Can Alzheimer’s Be Reversed? A Doctor’s Groundbreaking Approach: Dr. Chip Teel

Today I have with me a colleague in medicine, Dr. Allan - also called Chip - Teel, and he has many interesting things to say about how we keep our brains healthy in this day and age. Thank you for coming in, having a conversation with me today, Dr. Teel. Dr. Allan "Chip" Thanks for the invitation. You and I had the opportunity to intersect probably a few decades ago now when I was early on in my medical school education. And you've practiced in the Damariscotta area for 30 years? Dr. Allan "Chip" Yeah, closer to 35 now. Okay. Dr. Allan "Chip" So that's a long time to be a family doctor doing this sort of work. What inspired you to get into this type of specialty? Dr. Allan "Chip" Well, I always knew I wanted to practice in a small community, and I was fortunate to find one that also had a nice small hospital so I could do a combination of all of the things that I had trained in. I went to a really find training program in Pennsylvania that allowed me to learn all aspects of medicine and I wanted to continue to use those on a regular basis. And the practice at Miles Hospital and at Damariscotta allowed me to do that. You and I were talking before we started taping about your route to medicine, which was originally through the field of education. So after you went to Exeter and then Dartmouth, you spent some time up in Rangeley and you originally were doing teaching and also in Stonington doing teaching. So how did you find your way back into the medical field from there? Dr. Allan "Chip" Well, it was serendipitous that when I was doing my student teaching at Dartmouth, the rotation that I did was being a student teacher in Compton, California. And the Dartmouth advisor to the program was an OB/GYN who worked at Martin Luther King in Compton in LA and he and I got along very famously and every day after school, he would take me to his clinic or on weekends he would take me to the hospital and introduced me as a Dartmouth medical student, although I don't think I knew your foot from your elbow at that point, but he taught me an awful lot about medicine and he created a spark of interest. So when I was at a career path change in Rangely, after teaching at mostly the elementary school levels around different communities in Maine for a decade, I decided to go back to medical school based on the love of medicine that this gentleman had inspired in me. So it's turned out to be a wonderful profession and I hope to be able to keep doing it for a long time. I'm very, very fortunate to be a family doctor. You also told me that one of the things you've become really interested in, and one of the reasons we actually wanted to have you come in today is that you've been doing a lot of work with patients who have memory issues with cognitive decline and specifically Alzheimer's. And this is something that has brought new, I guess, life into your medical practice. I want to talk about that. Dr. Allan "Chip" Well, in private practice in Lincoln County, Maine, you're in the oldest county per capita in the oldest state per capita in the country. So you can't practice there without thinking geriatrics. And so much of geriatrics was about successful aging, was about trying to figure out how I adjust to the changes in my mind and body as I get older and had a large patient panel for whom those things were very important. So after working with them for some period of time, and I was inspired by a book called The End of Alzheimer's that came out five or six years ago, and it really sounded too good to be true that you could reverse cognitive decline with lifestyle and supplements after prescribing a lot of mainstream medications That made very little difference. So I was interested in this and kind of gradually moved from geriatrics in general to long-term care more precisely and now Alzheimer's in long-term care and in the community. Dr. Allan "Chip" So I've been refining what I'm doing and there's really been an explosion in brain health understanding in the last five or 10 years. There are an awful lot of antibody tests and measurements and volumetric MRIs of the brain that can be gotten. And so part of my interest was I've always liked languages and this was learning a new skill, a new language, and it was keeping my brain alive and it was allowing me to explore things partly on the depth of the experience that I've had over the last 35 or 40 years in medicine, partly because I was community based, partly because it allowed me to be a little bit of a researcher, a little bit of a pioneer in some things. And so those things all gave me a great deal of interests and allowed me to start implementing a program and trying to operationalize something that would change the trajectory of an awful lot of people with Alzheimer's disease in our own community. What are some of the things that you've learned about and what are some of the things that have surprised you regarding brain science? Dr. Allan "Chip" I was introduced to a volumetric MRI. So rather than just getting a one or two sentence narrative that says you don't have a brain tumor and you haven't had a stroke, everything looks pretty normal for your age, was what the kind of narrative report we used to get now with no extra effort, but just by ordering it through a place that has the ability to measure such things. I get a volumetric MRI on every patient, and that volumetric MRI allows me to get percentile measurements of 120 subsections of your brain. And so compared to