How GPS Quietly Runs the World & When Illness Has No Obvious Cause

Ever notice when you hear someone talking on the phone nearby it’s hard not to listen? You are only hearing one-side of the conversation and that can drive your brain crazy. It’s not just annoying and distracting it can actually be dangerous. https://now.uiowa.edu/news/2017/06/ui-study-explores-why-cell-phone-use-leads-distracted-driving It’s hard to imagine life without GPS. But now it has become so woven into daily life that most of us never think about it. We use it to navigate, order food, track packages, find rides, locate our phones and even synchronize financial transactions. Yet GPS wasn't created for that. It began as a military technology and evolved into one of the most important—and expensive—infrastructure systems ever built. How does GPS actually know where you are? Why is it free to use? Who pays for it? Is it spying on you? Here to explain is Katherine Dunn, business reporter, editor and author of the book Little Blue Dot: How GPS Shaped the Modern World (https://amzn.to/4uvtk2M). Why is it that millions of people experience chronic pain, fatigue, digestive problems and other ailments that doctors and medical tests often fail to explain? Too often they're told "it's all in your head." But according to psychiatrist Susan Trachman, that phrase badly misunderstands what's happening. The connection between the brain and body is far more powerful than most people realize. Thoughts, emotions and stress can trigger genuine physical symptoms—and understanding how can be the key to finding relief. Susan has spent more than 30 years treating medically unexplained illnesses. She is author of the popular Psychology Today blog and the book It's Not Just in Your Head. (https://amzn.to/4oqvjDP) Listen to a tennis match or walk through a gym and you'll hear it everywhere: grunting. Sometimes really loud grunting. It seems odd. Maybe even unnecessary. So why do athletes do it? Is it habit? Showmanship? Or is there something else going on? https://www.womenshealthmag.com/fitness/a64691561/grunting-power-output-study/ PLEASE SUPPORT OUR SPONSORS AIR DOCTOR: Head to ⁠⁠https://AirDoctorPro.com⁠⁠ and use promo code SYSK to get $250 off select AirDoctor air purifiers, including the 3500, 4000, and 5500 models. Plus, you’ll receive a free 3year warranty! RULA: Thousands of people are already using Rula to get affordable, high-quality therapy that’s actually covered by insurance. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://Rula.com/sysk⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ to get started. QUINCE: Elevate your summer wardrobe. Go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://Quince.com/sysk⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for free shipping on your order and 365-day returns. Now available in Canada, too! SHOPIFY: It's time to turn those "what ifs" into CHA CHING with Shopify Today! Sign up for your $1 per month trail and start selling today at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://Shopify.com/sysk⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Speaker 00

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• 0:32Mike Carruthers?

  Today on Something You Should Know: Why listening to a person talk on their phone to someone else can be dangerous for you. Then, the fascinating story of GPS and things about it you may not know.

• 0:46Speaker 02

  Our day-to-day experience with GPS is Google Maps, navigating around. But what the satellites also provide is they have atomic clocks. So they're providing extremely accurate time to clocks that are not very good, like the one on my iPhone.

• 1:00Mike Carruthers?

  Also, why do tennis players and weightlifters grunt so loudly? And when you know you're sick, but the doctor can't find anything wrong, it can be really discouraging. And it happens to a lot of people.

• 1:13Speaker 03

  Who go from doctor to doctor. And when the physician cannot come up with a diagnosis, they might say to the patient, "We really can't find anything wrong with you. It's all in your head. Go see a psychiatrist." Which is how they end up in my office.

• 1:26Mike Carruthers?

  All this today on Something You Should Know.

• 1:31Mike Carruthers?

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• 2:00Mike Carruthers?

  And shop.com is actually a really clever idea. It brings lots of different stores together in one place. So, instead of bouncing around from website to website, you can search across stores, find what you're looking for, and track your orders, all in one place. Clothes, electronics, gifts, things for the house, all kinds of stuff. And whether you win or not, it's worth knowing, but with a thousand chances to win $1,000, I'd certainly take a look. Enter to win the $1 million Shop Cash giveaway from now until November 1st. Just go to shop.com. There are so many ways to win.

