Dr. Angela Knapp is a naturopathic physician who works extensively with children. She talks about increasing rates of autoimmunity in children, and causative factors – factors we can and cannot control. Listen for ideas on:
- Infections and autoimmunity
- Molecular mimicry
- Increasing rates of autoimmunity
- Risk for children with Autism / Down Syndrome
- How do gluten and dairy impact autoimmunity
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Disclaimer: The information in this Podcast is for educational purposes only. Vaishnavi Sarathy, Ph.D. is an educator, not a doctor, specifically not your child’s doctor. Please consult your physician before implementing any supplement or diet recommendations.
Audio Transcription:
Vaish:
Welcome back to functional nutrition and learning for kids. I’m your host Vaish and I make it my job to research exciting news, whether that be in functional medicine, functional nutrition, conventional medicine, or learning strategies for your kids with disabilities. Today I’m so excited to have as my guest Dr. Angela Knapp. Dr. Knapp that’s KNAPP is a naturopathic physician. Her medical practices have focused on pediatric special needs with an emphasis on biomedical causation.
She has been privileged to work with many children with Down syndrome, pandas, autism, and ADHD. Dr. Knapp is also the creator of the pans and pandas with the expert’s Facebook Live series. She has lectured throughout the US to medical professionals and parents alike. She is passionate about working with children and is the proud mother of three children. Welcome, Dr. Knapp. I’m so happy to have you here.
Dr. Angela Knapp:
Thanks so much. I’m so happy to be here with you. I’m excited to be on the podcast. I just was listening yesterday to your interview with Dr. Wakita Handy. And that was helpful. So thank you.
Vaish:
Yeah, that was a great interview. She’s awesome. We’re here actually to talk about molecular mimicry, which is today’s special topic. I was wondering if you just wanted to jump in and tell us what is molecular mimicry and how does it relate to autoimmunity?
Dr. Angela Knapp:
Sure, absolutely. I think molecular mimicry is really, really fascinating. And my interest stems from the concept of biomimicry, which is much broader. That sort of applies more to in nature where we like in broad nature, animals and, and even now, inventions by using nature as a means of mimicking it in order to optimize, let’s say defense mechanisms in the natural world or in our human world inventions, right? So like they’ll grow but molecular mimicry is a natural process on a much, much smaller scale, where we have two molecules that sort of mimic one another. And there are many ways that people use the term molecular mimicry now, so one example would be from the linea vine, a toxin known as a cougar.
It was used on Arrow tips, right to shoot enemies. And that toxin would then paralyze people and how that works is a form of molecular mimicry because that naturally occurring toxin career looks a lot like acetylcholine. Acetylcholine is responsible for a lot of muscle, muscular contractions, many biochemical aspects of what’s going on in the body, and career will come in and attached to the acetylcholine esterase enzyme inhibiting acetylcholine from getting in there. And then that inhibits the enzyme function leading to paralysis. So that’s one concept. And that sort of leads to how we use molecular mimicry in the world of farms.
Pharmaceutical pharmaceuticals. So for example, progestin is a synthetic version of progesterone. And it mimics progesterone, but it doesn’t work exactly the same because it’s not exactly the same molecule. It’s almost the same. But our focus today comes from a scientist named Damien’s definition. And he originated the term in the 60s, really, with the understanding that pathogens can come into the human body. And they mimic self-right, they mimic our own tissues or different parts of our body as a way of hiding from the immune system. And a lot of his research was actually on worms. But what we see in the world of bacteria and viruses is that when they come in and mimic themselves as a means of hiding from the immune system, we really end up with this altered immune function leading to autoimmunity. So I’m really really simple terms.
In our body, in our biochemistry, we have keys and locks and the key has to fit into the lock to work. So with molecular mimicry, we have something like for example, the streptococcus bacteria that comes into the body. And the key part the part that fits in the door is exactly the same or almost exactly the same. But you know, it might be one that might be oval as compared to square on the end of the keys, so they’re not exactly the same all throughout, but they’re close enough that they can both fit into that keyhole just as well. And strap has been a long-known pathogen that causes autoimmune sequelae. Like rheumatic heart disease, sudden hams Korea, which is a movement disorder from the strep infection, and more recently pans and pandas.
Vaish:
So does that make sense to sort of ask you for a little bit more of a of a detailing on especially strapped back on anything. So if I understand this correctly, so the body recognizes strap as a pathogen. However, as it mounts and anti-body responds to strep, there’s also some proteins in the body that looked like stroke, is that correct?
