Nemi

I want to throw something by you: what if dementia-like diseases can be linked to sleep disorders? Several papers recently have linked CSF flow through the brain during sleep (the glymphatic system), which appears to be “cleaning” the brain of waste, like the plaques seen in Alzheimers. Specifically, what if a disruption of CSF production is being impacted by, say, an imbalance of CSF precursors (like electrolytes) caused by something like a hormonal imbalance or low-grade kidney issues that don’t get picked up by normal tests? This would short-circuit the glymphatic process not allowing the body to create as much CSF as it needs. Then the brain won’t get as much cleaning as it should.

EDIT: sorry, I did not see your later reply saying that you WERE focusing on sleep disruptions! my bad. And, interesting…

No, I never had any tests beyond the simple blood tests checking my electrolyte levels. This was before I realized that those tests won’t show you the problem. I simply made a hypothesis and tested, over and over.

I have toyed with the idea of visiting a nephrologist, but I just can’t psych myself up for the long slog that would be. I live in a fairly large city but given the rarity of these syndromes, it would not surprise me at all if any local nephrologists have even encountered anyone with one of these conditions. I have also considered seeing a ‘functional doctor’, but just have not gone down that road. Honestly, I seem to have my symptoms under control, so what they could add at this point? There is no treatment or cure for this, only managing symptoms (assuming this is what I have, to be fair).

It all makes sense to me though. Though this is something that got bad enough for me to make a concerted effort to figure out just in the last decade, if I reflect back on my life I have seen problems associated with it back into my 20’s. In my case, I don’t think it is something that “happened” to me, but something I was born with that is just progressing as I get older.

By the way, I was re-reading a comment of yours from up above and I realized that you were referring to heart palpitations like you were already getting too much potassium. Here is the thing – you can get heart palpations from too much AND too little potassium. Also from too little calcium. Just food for thought.

I have updated my profile with my contact info. If you ever go down the route of getting diagnosed or have any other questions, feel free to contact me anytime. Good luck!

I find magnesium a tricky one to get right for me. I have tried most of the kinds available and have settled on magnesium chloride in a liquid form. It has a god awful taste, but has absolutely no other side effects.

Citrate causes me to have too soft of stools. Glycinate is often recommended for sleep, but for me it has the opposite effect – it wires me. I have tried taurine, malinate, and threonate, but chloride just works the best for me.

Electrolytes do ‘wear off’ in the sense that they are constantly depleted by your body, even when everything is working well. I have come up with the metaphor that electrolytes are like gas and oil in your car. They are constantly used up and need to be replenished. This is normal.

The good news is that I noticed the difference immediately!

I hear you, I was in the same boat. I had been to the doctor many times without much luck. I am outwardly healthy looking. Thin, fit with no other problems. I had a good doctor, but doctors are used to dealing with acute problems in people that are simply unhealthy. When they see me they are often dismissive that I have any real problems. I had a pretty good rapport with my doctor so he would do tests and we would have some good dialog, but he retired and, honestly, it is just too frickin difficult to go through the process of bringing a doctor up to speed on what my history is.

Fortunately for me I was able to retire at 50 and I am an avid consumer of information, so I spent an inordinate amount of time educating myself. I went down many wrong paths (as another commenter pointed out, diabetes can cause a lot of these symptoms). I wish I could say I brute forced my solution, but it was some innocuous comment on HN about potassium deficiency that made me look into it, and the rest is history. It was my “break through”, so to speak.

I take anywhere from 600mg to 800mg most days spread throughout the day depending on meals and activity level, but as much as 1000mg some days. Never all at once.

On a related note, here is the thing about measuring electrolytes – your body goes through great efforts to make sure your electrolyte levels in your blood are in balance. But here is the kicker, only sodium ‘primarily’ resides in your blood. The other electrolytes primarily reside in your other tissues. For example, potassium is mostly held inside your cells like muscle tissue. As a matter of fact, this is how muscles contract. When muscles contract, potassium temporarily moves out of the cell and sodium moves in. Then in a minute potassium and sodium reverse back to normal. This is one reason your muscles fatigue and then become usable again a short time later. When your cells are short potassium then your muscles fatigue quickly and don’t bounce back.