• 2:44Mike Carruthers?

  That's shop.com. Shopping designed around you. No purchase necessary. Restrictions apply. Official rules available at shop.com.

• 2:56Speaker 04

  Something You Should Know. Fascinating intel. The world's top experts. And practical advice you can use in your life. Today. Something You Should Know. With Mike Carruthers.

• 3:09Mike Carruthers?

  You know what can be really annoying and distracting? Is listening to someone else talk on their phone to someone else. And it can have some important consequences you should probably be aware of. Which is why we're starting with that today on this episode of Something You Should Know. Hi, I'm Mike Carruthers. Thanks for joining me today. So you ever notice how hard it is to ignore someone else's cellphone conversation? You might be reading, or working, or driving along just fine, until the person next to you starts talking on the phone to someone else. And then suddenly, you can't concentrate. Psychologists have a name for it. It's called half-a-log.

• 3:52Mike Carruthers?

  Hearing only one side of a conversation. Research shows that half-alogs are more distracting than listening to two people talk face-to-face. And the reason is, your brain is naturally wired to predict what comes next in a conversation. So when you hear only one side, your mind keeps trying to fill in the blanks, which quietly steals your attention away from whatever you're doing.

• 4:18Mike Carruthers?

  This can become problematic if you're driving your car and your passenger starts a phone call with someone else. That can be very distracting for you while you're trying to pay attention and drive the car. And that is something you should know.

• 4:36Mike Carruthers?

  When was the last time you were trying to figure out how to get somewhere and actually pulled out a paper map? For most of us, it's been years. Today, we simply pull out our phone, tap in an address, and a calm voice tells us exactly where to go. It is truly amazing, and yet GPS wasn't created to help people find coffee shops and avoid traffic. It was built for the military. It is operated by the US government. It costs billions of dollars to maintain, and yet anyone on earth can use it for free. GPS doesn't just help you get from point A to point B. It quietly runs much of the modern world.

• 5:18Mike Carruthers?

  Everything from banking and shipping to farming, emergency services, power grids, and the internet itself depends on its timing signals. So how does it all work? Where did it come from? Who runs it? And why is it free? Here to explain is Katherine Dunn. She's a business reporter and editor who works at the Reuters Institute for the Study of Journalism at the University of Oxford. And she's author of the book Little Blue Dot: How GPS Shaped the Modern World. Hi Catherine, welcome to Something You Should Know.

• 5:50Speaker 02

  Hi, thanks for having me.

• 5:53Mike Carruthers?

  So before we get into the history of GPS, which I think is a rather fascinating history, explain to me in basic language, how does it work?

• 6:04Speaker 02

  The globe is basically encircled by a series of satellites. We're talking about the US Global Positioning System here, but now there's a bunch of these systems run by different governments. And they all operate on more or less the same idea. So the globe is encircled by these satellites, and you're sort of in sight of minimum four of them at any time. And people often think it's, oh, it's about triangulation, but actually... Your location is being found on Earth through time. So the satellites are sending out a signal from space. And say you have your phone, I have my iPhone next to me. It's actually calculating the length of time it takes for a radio signal to reach you on Earth.

• 6:49Speaker 02

  And it does that three times, longitude, latitude, and elevation. So it calculates your position in three dimensions. And then the fourth one actually calculates time, which is arguably the most important and sort of the trickiest to explain. But yeah, you're looking at four sort of dimensions here. Longitude, latitude, elevation, and time. And that situates where you are on Earth. But it's really about making that calculation. And we can do that because electromagnetic waves move, you know, in a vacuum. They move at a steady known speed, and that's from Einstein. So this is really putting a lot of Einstein's theories into practice

• 7:32Speaker 02

  and helping us understand where and when we are on Earth.

• 7:37Mike Carruthers?

  So those four satellites that find my phone and communicate with my phone, is my phone communicating back with it or not?

