pain, indigestion).

Factors that may negatively alter the sensitive bacterial balance lead to dysbiosis or SIBO and include:

  • Antibiotics (with certain antibiotics it can take up to 2 years to regain a healthy microbial balance in your gut)
  • Chronic stress
  • Non-steroidal anti-inflammatories (NSAIDS)
  • Constipation
  • Standard American Diet (SAD diet – high in unhealthy fats, processed carbohydrates, and sugar and low in fiber and vegetables)
  • Food allergies and Sensitivities
  • A weakened immune system
  • Intestinal infections (such as yeast overgrowth) and parasites
  • Inflammation
  • Poor function or removal of the ileocecal valve (valve between the small and large intestine)

There are several common symptoms of dysbiosis and SIBO. You may be experiencing several of them. They include :

  • Bloating, belching, burning, flatulence after eating
  • A sense of fullness after eating
  • Indigestion, diarrhea, constipation
  • Systemic reactions after eating (such as headaches and joint pain)
  • Nausea or diarrhea after taking supplements (especially multivitamins and B vitamins)
  • Weak or cracked finger nails
  • Dilated capillaries in the cheeks and nose (in a non-alcoholic)
  • Iron deficiency
  • Chronic intestinal infections, parasites, yeast, unfriendly bacteria
  • Undigested food in stools
  • Greasy stools
  • Skin that bruises easily
  • Fatigue
  • Amenorrhea (absence of menstruation)
  • Chronic vaginitis (vaginal irritation)
  • Pelvic pain

Dysbiosis is not uncommon in women with endo. Endometriosis-associated intestinal inflammation may alter the balance of gut microflora.[i] Balley and Coe investigated the intestinal microflora in female rhesu monkeys and found an increased amount of intestinal inflammation and fewer aerobic lactobacilli and gram negative bacteria in monkeys with endometriosis compared to those without the disease. A disruption in the gut microflora (dysbiosis) can have negative health consequences including poor digestion, malabsorption of nutrients, increased inflammation, and increased gastrointestinal infections.[ii] Intestinal microflora act as a barrier to gut pathogens by blocking attachment to the gut-binding site and produce antibacterial substances.

Problems with an overgrowth of bacteria in the small bowel can also result in the common gastrointestinal complaints among women with endometriosis. Recent studies have demonstrated the presence of Small Intestinal Bacterial Overgrowth (SIBO) in women with endometriosis.

In one study, 40 out of 50 women with laparoscopic confirmed endometriosis were found to have SIBO. [iii] SIBO needs to be considered as a contributing factor anytime a woman has severe bloating.

The gut also plays an important role in estrogen elimination. Phase II detoxification in the liver (medical term for the process of eliminating many hormones including estrogen) utilizes conjugation of estrogen to other compounds so they can be excreted in bile.[iv] If the gut flora is unbalanced, certain bacteria secrete an enzyme called beta-glucuronidase, which cleaves the glucuronide molecule from estrogen, allowing estrogen to be reabsorbed into circulation vs excreted in the stool. Lactobacillus, a healthy bacteria, decreases the activity of B-glucoronidase.[v] If the activity of B-glucoronidase is increased, more estrogen will be reabsorbed and potentially worsen the endometriosis.

Do you have any of these symptoms? If you do, they may be caused by more than your endo inflammation. If you have these symptoms after good quality endometriosis excisional surgery, your endometriosis is gone, but your symptoms may be a result of other conditions such as the ones discussed above. Some tests that may be performed include a hydrogen/methane breath test, a comprehensive stool study through a lab such as Genova Diagnostics, organic acid testing, and food sensitivity testing. There may also be therapeutic diets that can be helpful for symptom management such as the Specific Carbohydrate diet, the FODMAP diet, the Microbiome Diet, and the Autoimmune Paleo Diet. There is no one size fits all treatment for dysbiosis. Some diets that help with dysbiosis can make SIBO worse. A qualified practitioner can help to determine what studies and treatment may be helpful.  Some of the lab tests which may be relevant are included in our Specialized Lab Testing at Vital Health Endometriosis Center.

You may be interested in this video : Enterome: the gut microbiome and it’s impact on our health:

Wishing you a happy and healthy day,

The Vital Health Team


Vital Health Endometriosis Center continues to provide the most comprehensive approach to the diagnosis and treatment of endometriosis.