a, "looks pretty good to me" kind of eyeball, you get 120 percentiles that are age and gender matched. So most people don't order that because it doesn't come with a guide. And so you have to learn an awful lot of neuroanatomy to be able to interpret that for your patients. Dr. Allan "Chip" So now that I've ordered 150 or 200 of those over the last four or five years, I started writing a amateur guide three or four years ago, and now I give that to all of the patients after we have reviewed their findings. And to my surprise, by the elementary research that I was able to do through the online libraries that one can access, I was able to put down some tidbits of interests from each of these subsections of the brain. And then with those I could convey to patients why they couldn't remember my name or why they couldn't recognize somebody's face at the post office or why they were bumping off cars in the parking lot or why they were having difficulty with a lot of hormonal things because of atrophy of their hypothalamus or dealing with the short and long-term memory implications of what your hippocampus is or how afraid or brave you were based on what was going on in your amygdala. Dr. Allan "Chip" So it kind of became a very fascinating way to start to describe for people in everyday layman's terms what their strengths and weaknesses were. And every single person has had a very different MRI with different strengths and weaknesses. And so it's ideal family medicine fodder because you are able to say, here are your strengths, here are your weaknesses. This is why you've always had trouble putting together things that were under the Christmas tree for your kids because that was a part of the brain and the visual spatial world that maybe you never were really good at. Oh yeah, I never was or something like that. So that was a big surprise. The other thing was the brain active antigens and antibodies that can be measured when you remember how we were inundated with trying to understand the COVID-19 testing. Now, if you amplify that by every antibody and antigen that is of some bearing in the brain, there is also a lab company that does a protein array of 60 autoantibodies that you might have mounted against a number of things related to your blood brain barrier related to the role of inflammation, autoimmunity, infection, a demyelination on brain processes. Dr. Allan "Chip" So again, by delving into this and trying to find out what could be measured and then having enough patients who were willing to let me test them and try to understand what those things meant for them, we started to develop a pretty interesting protocol on how you can come in, tell me what you're noticing, do some cognitive tests that we have all gotten familiar with from MoCAs to mini mental status exams to other subjective questionnaires, and then try to do an extensive array of lab and imaging. And then with these things, try to formulate a plan. And a lot of the plan is based on the research of a number of neurologists in different parts of the country or different parts of the world about everyday things that people can do related to diet and exercise and supplements and reduction in stress and doing brain stimulation, games, improving sleep, and all of these things that can have an impact on our cognitive processes. So it's become a vast and complicated project, and I would look forward to anybody else wanting to find out more about it and see what's behind this curtain because I think there's an awful lot that could be done and could be done in relatively short order if we got out of the mindset of everything has to be a magic pill or we have to wait for figuring out the entire biochemistry of the brain and how that can all be reversed with one monoclonal antibody. We have to get beyond thinking that way. There's so many things that as you're talking that are coming up for me, and I think the first one that comes up for me is originally when I was in medical school, the approach to things like Alzheimer's or other neurologic issues was sort of a yes or no. You have it or you don't have it. And it was always based on brain disease versus brain health. And what you're talking about is the fact that the brain is as different amongst people as hair color or eye color or all the variations. So that's part one. Part two is we can actually do something with this information personalized to each individual. And then I think this idea that the neuroplasticity is something we've only just started to understand. Dr. Allan "Chip" It's only something that we've started to hear about regularly. There was Nobel Prize winning work in the sixties and seventies that said that you could grow new brain cells. And then there was work a decade ago that said every day you're giving birth to about a hundred new pluripotent stem cell-like things in your hippocampus, but most of them don't grow up, so you have to optimize their ability to be fertilized and mature to grow new brain cells. So yeah, the neuroplasticity is something that is diametrically opposed to what we were taught in high school and college. And we also have to overcome the fear and the hopelessness that has kind of been with this disease. People have been more afraid of getting Alzheimer's than they were of heart attacks or stroke or cancer for a very long time and still are. So part of the big change is that Alzheimer's is as different as the number of people that have it. Dr. Allan "Chip" And one of the nice things about doing some of these imaging tests is individualizing