• 7:47Speaker 02

  So one thing you have to know about GPS is it's actually a one-way system. So the satellites collectively don't know where you are. It's all one-way. So you can think of it, it's like being underneath a showerhead. It's just raining down on you, basically. And what turns it into a two-way system is the way that your phone is stitched into all of these other things. You know, telecommunications systems and wireless networks and that sort of thing. So yeah, the satellites don't individually know where you are. None of the system knows where you are. And the reason it's like that is because it was built for conflict, right? So the whole idea was that you could use it wherever you were on Earth,

• 8:30Speaker 02

  but it wouldn't simultaneously give you a way if somebody was looking for you. So that's one way to think about it. We do think of it as a two-way, trackable system. But the trackable element comes from all the other aspects of technology that interact with GPS and the way that we use it.

• 8:47Mike Carruthers?

  And so the signals are coming in, and it's the phone or the thing in my car or whatever that is making sense of those signals and turning it into a dot on the map.

• 8:59Speaker 02

  Yeah, exactly. The math on one level is pretty simple. You've got four equations. But actually, this is like a computer in space, talking to a computer in your phone, talking to other computers at base station, you know, in as part of the US government. This whole system is a US government system. So actually, what's going on here is incredibly complicated. It's a lot of different computers talking to each other. That's kind of the core of it.

• 9:29Mike Carruthers?

  Something I've always wondered about GPS when I'm using it. For example, if the satellites are finding my phone and sending signals to it, how does it know where I am? How does it do that when I'm, say, at the bottom of a parking structure or in a tunnel where theoretically, radio signals can't get to it? How does it know where I am?

• 9:55Speaker 02

  But basically, the US government puts together sort of a predictive list of where all the satellites are going to be in the next however many hours. So if you've ever wondered sometimes, if you get off a plane, for example, and you don't have data reception yet or you don't have other things, and your phone can kind of give you an indication of where you are, right? If you just open Google Maps, for example. Part of this is there is a predictive element built into it. And your phone and the chip inside your phone is interacting also with a database. So it can make a guess of where you are, even when it doesn't actively sort of have all of those satellites within sight.

• 10:40Speaker 02

  And this is one of the things that allows your phone, if you open Google Maps or something, to connect so, so, so, so quickly to your location, is the fact that it has some indication of where the satellites are and therefore where you are. And so it kind of makes a jump. It makes a prediction. And from that prediction, it can adjust.

• 11:01Mike Carruthers?

  So yeah, so it's kind of making assumptions about where it's likely that you are when it can't see you. And then it'll it'll re-correct itself when it does see you.

• 11:11Speaker 02

  Yeah, exactly. It's this constant process of test and refine, test and refine, and test and refine. And the reason all of this testing and refining can happen is because, of course, we're dealing with chips and we're dealing with computers. You know, it was when this whole system was created, it was something pretty incredible, the level of computing that needed to go into a system like this. And the fact that we're still using it today, basically, more or less, as it was designed.

• 11:39Mike Carruthers?

  Is it possible to know how many people or businesses or how many users there are of GPS at any one time? Or, you know, you gave the analogy that the information is one way like a shower, where it's just coming out of the shower, that you wouldn't really know how many people are getting wet.

• 12:00Speaker 02

  So we have no idea how many people are using GPS at any one time, or the other systems that are similar to GPS run by other governments. We have no idea, you know, how many people are collectively using these systems. It's not even how many people, it's how many chips and electricity grids, or cars, or all of these different pieces of technology, right? Because it's just sort of raining down on you, it's passive. And from the beginning, when they were looking at how popular GPS was becoming with civilians, one of the things the US government didn't know is, how many people are actually using this thing? How popular is it for civilians outside of military uses? And they could only guess, really, based on how many sort of receivers were maybe being sold, or who was making chips.

• 12:45Speaker 02

  But it was just that, it was a guess. We don't know how many people are using it at any one time.

• 12:51Mike Carruthers?

  Well, it's kind of like if you were operating a radio station and sending out a signal, you don't know who's listening.