Dr. Angela Knapp:
Exactly. So with rheumatic heart disease, it is cardiac tissue, and in pans and pandas, it’s tissue in the basal ganglia, where they’re not exactly the same, but they’re similar enough, and this is different than the enzyme concept. Because what happens is our immune system recognizes that strap. It says, Oh, hey, that’s a foreigner, I’m gonna make my immune cells, my T cells to attack it. And then those T cells start seeing the basal ganglia tissue and going, wait, this is fine.
Let’s attack this, instead of protecting ourselves. So it’s these T cells, there’s this concept of tolerance, where our body should be able to detect what is self and protect it, and what is foreign and attack it. But with auto-immune reactions and molecular mimicry. In particular, there’s a way that these T cells, bypass tolerance, and then start attacking self. And this is where we get into autoimmune destruction of our tissue and those elevated antibody levels. So pardon me, if you’re looking at it. Yeah, if you’re looking at thyroid, then there are certain markers, thyroid peroxidase, antibodies, thyroid globulin antibodies, that you would see elevated because the body’s actually attacking the self and no longer just the triggering event.
Vaish:
That is a great explanation. And you brought in the concept of tolerance. Which would you say explains why not everybody that gets trapped has an autoimmune reaction, like or has pandas-like symptoms? Is that is that where the bio-individuality comes in? Where there’s like tolerance is exceeded or not exceeded?
Dr. Angela Knapp:
Well, I certainly think that’s one part of it. I think genetics plays a big, big role as well. Epigenetics has become quite an issue of attention as well. And then, you know, what we’re exposed to in our environment is going to affect how our immune function is. So I think the more we add different triggers to our body that are going to shift our immune function, the more likely we are going to be to see a change in our tolerance. So yes, I do think tolerance is a big part, but I think there are a lot of key factors that influence tolerance.
Vaish:
Right. And we’re, we’re in a world where there’s probably way more invisible triggers than they used to be 50 years ago. So as a trigger or as a model of autoimmunity. It is generally accepted that molecular mimicry is the primary causative factor for autoimmunity. Are there other models? And is this just a theory or is it?
Dr. Angela Knapp:
I think that’s really going to vary The answer to that is going to vary based on who you talk to. But molecular mimicry has certainly been proven and around for a long time, like I said, with bacteria, like streptococcus as well as Cambogia tonight, but there are many, many mechanisms of autoimmunity at least 10 the actual way that molecular mimicry plays out is still being investigated. So it’s, it’s certainly been proven, but what exactly is happening is a little bit unclear.
Vaish:
That makes sense. And, and I we can expect that there’s going to be more and more detailed models of autoimmunity as we go on. I mean, there’s literally hundreds, at least 100 autoimmune disorders present and I was just reading recently that it is the largest category of diseases that fall under chronic diseases, disorders and most chronic disorders are related to autoimmunity. So, is this is it your experience in your practice that autoimmunity is increasing at a pretty fast rate in the general population?
Dr. Angela Knapp:
Absolutely. And as you know, I do a lot of talking with and working with people with autoimmune encephalitis. and if we talk about the different bacterias and the different forms of encephalitis, I mean, that alone can be a dozen types of autoimmune disease and then the instance or the commonality of autoimmune disease in young children is certainly becoming more and more widespread. Yeah, I mean, I think that the number is about 5% of the world has an autoimmune disease.
Wow, that is steadily climbing. And the statistics are sort of hard to come by because there are multiple diseases. But we also know the autoimmune disease is highly underdiagnosed and most people go to multiple doctors before they get answers. So I feel very strongly that it’s a big number and continues to rise rapidly. Absolutely. Yes.
Vaish:
It’s also very misunderstood in the general population. And there is a huge gap in how information is disseminated from their PCPs about autoimmunity, and about the definitely about the causes of autoimmunity that you were talking about.
Dr. Angela Knapp:
Absolutely. I would say the causative aspect of autoimmunity is not expressed to patients. Most of the time, they have no idea that there’s some underlying thing, they just that there could have been a triggering event. Certainly, patients have no concept of the fact that it could have related to an underlying virus or bacteria.
Vaish:
Yes. So bringing that back to a further root cause. Can we talk about the role of nutrition digestion in this area, especially because there’s been a lot of talk? And I actually want to do a podcast about molecular mimicry as it relates to gluten at some point? What is what’s the role of how does digestion relates to this concept of either molecular mimicry or autoimmunity?