what your brain strengths and weaknesses are, and then trying to play to those strengths or weaknesses by once you know them and your spouse and family knows those things, then what are the workarounds if nothing else that you can do, knowing that this isn't an all or nothing kind of situation and that your brain print is as different as your fingerprint. And that there are so many different things that you can do with information if you're not afraid of finding out about things and then working with it. And we in allopathic medicine just have so much to learn from things that have been going on for quite some time in integrative medicine or complimentary medicine, and those things are starting to merge. But more importantly, in much of mainstream medicine, there was an awful lot of focus on the role of inflammation and low grade inflammation on these conditions. Dr. Allan "Chip" One of the seminal takeaways from working with Dr. Bredesen's approach to things is that what you see with Alzheimer's right now is the culmination of 20 or 30 years of low grade inflammatory changes that have been taking place in your brain because of unhealthy lifestyle kinds of things. So if you can actually get into those things when you're 50, then the chances of reducing or even eliminating significant numbers of Alzheimer's disease patients is very real. He has a catchy phrase where he says the same way that we should be recommending that everybody have a colonoscopy when they're 50. Everybody should have a cog when they're 50. They should be taking stock of what their family risk, personal risk, and other things are for cognitive decline when they're 70 or 80 and starting to do something about it early on in a preventative fashion. Yeah, I mean that's such an interesting idea because you're absolutely right. We spend a lot of time in family medicine thinking about prevention, and oftentimes it's secondary and tertiary prevention where we're trying to run after something after the horse has already left the barn, but we're running after heart disease or diabetes or some of these other major organ damage related syndromes. You're talking about brain health. I mean, how often do we actually ask that question of our patients? What types of activities are you engaging in that actually may be improving or causing problems with your brain health? I don't know how many of us actually have that conversation with patients. Dr. Allan "Chip" I don't think we have that conversation. And yet the patients in their own way, whether they're getting excited about wordle or other brainstem kinds of things, whether it is Lumosity or whether it is Brain HQ or something like this that you can do online or whether it's doing crossword puzzles or all sorts of things like that, the brain is a muscle and it is a use it or lose it kind of muscle. And if we're not going to continue to stimulate our brain and do different things, it's a great opportunity for prevention. And the preventative program is good for every other disease that we talk about as well. So it's not like you have to do this for your heart and this for your lungs and this for your kidneys and this for your brain. They all kind of amount to the same thing. We have to embrace a healthy lifestyle, and that's what family docs have been trying to learn and disseminate for a very long time. As you and I were talking before we started taping, is this idea that it is in communities that we see people's withdrawal from everyday life, and sometimes it's because they are, maybe there's fear, maybe there's shame. Maybe it's just the sense of loss of their ability to think about things the way they once did or interface with people and the outside world the way they once did. But if we bring the conversation around brain health to the surface and people start having a conversation around, these are the things that I'm noticing that I've lost, but here are some of the things that I'm doing that actually are improving my brain health, maybe we will have less fear around losing our minds. Maybe we'll have more mutual support for one another's aging. Dr. Allan "Chip" One of the things that you mentioned that is was an "aha" moment for me in the last year was on some of these one-on-one conversations, I was finding that the left hand half of your brain is your language center for most people and many different parts work together to accomplish that. But I was finding that many very well-educated and very active minds were becoming more withdrawn. And some of it was an early awareness that they did not have as much confidence to wade into a conversation. And I specifically remember a woman from this area who would still go out with her girlfriends for lunch, but she became a less and less active participant in the conversation because she was afraid that she would get partway through a thought and lose her place. Dr. Allan "Chip" They would all be aware of the word finding difficulty that she was having. So not only was she testing positive for word finding tests, but she had also self muzzled herself because she really did not want to expose things and think that her other friends would think less of her. So there is a permission structure that we have to get past where we need to be continuing to say that, yeah, I might not be able to remember what I had for my example with my dad, he couldn't remember what he did yesterday or what he had for breakfast this morning, but he was still a great conversationalist. You could still have a very nice meeting with him, whomever. It