• 12:58Speaker 02

  Exactly. It's exactly like that. It's radio waves, and you don't know who's on the other side. Which is interesting, when the US government has developed a tool that's, you know, it's a military tool, but they realized fairly early on, oh, there, whoever they were up against could use it as well.

• 13:15Mike Carruthers?

  I know the history of GPS is, I find this story pretty interesting, and I'd like to get you to tell it. You could probably go for hours on this topic. But just in a nutshell, what is the story, the history of GPS?

• 13:29Speaker 02

  The GPS system, as we know it now, is from the early 1970s. And it essentially emerged out of the end of the Vietnam War.

• 13:39Speaker 02

  As a tool to bomb, more precisely. This had been a real issue in the Vietnam War. This lack of ability to really precision bomb. And there were a lot of different competing systems within the US military. You know, systems that could do one thing better or another thing better. There had been a predating system that came out of the late 50s. And so this was sort of a refinement of a lot of ideas that had been building and building and building. But yeah, it was essentially a tool to make bombing more precise. And it needed to work in three dimensions because you were really thinking at that

• 14:21Speaker 02

  time about, you know, fighter jets or missiles or things where you were working in three dimensions. So you have the system and it's sort of in the bowels of the Pentagon. It's designed, they're testing it, they're trying, trialing it. If you think about it, it's, you know, it's incredibly, incredibly, incredibly expensive program because you're launching satellites, right? And one of the really surprising things about it that I was very surprised by, it was it wasn't popular in the Pentagon. It wasn't like people automatically saw, oh, this is something transformative that we really, really want. Let's shell out loads of money for it. Let's keep it going. It was constantly at risk of getting its budget cut, even canceled.

• 15:03Speaker 02

  So over time, you know, you're looking at decades to get the system up to the way we see it today. And the way we see it today is only essentially from 2000 that it became as accessible to civilians, that it became as fast and as super, super accurate as, as we understand it now. And it started being put in, you know, cars and cell phones, kind of in a mass scale.

• 15:29Mike Carruthers?

  Yeah, I want to find out more about that, about how it moved from being a military thing to becoming basically a consumer product. And we'll do that in just a moment.

• 15:44Speaker 05

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• 16:12Speaker 06

  When fall comes back around, there's a sense of a reset. And new pieces from Lululemon's Fall Drop are an inspiration to push your goals and elevate your routines. As your calendar fills, easy-to-layer styles meet the demands of your day. And as you challenge yourself to try even more, versatile sets transition with you. The Lululemon Fall lineup brings new levels of comfort and confidence, whether you're starting something fresh or starting something over. Check out the latest arrivals in-store and on lululemon.com now.

• 16:41Mike Carruthers?

  We're talking about GPS, and my guest is Katherine Dunn, author of the book Little Blue Dot: How GPS Shaped the Modern World. And Catherine, I'm really curious how GPS got in cars, because as you said, it was a military thing. And somebody must have been sitting around going, hey, I have an idea. Why don't we put it in cars? And then people can know where they are and know where they're going. How did that all start?

• 17:11Speaker 02

  The people who had the idea to put it in cars were, first and foremost, the Japanese. So as it starts leaking out of the US military, as they get enough satellites up that you can, you know, get, they call it a fix. You can get a location and a time to some extent. It's some time that, nothing like what we have now, but still really, really amazing. It started kind of leaking out of the military. And quite quickly, what you saw happening is people realizing the potential. So in Japan, they realized really early on that this was going to be useful for managing earthquakes.

• 17:50Speaker 02

  You know, they were going to put it on buildings and see how they were shifting and using it to track things. They started using it on boats really early. They started using it on fishing fleets really early. And then, yeah, it was really the Japanese who thought, okay, we can put this in a car. But when they started putting it in cars, it was these really elite futuristic cars. They were sort of in this battle with the US at the time in the late eighties um to produce these incredible futuristic cars with computer consoles and things that have now become really standard. So it started showing up in these sort of show cars. The same year that GPS appeared in a car at the Tokyo Motor Show was the same year that they had a car that was modeled after like the Batmobile.

• 18:35Mike Carruthers?

  And what year was that?