Visit Our Resource Center to Learn More About Endometriosis

Read & Share What it Really Means to Have Endometriosis


[i]. Balley M, Coe C. Endometriosis is associated with an altered profile of intestinal microflora in female rhesus monkeys. Human Reproduction. 2002;17(7):1704-1708.

[ii]. Miniello V, et al. Gut microbiota biomodulators, when the stork comes by the scalpel. Clin Chim Acta. 2015. Web. Accessed February 25, 2015.

[iii]. Mathias JR, Franklin R, Quast DC, et al. Relation of endometriosis and neuromuscular disease of gastrointestinal tract: new insights. Fertil Steril. 1998; 70:81-88.

[iv]. Evans, J. An integrative approach to fibroids, endometriosis, and breast cancer prevention. Integrative Medicine. 2008; 7(5):28-31.

[v]. Goldin BR, Gorbach SL. The effect of milk and lactobacillus feeding on human intestinal bacterial enzyme activity. Amer J Clin Nutr. 1984;39(5):756-61.


The Endo Patient’s Survival Guide, co-authored by Dr. Andrew Cook, Libby Hopton and Danielle Cook, is the essential patient’s companion to living with and overcoming endometriosis and pelvic pain: from seeking help and getting an initial diagnosis to navigating treatment options and achieving optimal relief and wellness.

The guide is now printed and available for order on

Endo Guide cover FINAL1


Studies have linked endometriosis to poor detoxification.  This may be partly due to genetic defects in detoxification pathways such as MTHFR, COMT, SOD1, SOD2, GSTM1, and various CVT genes. If there is a mutation in any of these genes, detoxification suffers, toxins build up in the system, and detoxification gets backed up even further. If your “toxic load” (amount of toxins you are exposed to) is high, the result is gene expression as illness.

One common gene mutation is the MTHFR or methyl tetrahydrofolate reductase gene. This gene is responsible for a process called methylation. Methylation is a biomolecular, nutritional pathway that is critical to many functions in the body. For example, methylation is responsible for cellular repair (production and repair of DNA and RNA), detoxification, making and disassembling neurotransmitters (example, dopamine, and serotonin), and formation and maturation of red and white blood cells and platelets.

Related health problems from a defect in MTHFR include autism, addictions, miscarriages, infertility, depression, anxiety, psychiatric disorders, multiple chemical sensitivities, fibromyalgia, Parkinson’s disease, irritable bowel syndrome, strokes, migraines, breast cancer, heart disease, Alzheimer’s disease, Multiple sclerosis, and others.

In addition, a defect in MTHFR will decrease the amount of glutathione your body produces.  Glutathione is a potent antioxidant (protects against cellular damage) and a critical player in cellular detoxification. This significantly lowers your body’s ability to protect itself against toxins and remove unwanted waste materials. Furthermore, methylation is a critical step in the process of removing old estrogen from the body. If this process is not working at optimal function, estrogen can build up and increase endometrial growth.

So what can you do for your endometriosis and lessen the toxicity in your body?

First, you can be tested for a mutation in MTHFR as well as other genetic defects.  There are several options for testing, and Vital Health Endometriosis Center can guide you with appropriate testing.  Second, you can decrease your toxic load and increase your body’s ability to detoxify.

You can do this by taking the following steps:

Decrease your exposure to xenoestrogens (Bisphenol (BPA), phthalates, polychlorinated biphenyl (PCB), some pesticides, some herbicides, triclosan, and polyvinyl chloride (PVC)).  Xenoestrogens are man-made compounds that mimic the action of estrogen in the body.  In addition to behaving like estrogen, they have a much stronger action and increase estrogen dominance. You can do this by making the following dietary, consumer and lifestyle changes:

  • Eat organic produce, dairy (or eliminate), and meats
  • Use natural pest control in your home and garden
  • Avoid synthetic flea shampoos, flea collars, and flea pesticides on your pets
  • Avoid shampoos and beauty products with parabens, phenoxyethanol, and phthalates (go to and use their “Skin Deep Guide” to find non-toxic products)
  • Avoid nail polish
  • Avoid DEHA cling wrap
  • Never heat food in plastic containers in the microwave or put hot foods into plastic containers (better yet, use Pyrex containers)
  • Avoid Teflon and non-stick cookware
  • Avoid plastic water bottles
  • Avoid consuming foods from tin cans (they are lined with BPA)
  • Avoid drinking from Styrofoam cups or containers
  • Use natural cleaners
  • Avoid BHA and BHT in processed foods
  • Avoid FD&C Red No. 3 in processed foods
  • Limit coffee and other caffeinated beverages
  • Drink clean, filtered water
  • Avoid marijuana.
  • Eat organic, whole, REAL food
  • Clean with Natural cleaning products
  • Sweat often – sauna, yoga, Epsom salt baths
  • Exercise – increases glutathione (but do not over-exercise – you should feel energized when you complete your workout)
  • Avoid exposure to mold and other toxins
  • Do stress reduction daily – for example, do 5 minutes of deep
  • Eat the rainbow daily
  • Eat from the onion family such as onion and garlic
  • Eat cruciferous vegetables such as kale, chard, broccoli, cauliflower, and dandelion greens
  • Drink half your body weight in clean, filtered water
  • Increase your fiber intake

Those of you who suffer with endometriosis, we’d love to get your feedback. Have you lightened the “toxic load” on your body? What effect did it have on your endometriosis? Please share your story for the benefit of others.

Further reading

What is nutragenomic medicine?
What is nutritional counseling?

In 1908 Dr. Eli Metchnikoff was awarded the Nobel Prize for his work on friendly bacterial flora. He coined the term “Death begins in the gut”. His research described an imbalance of the bacteria, or microbiota, in the gut. We have literally trillions of bacteria that reside in our bodies. Our digestive tract has more bacteria than cells. Normally we relate bacteria to illness; however, some of the bacteria in our gut are essential to our good health. When we have an imbalance of bacteria in our gut it is known as dysbiosis. Dr. Metchnikoff believed that this dysbiosis in the gut was the root cause of many diseases.

In the last 100 years, many new microbes have been discovered, and we are continually learning more and more about how this delicate balance of microbiota in our
gut impacts our health. For example, some of the more pathogenic microbes in the gut release poisons such as ammonia and phenols that damage the cellular lining of the gut. In addition to the damage they do in the intestines, these poisons can also be absorbed into the bloodstream causing systemic inflammation, organ damage, and a multitude of health problems.

Most people attribute the gut’s role in our health to simply digesting food, absorbing nutrients, and excreting waste products from our bodies. However, the gut is responsible for much, much more.

Most people attribute the gut’s role in our health to simply digesting food, absorbing nutrients, and excreting waste products from our bodies. However, the gut is responsible for much, much more. For example, the majority of the body’s immune system is found in the gut. It is our front line defense system to protect us from danger from the outside world. In fact, the gut is actually outside of our bodies, not inside. When we damage or disrupt the balance of the microbiota in our gut and damage the intestinal lining, we damage the front line of our personal defense system. The gut becomes “leaky” and allows undigested proteins from food, toxins, bacteria, fungus, viruses, etc. to enter into our bloodstream. The result is disease such as Irritable Bowel Syndrome, Ankylosing Spondylitis, Rheumatoid Arthritis, Inflammatory Bowel Disease, Multiple Sclerosis, Chronic Fatigue, Eczema, food allergies, cirrhosis, and many more. Some common symptoms of poor gut health include acne, ADD/Autism, aggressive behavior, arthritis, asthma, food sensitivities and allergies, belching/bloating, blurred vision, cardiovascular disease and symptoms, cystitis, dental caries, depression, brain fog/confusion, diaper rash, weight gain or difficulty losing weight, fungus (toe, finger, vaginal, intestinal, mouth), inflammation, fibromyalgia, fatigue, anal itching, heartburn, and more! Do you have any of these symptoms?

You are probably wondering how this could happen. It really is not that hard to push yourself out of balance in 2011. Some common causes of dysbiosis include repeated use of antibiotics, use of antacids and proton pump inhibitors, a high fat, high sugar, low fiber diet, foreign travel, contaminated foods and water (chlorine, pesticides, antibiotics, etc.), and chronic stress. Do you think you may be out of balance and would like to be back in balance?

At Vital Health Endometriosis Center, I take an integrative medicine approach (treating the source of the health complaint versus the symptom to restore optimal health) to healing a person’s body. I almost always start with the gut. I use an approach known as the “5 R program” (Remove, Replace, Reinoculate, Repair, Rebalance). I use foods, specific vitamins, and herbs, and stress reduction to help repair the gut, re-establish a healthy balance of microbiota, and restore optimal health to our clients. I am looking forward to helping you achieve a healthy gut and a healthy body!

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