You can’t measure this level of potassium. Your blood levels might be just fine, but your cells may be deficient and you will never know. It is the same with calcium and magnesium (bone). If you ever get a blood test and your electrolytes are off, you probably need to be in the hospital. It means shit is so bad that your body has lost its ability to compensate. But it also means that if you go to the doctor and get your electrolytes tested, they will likely be in the normal range, but that does not mean you aren’t deficient.

Yep, it came up on my radar early on but all indications are that it is not diabetes. There was a time where I was looking at it pretty hard.

I take anywhere from 600mg to 1000mg throughout the day. It depends on my diet and other things. Never all at once.

Sorry, you asked about ‘possible upstream causes of electrolyte deficiency’.

In my case I believe it is caused by an undiagnosed kidney problem loosely called ‘salt-wasting syndrome’. There are many types, but they all revolve around a genetic disorder where the tubules in your kidneys that are responsible for removing different electrolytes from the urine and retaining them are malformed and are not able to keep the electrolytes like a normal kidney does. Here are a few I found in my research:

-Bartters Syndrome- https://rarediseases.org/rare-diseases/bartters-syndrome/

Many different variants, so this is a possibility. Type 5?

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-Gitelman syndrome- https://rarediseases.info.nih.gov/diseases/8547/gitelman-syn... Symptoms include tingling of face

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Fanconi Syndrome https://www.merckmanuals.com/home/kidney-and-urinary-tract-d...

I my particular case, I believe I have a type that does not impact sodium, but does potassium. When I eat a high sodium meal it causes me to pee a lot to try to get the my sodium levels back to normal. However, my body can’t retain potassium when it does this (and since I was eating much more sodium and much less potassium than my body required) I end up with normal sodium levels but low potassium levels. Taking potassium a few hours after a meal “fixed” this.

Short of genetic issue like this I am not sure what could cause it. I think this can be an early symptom of Diabetes, but don’t know much about that. What I am talking about here has got to be rare, so it may not be applicable to you.

Just another anecdote – when reading some of these links it made me remember another interesting symptom I used to have that I did not know was related: I would get “facial numbness”. Specifically, my lips and the immediate surrounding area would feel slightly numb. Usually in the morning after a poor night of sleep. I would remember feeling this on the way to work in the car. It would contribute to that dazed feeling I felt like I would swimming through a mental fog.

Oh, and one more! I also don’t get nearly so hung over from drinking! This was a surprise for me. I have always drank a lot of water while drinking alcohol, but I would always have the worst drained feeling the next day with such a headache. The headache would last all day. However, if I now take some potassium while drinking and throughout the night (depending on how much I drink), I often don’t have much of a hangover. This amazes me! I am 57 and used to drink a lot when I was in my 20’s. I had some friends that could be normal the next day and it always blew my mind. Now I think I know why. They have normal kidneys!

I also started with general “electrolytes” but found that one of my problems was that I was getting way too much sodium and not enough potassium. This was the primary driver of my post-meal somnolence. Most general electrolyte supplements are primarily sodium, and this was exacerbating my symptoms in some cases. I now only eat meals that have a reasonable amount of sodium and then take a couple of potassium tablets a couple of hours after eating if I feel myself starting to get a little sleepy. 30 minutes later I am ‘back to normal’, whereas I used to be sleepy for several hours as my body tried to bring my electrolytes back into balance. I also would have massive unquenchable thirst during this that I now don’t have.

I have read no studies that link CSF production with electrolyte deficiencies. This is a hypothesis of my own with no backing, so take it for what it is worth. Having said that, there have been many posts on HN on the recent studies on CSF https://news.ycombinator.com/item?id=39723704. I made the connection with CSF production and electrolytes when I was reading more about CSF production and it jumped off the page at me that potassium and other electrolytes are used to create CSF. It all just came together for me why taking potassium has helped me so much.

I also take magnesium for sleep. I swear by it.

I also believe I have an underlying kidney disorder that was causing all sorts of subtle problems and after researching for years decided to try potassium supplements and it relieved the acute symptoms I was having (daytime sleepiness after meals) and also a whole slew of symptoms I didn’t realize I was having (poor workout performance and recovery, constant thirst from sodium/potassium imbalance, heart palpitations, especially at night when lying in bed, temperature regulation when trying to sleep, restless legs at night, and sleep quality).