• 18:37Speaker 02

  That was 1989. It was right, right before the Berlin Wall fell. It was also right before Japan's economy crashed.

• 18:45Mike Carruthers?

  And so it started to appear in cars regularly when? Around 2000?

• 18:52Speaker 02

  Yeah, around the 2000s. So through the 90s, it was sort of this real high-tech novelty thing in Japan. It didn't work that well. But what happened in 2000, GPS got a lot more accurate for the average person. And this coincided with sort of the digital revolution where you started getting these really, really small chips, right? You started getting mobile phones. By 2007, you have, you have the iPhone. And in the meantime, if you remember TomTom and you remember these navigation devices you could put in your car, that was really like the boom, I would say, you know, sort of 2000 to 2007, 2008.

• 19:33Speaker 02

  That was really when average people got this in their car and they realized how useful it was.

• 19:38Mike Carruthers?

  And so does anybody make money on this? Who, well, who operates those satellites? Is it still the military?

• 19:45Speaker 02

  Yep, it's, it's the US military. I mean, who pays for it is the US taxpayer. Um, but at the same time, when you think What comes back in the form of who makes money off of it would be all sorts. Every business with logistics, the tech companies. It's just, it's so unimaginable almost at this point for these businesses to run without GPS. If you think about Uber, you think about these dating apps. You know, they maybe work with wifi, they work with all these other things, but all of this location-based services and never mind global trade.

• 20:25Speaker 02

  And one of the points that I think is really easy to miss is actually that just as important, sometimes more important is time, is the fact that GPS provides extraordinarily cheap and accurate time. And of course, our day-to-day experience with GPS is, you know, is Google Maps, is your car is navigating around. But what the satellites also provide is they have atomic clocks. So they're providing extremely, extremely accurate time to clocks that are not very good, like the one in, the one in my iPhone. And it creates this sort of stitch and this synchronization that we really need for digital life.

• 21:05Speaker 02

  We need it for electricity grids, you know, we need it for all kinds of digital systems. We need to know that, you know, the email will leave at X time and it arrives at X time. It's like this heartbeat, right? Where everything's sort of synced up.

• 21:21Mike Carruthers?

  One of the, one of the things now though with GPS, the way people use it, which is I think primarily, you know, with maps and things like that, you get all this other information. That's not GPS, right? That's not calculating your trip time. That's not telling you how bad the traffic is. GPS is really just telling you where you are. Is that a fair statement?

• 21:44Speaker 02

  Yeah, but where you are, but then also that's, everybody else's location is also based on GPS. It's sort of like a skeleton underneath a lot of things, sort of stitching everything together. And then we, you know, things get layered on top, obviously. But the basic location and the basic time is, is really GPS.

• 22:04Mike Carruthers?

  So if I'm understanding all of this correctly, GPS is essentially and only

• 22:11Mike Carruthers?

  A system that tracks your location and time. Everything else that you see on, say, Google Maps or Waze or whatever, all that other information, that's not GPS, that's Google Maps or Waze. Layering on top of the GPS location, traffic conditions, where the restaurants are, that's not GPS. So GPS is basically location and time. It is what it is.

• 22:40Speaker 02

  I think GPS is what it is. You have to remember, this is still a system from the 70s. It still follows those core principles. What people have often said to me is that the Chinese equivalent of GPS, Baidu, it is a lot more complex. It's more satellites. Some people say there is a two-way element there. There is a transmission element. So you do have these newer systems. This is a much, much, much newer system, like from the early 2000s, kind of, we're talking about it, you know, coming up to speed.

• 23:21Speaker 02

  Even Galileo is sort of late 90s, 2000s, you're moving into the launching of satellites. So they're newer systems and then they are more complex. But yeah, the fundamental idea of GPS, the way we've been using it, I can't imagine it really changing, but people are still finding new and interesting ways to use it.

• 23:46Mike Carruthers?

  And so when it gets into my phone and it gets into my car and it's raining down all these things and then Apple, for example, will take that information and build on top of it and give you the estimated time of your trip and everything, is Apple, is anybody paying the government to use GPS? Or it's just the taxpayer dollars?