Dr. Angela Knapp:
There are so many directions I could go right now. And I really do feel like food is a major part of our destiny in terms of our health. Right, there are so many ways that food is going to affect our body, we know that our microbiome is playing a massive role in our health and our immune function and that the food we eat is integral to populating our microbiome with a healthy population of microbes. So that’s just one little tiny aspect of it. But I have a whole slew of things before I jump into it.
I just want to talk about that gliadin molecule because it’s also postulated that casein is another one that casein is a protein from dairy. And that is another one that’s postulated to pass through our gastrointestinal tract, and confuse our body. casing and gliadin alike have been looked at for Hashimoto’s thyroiditis, which is a thyroid autoimmune condition.
When we take antibiotics that shift our gut microbiome, our gut microbiome is going to shift the nutrients that are available, the mucilaginous layer that’s coding our gut, it’s going to manage whether we have good or bad bacteria is going to affect how we’re able to absorb the nutrients in our gut. And that’s going to also affect the number of things in our immune system, we need to look at the digestive enzyme cascade.
So are we chewing our food? Because what are we smelling our food because that starts our digestive enzyme cascade, and then that digestive enzyme cascade, right? That’s going to tell our, our liver, or our gallbladder to release bile is what we call a surfactant.
It has so many functions, but one of its functions is like a soap along our intestinal lining to keep flushing through the bacteria along our digestive gastrointestinal tract in order to help maintain a healthy microbiome because we don’t want foreign microbes or unhealthy microbes or potentially pathogenic microbes growing in such a great population.
So that’s why our bio is really important, especially to break down fat as well. And then, like I was talking about earlier, that mucilaginous coding along our gastrointestinal tract is going to keep that tissue nice and supple and healthy. And keep those gap junctions which are the tight junctions.
These are the little spaces between the cells in our intestinal epithelium or the wall of our intestine. It prevents proteins that are in broken down enough from passing through into our body and causing that confusion of attacking that foreign protein and then getting confused and saying wait, that thyroid is the same as that protein.
Let me attack them books from what our gut is responsible for a lot of how our immune system is functioning right, are we absorbing the nutrients that are going to support the reduction of our immune cells and the flow of our lymph. So the god plays many roles besides just that leaky gut picture, it’s also really responsible for a great deal of our immune function, there are more, there’s more communication going from our gut to our brain than our brain to our gut.
All of that relates to how our immune system is communicating and how our body is able to recognize foreign invaders and break them down. So if we have a really unhealthy digestive tract, we’re much more prone to a lot of inflammation and inflammation that is not controlled is a major risk factor for autoimmune disease.
Vaish:
In terms of the population that we are working in, are you Is there any research or even just observation, it doesn’t have to research, any correlations between a child having a diagnosis of either autism or Down syndrome and a higher risk for autoimmunity,
Dr. Angela Knapp:
Every child is unique, we do know that children with autism tend to have a significant family history of autoimmune disease, and that alone is going to increase risk for autoimmune disease in anyone. Then 38% of mothers with auto or 38% of children with auto with autism have a mother who has an autoimmune disease. So that is also a big risk factor. And then when we talk about Down syndrome, we know that many people with Down syndrome have a dysregulation of the immune system because the thymus, which is a little gland, that’s above the heart between the lungs and is responsible for the production of T cells, or the maturation of T cells, that thymus is shifted in the way that it functions and the central part, the neuro modularity cortex tends to have fewer lymphocytes than you would see in a typical sinus.
So that is going to affect the immune function as well. And you know, that also plays a role in why people with Down syndrome tend to have less solid tumors, because of the shift in our immune function. But it does increase the risk of autoimmune disease in many people with Down syndrome.
I’ll say I mean, I see quite a few children with Down syndrome, and probably around 70% either have Hashimoto’s, and graves disease, or alopecia, which is alopecia areata, which is arguably autoimmune. Or also, I see quite a bit of celiac disease. That being said, I always think about the fact that my patients with down syndrome, many of them have early life circumstances where they’re either dealing with surgery in a hospital setting on many medications, and that alters our physiology and how we respond to things and our gut microbiome. And I think that’s a huge factor too, not necessarily the chromosome.
Vaish:
The biggest risk, our triggering factor is always stress. Right? Exactly. Yeah, exactly. So if we were to bring this down to three action items to reduce the risk of autoimmunity or if you don’t even know whether your child has an autoimmune disorder, just to increase the overall health of the immune system, what would be three things that you could a parent could do at home right now.
