Category "Dr. Andrew Cook"

Please tune into your local CBS station to see Dr Cook on Monday, 12-5-16, on The Doctors TV Program. It will air in California at various times, depending on location.  For those unable to watch the program at the airing time, there will be a post airing video available on our website, our Facebook page, and on The Doctors CBS website.  San Francisco Bay Area residents can view on KRON-TV at 2pm, Los Angeles Area can view on KCAL-TV at 11am.

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 disease-producing 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.

Ready to start your healing journey? Request a free virtual consultation today.

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[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.


Cold and flu season is upon us.  In addition to being inside more, we also tend to be under more stress with the New Year upon us.  This is the perfect recipe for catching a cold or flu!  A mounting amount of evidence has shown that stress lowers our immune system.  To help you to stay well this cold and flu season, I have put together a little survival recipe for avoiding the cold and flu.  I have also included some natural remedies for helping to shorten the duration and lessen the severity of a cold or flu if you become sick.  In addition, we have provided a few supplement suggestions to help you prevent or fight a cold or flu.  Feel free to contact us with any questions.  Be well!


  • Vitamin D: Low vitamin D levels have been linked to increasing your susceptibility to colds and other infections. 2,000-5000 IU per day in winter is safe and reasonable.
  • 1-3, 1-6 Beta Glucans: Research has shown that these compounds strengthen the immune system and protect you against viruses and bacteria. These compounds are found in certain types of mushrooms.  They help your white blood cells bind to and kill viruses and bacteria.
  • Probiotics: Whatever your age, research suggests that the preventive use of probiotics can reduce the duration and severity of common colds. Health bacteria is also critical to a healthy immune response and reducing inflammation.
  • Stress reduction:  Practice a stress-reduction technique. Stress weakens our defenses and makes us more susceptible to becoming ill.
  • Exercise:  Get regular exercise. Exercise helps keep the immune system strong; however, don’t overdo your exercise, as this can weaken your immune system.
  • Sleep:  Get plenty of rest. Adequate sleep is necessary for the body to repair, heal, and fight infection (8+ hours nightly).  Interesting side note – a new study from Stanford shows that women need more sleep than men, because we use our brains more with multi-tasking throughout the day. We need additional hours to “recharge” our brains.
  • Diet:  Nourish your body with whole foods and lots of colors (from fruits and vegetables). Stay away from sugar, which can weaken immune cells fighting ability.
  • Hydration:  Use water as preventive medicine. A quick cold rinse after every hot shower is a good way to stimulate immune cell activity. In addition, gargling with plain water a few times per day has been shown to prevent colds.
  • Adequate protein:  Eat protein at every meal.  Protein provides the building blocks for your entire body.  This includes strengthening and repairing your immune system.
  • Attitude:  Laugh a lot!  Laughter can strengthen lower stress and strengthen your immune system.
  • Reduce your exposure to infection:  Wash your hands!!!

When you are sick:

  • Drink plenty of fluids in order to maintain water balance and to thin secretions.
  • Eat raw garlic, which kills bacteria and viruses. Crush a clove or two and add to foods like soups and grains just before serving.
  • Gargling with plain water 3 x’s daily removes mucus and keeps bacteria and viruses from sticking around.
  • A warm, humid environment created by a humidifier may provide some comfort while fighting off a cold.
  • Saline nasal rinses (3-6 x’s daily) (a standard 0.9% saline (sodium chloride) solution with trace elements and minerals in concentrations similar to those in seawater). Neti pots (small pots for nasal rinsing) and mineral salts to use with them are now widely available.  We have a few of these at the office or you can purchase one at a health food store or pharmacy.
  • Try a small amount (a few Tbsp daily) of some raw honey.  It kills bacteria and can soothe irritated mucous membranes. It should not be given to children younger than 12 months old.
  • Eat healthfully.  Opt for fresh fruits and vegetables and whole grains, and lean proteins, as excessive sugar, dietary fat, and alcohol have been reported to impair immune function.  Pass on the OJ – it is very high in sugar.  Look for a lower sugar source of vitamin C such as eating an orange and drinking a glass of water.
  • 8+ hours of sleep nightly.

Helpful Supplements:

  • High Quality Multivitamin:  This is the foundation for a healthy immune system.  It provides all the vitamins and minerals you need for building blocks.
    • Example: Metagenics formulaPhytogenics without Iron
    • Dosage:  Take 1-2 daily with meals
  • 1-3, 1-6 Beta Glucans:
    • Dosage:  250 mg daily
    • Andrographis:  Andrographis contains bitter constituents that have been shown to stimulate the immune system, decrease inflammation, and fight infection.
      • Dosage:  400-2000 mg 3 x’s daily
      • Precautions:
        • Careful with gallbladder disease, autoimmune disease, kidney disease
        • Safety not known with pregnancy
        • Cytochrome P450 1A2, 2C9, 3A4
          Andrographis extract may alter how these drugs are metabolized.
        • Anticoagulants and antiplatelet drugs
          Animal lab studies have demonstrated inhibition of platelet aggregation.  Use caution and talk to your doctor if you are taking anticoagulant or antiplatelet medications.
        • Chemotherapy drugs
          Andrographolide may have antioxidant effects. This may interfere with the actions of some chemotherapy drugs.
        • Blood pressure lowering drugs
          Andrographis may lower your blood pressure.


  • Vitamin C: Studies have shown that taking vitamin C may make your cold shorter and less severe.
    • Dosage:  1-4 g daily
  • Zinc Lozenges: Zinc lozenges used at the first sign of a cold have been shown to help stop the virus and shorten the illness.
    • Dosage: 1 tablet (20-30 mg) every 2 hours for 1st 1-2 days of FIRST SIGN OF cold or flu.
    • Do not take long-term.  May cause a copper deficiency.
  • Probiotic:
    • Dosage 10-200 billlion CFU daily
    • Efficacy of formula varies depending on bacterial strains and delivery system used
  • Vitamin D:
    • 2000-5000 IU daily
    • Best to have levels checked with a goal of 60-80 ng/mL
  • Olive Leaf: antiviral, antibacterial, antiparasitic
    • 1000 mg 4 x’s daily
    • Precautions:
      • Caution with Coumadin
      • Not to be used with pregnancy – safety not known
      • May have a die off reaction – start with lower dose
      • Separate dose 1 hr before or 2 hours after probiotics

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