• 24:10Speaker 02

  Yeah, it's taxpayer dollars.

• 24:12Mike Carruthers?

  Wow, that's nice of us.

• 24:14Speaker 02

  It is. It's really nice if you think about how many industries are built on the back of this. Yeah.

• 24:20Mike Carruthers?

  Well, and how many industries have been destroyed by it? I mean, the map business is pretty much dead. And that whole part of your brain where you used to have this sense of direction and kind of have to know where you're going, you don't have to know that anymore.

• 24:37Speaker 02

  Yeah, and if you think about, a lot of jobs have really been transformed by this as well. If you think about surveyors, that's a job that has changed unimaginably since the invention of GPS. And in fact, surveyors were very, very early adopters of GPS because it immediately cut down their work time. So that was sort of fundamental to changing the way that job was done. But yeah, it's interesting too, because the US government also realized in the late 90s that whole industries were being refined or built on top of this product.

• 25:20Speaker 02

  And at that point, actually, they went and they spent several years going around the world promoting GPS and getting other countries to adopt it. So, you know, it was a tool of power as well for whole country's civil infrastructure, their airports, their energy grids, all these things to become actually very dependent on this system.

• 25:44Mike Carruthers?

  Yeah, I suspect maybe because it's free and it's always been free, that GPS kind of slid under the radar and kind of crept into our lives. We didn't make a big thing out of it because we didn't have to pay for it. And yet, look at how dependent we are on it now. It's quite a story. I've been talking to Katherine Dunn. She is author of the book, Little Blue Dot: How GPS Shaped the Modern World. And there's a link to her book in the show notes. Great to have you. Thanks, Catherine.

• 26:14Speaker 02

  Well, thanks so much, Mike. I appreciate it. Thanks for interviewing me.

• 26:19Speaker 05

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• 26:48Speaker 06

  When fall comes back around, there's a sense of a reset. And new pieces from Lululemon's Fall Drop are an inspiration to push your goals and elevate your routines. As your calendar fills, easy-to-layer styles meet the demands of your day. And as you challenge yourself to try even more, versatile sets transition with you. The Lululemon Fall lineup brings new levels of comfort and confidence, whether you're starting something fresh or starting something over. Check out the latest arrivals in store and on lululemon.com now.

• 27:22Mike Carruthers?

  Have you ever gone to the doctor with a physical symptom and the doctor couldn't explain it? Maybe chronic pain, or fatigue, stomach problems, or something else that was clearly real to you, yet every test came back normal? It's a frustrating experience that leaves many people wondering if they're just imagining it. And yet medically unexplained symptoms account for a surprisingly large percentage of primary care visits. And when no clear cause can be found, patients often hear some version of, "Well, maybe it's just stress," or "Maybe it's all in your head." But what if that conclusion is wrong? According to my guest, Dr. Susan Trackman, many mysterious symptoms are very real physical

• 28:06Mike Carruthers?

  experiences created through a powerful connection between the brain and the body that science is only beginning to fully understand. Understanding that connection can be the key to finally making sense of symptoms that seem to make no sense. Dr. Trackman is a specialist in psychosomatic medicine and author of the popular Psychology Today blog, "It's Not Just in Your Head." And she's author of the book, "It's Not Just in Your Head." Hi Susan, welcome.

• 28:36Speaker 03

  Thank you, Mike. I really appreciate the invitation.

• 28:39Mike Carruthers?

  You know, I guess it just doesn't seem intuitive that when you have a physical problem, to think that it has something to do with what's going on in your brain. Because a physical problem is a physical problem, and therefore should have a physical solution. Which is why I imagine people have trouble buying this idea of a brain-body connection sometimes.

• 29:03Speaker 03

  What we do know, and I could say to my patients, if I cut off your head, could you function? And of course, they look at me like, you know, cross-eyed, and I'm like, of course not. So, I think rather than looking at the brain and the body as two separate entities, it makes sense to look at them as being connected, because in fact, they are. So if you think about the brain as a big computer, computer has all these USB ports, and they're connected to various organs in the body. And so communication flows in both directions, from the computer, the brain, out to the organs, and back in turn, to send information back to the brain.