Dr. Angela Knapp:
Okay, so I broke this down into attention prevention and reinvention. Oh, the reinvention piece is once the autoimmune disease has taken root, but attention is let’s look at family history. Is our child at risk? Because there’s another autoimmune disease. Let’s look at genetics looking at immunization schedules. So I don’t want to talk about whether immunizations are good or bad to each his own. But what we have found or what research has shown, is that immunizations can shift the immune response and predispose people to different autoimmune diseases.
So there’s research on HPV immunization and increased autoimmune disease. And there’s also research on other immunizations and autoimmune diseases. So that doesn’t mean immunizations are bad. immunizations are miraculous. But we really need to look at the schedule where children are receiving their immunizations and our own child’s immune function before jumping in to route the standard schedule. And then finally, the environment.
Right. What is the environment that our child’s grow up in? Do you have a woodstove right air pollution has been linked to epigenetic changes can increase the set of susceptibility to autoimmune disease, obviously water, we know that there have been major issues with things like lead in water prevention is hygiene, right? So we are living in such a busy world, I struggle as a mama with, oh well, my kids in three dance classes and soccer and the data and data.
Really, we need to be very careful about not stressing out our children, because stress, as you said earlier is a major risk factor and a common trigger for illness and autoimmune disease. And along with that, go sleep, we really need to make sure that our children are sleeping effectively. And then our diet, obviously, and I think that is a really, really difficult piece of the puzzle, make sure that they’re getting the minerals and vitamins and those fatty acids in our foods that are sort of less present just because of the way our environment as well.
Vaish:
So I was just saying that it’s not as straightforward as it sounds to just even get your vitamins, minerals, and essential fatty acids from the food it sounds like it would just eat regular food and that would happen but it doesn’t normally always happen. Right?
Dr. Angela Knapp:
I wish I wish it did or eat you know. Okay, so then I’ll jump into reinvention recent research on multiple sclerosis has shown that HLA which is human leukocyte antigen and as implicated in MS can be shifted by epigenetic mechanisms. Taking looking at your life today and saying, Okay, well, I’m going to make every change I can to be healthy, I’m going to work on my sleep, work on my food, work on my exercise, sweating, making sure the amongst trees are working. So we’re talking about deep belly breathing, being mindful, sweating, and elimination. So urination and bowel movements should be regular.
These are all major factors that are going to shift your body’s ability to cope with the stressors that it’s dealing with and potentially shift those antibodies that it’s producing. So we can optimize our biochemistry with functional medicine tests, and look at where we need the most support. And then, you know, there are many immunomodulatory herbs, like Nigella sativa, which is black human, we have such amazing research coming out on mushrooms like Reishi, and should talkie.
There’s great research on cats’ claws. So working with a naturopath or functional medicine, nutritionist or functional medicine doctor can make a huge difference in how you’re handling your autoimmune disease and taking control of your life or your child’s life so that they have the best opportunity and health to move forward.
Vaish:
As we wrap up. Thanks for everything that you’ve shared. But is there anything that you would like to share about your practice.
Dr. Angela Knapp:
I am really focused on being present with my parents, I think one of my greatest skills, besides my knowledge, is that I tend to really be able to develop relationships. And so when I’m working with my patients, not only am I taking into consideration the children that I’m trying to bring health to or support family in bringing health to that child, but also making it reasonable for the entire family. Because stress is a major factor for everyone. And when you have a chronically ill child, it’s a huge stress stressor on the caretaker, and I really do work very hard to take that into account.
Vaish:
That’s fantastic. Thanks so much for sharing. This was like a, you know, a mini super thorough course on autoimmunity ml and molecular mimicry. And thanks for being with us. And I look forward to talking to you more about this topic in a different podcast later.
Dr. Angela Knapp:
I would love that I really appreciate being on and I should have said if anyone would like to reach out to me or access my information. You can find me at DrAngelaKnapp.com. I’m Dr. Angela Knapp on Instagram and Facebook and YouTube.
Vaish:
So not too bad is spelled Knapp correct.
Dr. Angela Knapp:
Yeah. Thank you. Thanks so much. I really appreciate being on I had a good time.
Vaish:
What a jam-packed episode. Thank you all so much for tuning into functional nutrition and learning for kids. Going forward. I will be meeting you every Friday so not Thursday, but I will see you next Friday. Signing off. I’m your host Vaish and today’s music was by Maitri Gosh bye!