was a new person or an old person in his life. So even though he had significant cognitive impairment, it did not make him any of the less interesting if you didn't get hung up on the things that he couldn't still do the way that he used to. I found the same thing with my father and my father's brain decline was as a result of a brain tumor as a result of his cancer. But he was a family doctor similar to the two of us. Dr. Allan "Chip" I remember him very well. Yes, and pretty much the same thing. He would get together with his fellow doctors and they all happened to, well, actually there was one woman, but the rest of them were truly fellow doctors for lunch. And over time we could actually see him be less and less comfortable. He would withdraw more and more because there was more and more loss around what he was able to contribute to a conversation with his former colleagues in family medicine. But what I found when I sat with him through the final years, final weeks of his life was that he still had amazing things to say and things to share, and we still were able to have great conversations. I just needed to have patience. I just needed to listen more and talk less and interact in the way that worked for him. And he still brought so much of himself to every interaction right up until really the moment that he passed away. Dr. Allan "Chip" And if you were the fly on the wall analyst looking at him after you finished talking with him, he probably had regained an awful lot more spark as well from that conversation. So if we take the currently popular music and memory analogy where people have found that if you put a headset on somebody and have it programmed for the playlists from their heyday in their twenties and thirties, a lot of people who are for all intents and purposes have checked out wake up again. So what would happen if we actually engaged these individuals in real conversation and simulated them by talking to them about things that they participated in? I recently, over the holidays, had a visit with a woman who was a very vibrant active of the member of the community, but now she can't really remember all of the things that she used to be involved in. Dr. Allan "Chip" But I remembered a number of them. And when I brought them up and started talking with her about them, you could see her start to make a few little connections to the things that at the beginning of the conversation she was unable to address. So part of the sadness is that many of us family caregivers, whether we are spouses or adult children, we have very limited conversations with our loved ones who have cognitive decline. And because we limit the conversations, they don't get stimulated. So part of it is on us, how can we do it a little bit differently to kind of help them wake up? And I'm quite sure that if we spent an awful lot more time doing that, it would bring them to life more than you can imagine. I agree with you. And I remember in particular one conversation with my father, and it was probably, I don't know, three or four weeks. Well, it was a little bit longer than that before he passed away, but he handed me his phone and he said, can you put my password in it? And I said, dad, I don't know your password. He couldn't really see very well. He couldn't really remember things very well. He said, well, my password is your birthday. So he remembered that it was my birthday and he couldn't make the connection into his phone so that he could put the numbers in. But he remembered that it was my birthday and it was so touching to me that that was a connection that was so important that he had maintained that to the very last few weeks of his life. And I think about that often when I'm talking with patients and their families that if we can just find the thing that is of importance to them, when I sit with a patient and I don't know them very well, so I'm not going to be able to remember something like, what's the password to the phone and the birthday? But if I can find something, if I can find some connecting point with that patient, then that brings them into the conversation rather than me spending a lot of time talking to their significant other or their caregiver around them, which I've always found so challenging because if a patient comes to see me and all I'm doing is talking to their child, their husband, their wife, their aunt, their uncle, then that's a missed opportunity. I would no rather want to do that than I would ignore a child that I was seeing as a pediatric patient. Just you have to find a way to connect. But it's not always easy, Dr. Allan "Chip" Like many other difficult conversations is that first step, once you do it, it's a lot easier than you thought it was going to be. So when you put your toe in that water and just start to have those conversations, you can connect on so many things. You are always surprised at what you have in common with your patients. And one of the challenges of medicine these days is trying to squeeze every ounce of that office visit for something else and not allowing those human connections to try to drive some of your analysis. I always remember being in a rural part of the state that many people had a garden, and I was not exactly criticized, but questioned at times by some of the spouses because they said he came in to see you and all you talked about was the garden or something like that. Dr. Allan "Chip" But I was in a devious way was asking how many rows he had turned over and how much physical exertion he had done and whether he