Podbit · The Peter Attia Drive
Anti-amyloid antibodies clear amyloid not just from brain substrate but also from the walls of small brain arteries. This disrupts vascular integrity, causing fluid leakage (ARIA-E, edema) and then actual blood extravasation (ARIA-H, hemorrhage). In severe cases with blood thinners or large vessel disruption, it can be fatal.
Where this was said
At 1:03:30 · chapter starts 1:00:00
Aducanumab's approval in July 2021 was one of the most controversial FDA decisions in memory: the agency overruled its own advisory board, which found the amyloid-lowering effects did not translate reliably into clinical benefit. Gayatri Devi was nonetheless among the first physicians to prescribe it, applying her personal rule: would she want this drug if she had Alzheimer's herself [1] — Gayatri Devi "The other thing, Peter, I always ask myself anytime a new drug comes out is, would I want this drug? If I had Alzheimer's now, knowing ever…" 1:00:59 ? Her answer was yes — reasoning that even a small clinical benefit combined with disease-modifying amyloid clearance was worth trying, especially if the ARIA risk could be mitigated with slow titration. The drug was ultimately pulled from the market not because of safety failures but because the post-approval monitoring obligations became financially unviable for Biogen, leaving only lecanemab and donanemab in the field.
Lecanemab and donanemab each cost approximately $26,000 per year for the drug alone, with additional administration fees ranging from $400 to $10,000 per infusion.
Self-help fails because people are sold one universal cure by the hyper-responders who had a transformative result from it. The real problem is context: every method works for the right person at the right time, which is almost never you just because the author says so.
Spencer Greenberg was once so socially anxious his heart pounded just approaching a stranger. His therapist gave him homework: go to a bar alone, talk to 5 strangers. Starting with asking for the time, he worked up to asking men for hugs — and his anxiety fell dramatically in 6 months.
A person who flies regularly but obsessively checks weather forecasts before every flight is not doing exposure therapy — they're teaching their brain that flying is only safe with the ritual. Safety behaviors prevent the brain from ever learning that the feared thing is actually fine.
The worry-time technique assigns all worries to one scheduled slot (e.g. 5 PM). Every time a worry surfaces, you write it down and ban yourself from engaging with it until that time. When 5 PM arrives, most worries feel trivial and the act of batch-worrying exposes how little it actually accomplishes.
In a randomized study of 20 habit techniques, 'habit reflection' stood out: recall a past habit you successfully built, write down what helped you succeed, then apply those same strategies to your new habit. It works because it's self-adapting — it uses whatever worked for YOU.
The tiny habits technique — always having a minimal version of your habit you can do when life gets in the way — keeps the mental machinery of habit formation from breaking. Paradoxically, people given a tiny-habit fallback option were MORE successful at the full habit, not less.
Fears and worries act like playground bullies — they want to ambush you. But when you deliberately seek them out and choose the time of engagement, they lose their power. The volitional act of starting the fight on your own terms is one of CBT's most underappreciated insights.
Most downtime defaults are things you regret immediately after — phone scrolling, binge TV. 'Glad you did it' activities meet the same need for rest but leave you feeling like you spent your time well. The switch from a bad screen to a documentary, a book, or a walk costs almost no extra effort but compounds into identity over time.
You rarely control your first reactive thought. But you can train your second thought — the response to the trigger — by asking whether your initial reaction is the most helpful one and replacing it with something equally true but more constructive. Over time, that second thought becomes automatic.
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