Sleep was the most surprising. I used to wake at around 3am and just couldn’t get back to sleep. I still wake up to pee, but I get right back to sleep.

The single most surprising thing is the quality of my sleep. I now sleep like a rock. So unbelievably hard. And when I wake I feel so rested and more clear headed. I don’t need to sleep as many hours anymore and feel better than when i would sleep 9 hours.

Recently several sleep studies started talking about how sleep is not a passive activity, but a ‘washing’ of CSF over your brain. I could get some details wrong since I am going off of memory, but I believe the amount of CSF movement and production basically triples when you sleep. I hypothesize that this is simply your bodies way of cleaning the waste products out of your brain. Do you know what precursors are to create CSF? Electrolytes like sodium, potassium, chloride, and bicarbonate. It is my hypothesis that I was ‘using up’ all the potassium available with the first couple of sleep cycles and once it was gone I was unable to effectively create more CSF, rendering my sleep ineffective.

All I need to take is a couple of 99mg tablets right before bed (along with some magnesium chloride) and I sleep like I did when I was 10. I am 57. To say it has transformed my life would be an understatement.

While true, this is overblown. RDA for potassium intake is 3500-5000mg daily for an adult male. Most people do not get close to this amount. Potassium supplements are 99mg per pill. You have to take a lot of pills to reach that level. Getting too much potassium by eating potassium-rich foods would be difficult without an underlying kidney disorder.

Having said that, don’t be a dumb-a* and take too much of a good thing.

Because part of their job, if they are good at it, is to present some data, measure how customers are responding to it, and then tweaking said data to get a better response. If you make it too hard for them to “tweak” it, then they will be more reluctant to tweak it. Thereby doing a poorer job.

Them being able to easily change the website is critical for them to be able to do their job. As in most things in life, it is a balance that needs to be achieved and not one thing that trumps everything else.

As others have said, WP gives them a way to easily change the data that they are responsible for. It should be the devs/systems engineers responsibility to make that data present as a static web page using plugins or caching layers and that should be transparent to the marketers.

So riddle me this - Netflix’s revenue is around $9.5B. So a little more than the running costs of OpenAI.

Do you think it is plausible that they will be able to get enough people to pay for OpenAI that Netflix? They would need much more revenue than Netflix to make it viable. Considering that there are other options available, like Google’s, MSFT’s, Anthropic’s, etc.

As a business model, this is all very suspect. GPT5 has had multiple delays and challenges. What if “marginally better” is all we are going to get?

Just food for thought.

The thing is, right now it is artificially cheaper. It is being heavily subsidized by all providers in a race to capture market share. It simply cannot stay this cheap forever at current costs.

Now, if costs change then we have a new story. But that is not guaranteed.

My first thought is - how do you get the contact information for a closed office?

My current hack, which is not as great as yours, is to put a reminder on my calendar for a few days before my 1 year prescription ends. If I order new contacts in the one year period for another year’s worth of contacts (even if I am not out yet), I essentially get to go 2 years between visits. I will try your hack next if I can figure out a good way to get contact info for an office that won’t object.

I agree, for those that prefer biking and camping vs Disney world and hotels, then Mister Money Mustache’s advice rings true and seems logical. For those that have other ideas of what consists of a ‘good time’, then there is a limit to the ‘cost cutting’ that can be achieved.

My main point is really this - be real with yourself on how frugal you can reasonably get sustainably. If you try to be as frugal as Mr Mustache and that is beyond your level of comfort, you are going to fail and/or be miserable and wonder why you are not enjoying your retirement because it is based on false figures.

I agree with much of this, but I do think that there is a flaw in his logic - he operates on the notion that saving more of your income has a two-fold impact on your ability to retire.

First, and most obvious, it increases how much savings you have. But secondly, he states that you permanently decrease your expenses, making that magical 4% withdrawal rate of your savings easier to attain.

And yes, while that is true on the surface, the underlying message is - if you just don’t have cable tv (streaming in today’s world) and other things like cars and basic vacations, then you are almost there! And yes, if you want to live as a monk then this could be considered by some as a noble thing. But some want to live reasonably comfortably (new-ish car, trips to places like disney world with the kids while staying in a nice hotel vs biking and camping).

I only bring this up because even mister money mustache has admitted that he is unusually monk-ish in his lifestyle choices. Don’t get me wrong, I actually retired 7 years ago partly on reading his blog, so I get it. But we have to be realistic on what his message is and what others are liable to achieve.