had any chest pain or shortness of breath while he was doing those things. So I was getting him talking and I was doing different things that had to do with his everyday life that were not only his quality of life, but also his ADLs and how his balance was in the garden and how hard it was on his knees and hips and back. So there were just so many things that you could blend into that if you were just a little bit clever, you didn't have to make that very difficult. That's another thing that you and I talked about before we started taping, and that is the ability to, as a family doctor or any sort of provider who interacts with patients on a longitudinal basis to find ways to be part of that world versus just the medical world where you were a teacher and you said, I also spent time doing electrical work and I learned how to do carpentry. And now you're talking about the gardening piece. And I think that sometimes it's learning the language of others so that you can connect with them that way and meet them there versus I'm the doctor, you are the patient, you come to where I am, we have to go to where they are and we have to sort of live a life that enables us to understand this bigger life. Dr. Allan "Chip" Yeah, we are always trained to take a decent social history, but the social history is way more than how much you're smoking or drinking. It is what do you do every day? And once you start to delve into that a little bit, it really allows you to reach them and also talk about all of the things that you want to talk to them about. Whatever's on your agenda is way easier if you've already got their attention by letting them talk about themselves and you spending a little more time listening rather than talking Chip. I know people who are listening will want to know what they can do for their brain health. And I know we're all familiar with do the crossword puzzle, make sure you go for a walk. And so there are some very basic things that I suspect you can tell all of your patients that are interested in maintaining brain health. What are some of those and what are some things that maybe people haven't even thought of? Dr. Allan "Chip" Well, one of the things that they can do is find a little paperback book called The First Survivors of Alzheimer's, and it is a book written and co-written by seven or eight people who are going down the path of Alzheimer's like their parents when they changed their lives and started following this lifestyle intervention and got their entire life back. And so it's a very poignant and inspiring little book about these seven or eight people. And then the last half of the book is about what specifically they were doing or others could do to try to emulate some of the things. So that's a starting point. Dr. Allan "Chip" But so the first Survivors of Alzheimer's, the other thing is to, I think bring up these topics. We family doctors are reasonably responsive when patients ask you something specifically, would you help me do this or would you help me look into that? Most of us really like to be in a partnership with our patients and when they take the lead, it's even easier. So part of this is to not be quite as afraid of this whole topic and find a practitioner in your area who will start that conversation with you. And I think there's going to be an awful lot more continuing to happen in the next few years. We've had some very fine small successes in our little group. We've had a retired 80-year-old chemistry professor who could no longer remember his date of birth or do single digit addition or subtraction without using his fingers. Dr. Allan "Chip" And six to 12 months later, he was doing highest level Sudoku online from the New York Times, so he wasn't ready to go teach chemistry again, but he was able to play cribbage every night with his wife and do all of the scoring in his head. And that was a huge improvement for the couple. Another individual who was 90 ish and couldn't speak anymore and couldn't get dressed without his spouse, queuing him through every bit of getting dressed in the morning. At the end of six to 12 months on this kind of a program, he was at least dressing himself and speaking in short sentences. He wasn't the person he used to be before. I don't want to mislead anybody to say that this is complete magic, but these were important things that were very important to those couples, to those individuals. And many people have had fewer repetitions of workarounds because they couldn't find the word that they were seeking. So many of these small things make a really big difference in our lives. Well, I've been speaking with Dr. Allan Teel ,Chip, who is not only a family doctor, but also the founder and CEO of Full Circle America, also the co-founder of Elder Care Network, and he is an innovator in independent senior living. It's really been a great pleasure to reconnect with you after at least a decade or so from not chatting, but you're doing great work and I really appreciate your taking the time to come and have a conversation with me about it today. Dr. Allan "Chip" Well, thank you for giving me this opportunity. And this week we are speaking with Dr. Chip Teel. I encourage people who are interested to read the book that he's referenced to maybe look up some of his work in the Midcoast region, start incorporating some of these things into their brain health, because it certainly has made a difference in many people's lives already in the work he's done, and I think it could make a difference in your life. Thank you for joining us.