I guess what I take most umbrage with is, he says that it is easier and more effective to cut expenses than raise earnings. And just like a business, this strategy quickly runs into diminishing returns. Raising the top line while keeping expenses reasonable is always the best strategy to an early retirement (or a successful business).

This only really works if you have a way to pay the bills outside of your salary, or are young enough to live with your parents or on a buddy’s couch.

Ok, I have never told anyone this, but I also sometimes wake up and “see” like a waterfall effect over my vision. It only happens very rarely and only for less than a minute after I get woken from a deep sleep. It is not unlike a moving sensation or water moving over my eyes. I realized that it is probably fluid moving over my visual cortex and being interpreted as vision. Seems weird and I have nothing to back it up on, but it has happened multiple times over my lifetime and the sensation is exactly the same every time.

This is totally off topic and will likely get downvoted, but the topic of whether physical controls in a vehicle is a non-issue or critically important is the kind of conversation I want to have when interviewing a prospective employee. It conveys so much in so relatively little. It shows:

* Empathy for others

* The ability to place oneself in an imaginary situation when using something and project what it might be like for you and others using that thing in all kinds of situations

* Evaluate something objectively even when you have sunk costs (say if someone spent a lot of money on a Tesla or something)

* most importantly, the persons judgement. How they view this topic of whether physical controls are important or not shows basic judgement, or lack thereof. That translates over into SO many other areas of life. As an employer, it tells you everything you need to know about whether this person is going to be a good decision maker or someone you have to micro-manage their every decision.

I think it is great that you know many people that use it daily. Can I ask how many PAY for it monthly? Is it as many people that, say, pay for netflix? Outside the tech world, of course. Do you see your friends and family paying for AI services directly? Because the amount of money to provide AI services is at least as great as it is to provide netflix. Probably way more actually.

What companies are making a ton of money on AI? Nvidia? Nvidia makes money selling chips to large, massively profitable companies that are in an arms race to capture as much market share as possible. Or they are selling to smaller companies trying to make a name. But none of those companies are making any money from the AI services they sell. All of them are spending massive amounts of capital.

What happens when we reach an equilibrium point where AI services are ‘good enough’? I’ll tell you what will happen, it will become another cost center for the big companies and all further development will cease once they have eliminated the competition.

Want an example? Smart home speakers. Do you think that Alexa and Google home are the best that they could do? Do you ever wonder why Alexa came out and made a splash and then Google frantically made one of their own, but once market share was evenly split between both companies all new development ground to a halt? It is because they were only going to spend enough to keep the other company from dominating then stop spending. Because there is no way to monetize it. Not really. You can charge for the hardware, but that is a pittance to them. Can you charge for the service? I use my google home all the time for some things, but if they told me they were going to start charging me would I continue using it? Probably not. There is a reason Amazon recently RIF’d a bunch of people on the alexa team.

People say that this is not like pets.com because profits are real, but are they? Or is it some crazy ponzi-like thing where the amazing profits being had by companies like Nvidia are going to dry up eventually. I say it more like Cisco of 2000, where they were making tons of money selling hardware to all those pets.com companies. Follow the money. Once you get to the person/company paying for the service, there is none. Not on this scale at least. I think there will definitely be companies that pay for an AI service, but the amount of total market spend will be somewhat less than the total spend for something like cell phone service or streaming services. You know, like those things that everyone you know, from technical to luddite, from rich to poor, all pay for. I don’t see AI reaching that level of ubiquity. Do you pay for email service? I know that the people on this site do, to some extent. Email providers charging for their services are a niche market. AI is destined to be the same.

Just to be clear, I agree with you that this will be like the internet was. It will change the world. But it is without a doubt a bubble, just like the early internet. And for the reasons that you say - everyone can easily see that it is ‘something’ just by using it. The barrier to entry is very low, just like opening a browser and going to a website was. It does not take a genius to see the potential. Which is all the more reason that dumb money is flowing like water into this bubble.

A more charitable interpretation was that this person had a massive attack of cognitive dissonance when you told them what you found and was not able to reconcile it.

They convinced themselves that “their” solution was actually a better fit/safer/more performant/etc and justified in the expense and effort. And it may have been, in all honesty. But likely not enough better to justify the time and expense.

The empathetic view is that we all suffer from this delusion, but some of us are better and recognizing it and circumventing it than others. Part of it is age/maturity/experience. Part of it is innate.

Don’t get me wrong, I am not excusing this behavior. I abhor it as much as you clearly do. But sometimes it can help with dealing with these types of people to reframe it as less malicious and more incompetence.

If you are valuing a business on SDE the multiple is usually 2.4-3. So this business as it is today would be worth more like 566-708. The beauty of building a business is that as the bottom line goes up your business is worth more, but it ALSO fetches a higher multiple. So a business with a bottom line of $1M will get 5-7 times earnings (note: not SDE), whereas a small business gets a lower multiple based on SDE.

I agree. I also worked on EHR software and what people don’t realize is that the “customer” isn’t the doctor. Not to be disparaging, but the doctor is “just” an employee.

The purchaser of the software is the administrator. And because of harsh regulations and legal liabilities in their industry, they need software that is compliant with regulations and limits legal liability on the institution. Full stop. If they can get that with a good UI/UX, then great! But in the end, this is just another case of “No one ever got fired for buying IBM”. It is all about incentives.

Companies like Epic could make their UX better, but that costs money. And what drives sales is being regulations compliant, and that is hard. It takes a ton of time. There is little time left over to make something work well considering no other software is challenging them on that front. It really is a situation of regulatory capture.

From the included chart it looks like we are back to the pre-pandemic “good times” in total deals, down from the “Must-invest-in-everything crazy times” of the last couple of years. Is this really bad news?

I am not an expert, but I don't think that is the way it works. My guess is that the only reason that they could vote without Sam and Greg there is because they had a majority even if they were there. That means they had 4 votes, and that means all other board members voted against Sam and Greg.

It does not seem reasonable that only some members of a board could get together and vote things without others present. This would be chaos.

No blood pressure meds.

I take about 150MG of magnesium and 100mg of potassium before bed. The magnesium is Chloride, but in liquid form and causes no laxative effect (but tastes terrible!). It is a product called ReMag. I am sure other forms will work just as well. The potassium is Gluconate as it is PH neutral. Potassium Citrate and Chloride would work just as well. I just get the Gluconate from Walmart as it is cheap and effective.

I also take Magnesium and swear by it. I also suspect I have some underlying kidney issues retaining many electrolytes and started taking a potassium with the magnesium at bedtime and it has transformed my sleep into baby-land. I sleep so hard now and when I wake up, I have no problem getting right back to sleep. I feel so refreshed the next day it is honestly shocking to me. I have always said that before I started taking both that I felt like I was on a one-way track to dementia. That is just how I felt. Very anecdotal, but I believe it in my bones.

If you don’t think that this goes on at Apple, I have a bridge to sell you.

Just food for thought - why do you think that the ipad (with the same processor as the laptop) has not gotten more capable over the years? They can’t figure out how to do it? No one on the ipadOS team has the brains to make it happen, or it just hasn’t occurred to them? Or maybe there has been an internal conversation and they realized that it would drop the sales of Mac machines below a threshold where fixed costs outweigh the mac team’s ability to stay afloat (pure speculation on my part)?

Make no mistake, Apple is no paragon of virtue here. I love their products (though they also frustrate me), but the company is largely the same as Google and Microsoft in ethics.

I hope beyond hope that we continue to iterate on the current GPT-4 model. But statements made by Altman himself make me leery that it might not happen. That, coupled with the fact that it is just so expensive to run make me wonder if this whole thing is sustainable.

Take this into consideration - NVDA’s massive profit in the last couple of quarters is someone else’s expense. When no one is making money on AI, can this continue? I absolutely think companies can make money using AI that people will pay for, but I am not convinced that companies can make money supplying AI services. I see it as almost a commodity type service, like internet access or something. There is no clear path to profitability, and that is ok to some extent, but with the massive costs this could come crashing to a halt very quickly.

So this is the exact same problem with Realtors. They will say that they have a fiducial responsibility to represent you and that they will try to get you the best price (either the most or least, depending on whether they are on the selling or buying side, respectfully). And they will do that, to some limited extent. But really their incentive is to close the deal. And that means telling you that this is the best price the counter party is willing to extend if they secretly think you will still do the deal.