• 29:44Speaker 03

  So that whatever's going on in your brain is going to affect various organ systems, and vice versa. A classic example is the brain-gut connection, which we hear a lot about now, because the brain and the gut are actually derived from the same embryonic material, and they communicate constantly. There's a big nerve that runs between the brain and the gut, called the vagus nerve. And so whatever's going on in the brain is going to affect the gut, and they're almost like besties who are texting all the time. So if the brain's like, ooh, we're anxious, the gut's going to be like, yeah, we really are, I think we need to do something about that. And so then people develop symptoms like diarrhea or cramps. So, we know that, and in fact, whatever's going on in the brain will affect other organ systems.

• 30:28Speaker 03

  For example, if your brain is stressed, it's going to impact your cardiovascular system, and you may develop hypertension. The American Heart Association has identified stress as an independent risk factor for heart disease. And that is the case for many other organ systems, including other categories of illness, for example, autoimmune disorders.

• 30:49Mike Carruthers?

  So what I'm curious about, though, is...

• 30:53Mike Carruthers?

  You just gave two good examples of how stress in your mind can cause problems with your cardiovascular system, or other things in your mind can set off your stomach and you get symptoms there. But not everything going on in my brain is causing symptoms. So, why is that?

• 31:12Speaker 03

  Well, something's happening, but you're not developing symptoms, so you're lucky. It's the folks who do develop symptoms, and unfortunately are categorized in a group called, we call it MUS, medically unexplained symptoms, who go from doctor to doctor, trying to arrive at a diagnosis. And when the physician cannot come up with a diagnosis, using usual physical exam, laboratory studies, and for example, even kind of radiographs, they might say to the patient, "We really can't find anything wrong with you, it's all in your head. Go see a psychiatrist." Which is how they end up in my office. And oftentimes, I can listen to what's going on and arrive at a different diagnosis, because

• 31:57Speaker 03

  I do consider not just the target organ, but what else might be going on. For example, their psychological state at the time, and also their environment. I mean, your environment very much impacts your physical health.

• 32:11Mike Carruthers?

  So then it is, in those cases, it is in your head, because that's where the problem is starting?

• 32:18Speaker 03

  You are absolutely right. And when patients will come to my office and say, you know, "My Dr. X told me it's all in my head." Well, what I'll say is, "Well, it is, because your brain's in your head, and your brain is your master computer, and your brain is sending signals to your other target organs, which may be causing your symptoms, but may not be picked up by a very well-meaning physician, who's not considering the other possibilities."

• 32:45Mike Carruthers?

  My sense is that when people say, "It's all in your head," what they're really saying is, "It's nothing."

• 32:51Speaker 03

  Correct. And you can imagine how that would be very dismissive or demeaning to an individual who's trying to arrive at a diagnosis for their symptoms that are causing them real distress.

• 33:04Mike Carruthers?

  But how often does this happen? How often do people present with real symptoms? And it turns out, it is in their head? Is it one out of a hundred? One out of a million? I mean, give me a sense.

• 33:17Speaker 03

  Sure, that's a great question. Forty percent of visits to a primary care doctor are for general symptoms such as headache, fatigue, difficulty sleeping, shortness of breath would be another one. And in only 25% of those cases can a quote "biological diagnosis" be found based upon the usual physical exam, laboratory studies, radiographs. But there's lots of diagnoses that take a bit more investigation. And so I like to think of myself as a medical detective because I think about other factors

• 34:00Speaker 03

  that may be influencing the individual at the time.

• 34:05Mike Carruthers?

  And those factors might be things like what?

• 34:08Speaker 03

  Workplace stress, stress at home, a toxic environment, an environment in which they're exposed to secondhand smoke, and they suddenly develop difficulty breathing. And they go to a pulmonologist, and the pulmonologist will do a chest x-ray and do lab studies and listen to their lungs, and they're like, hmm, and we don't see anything. And yet, the fact that they're being constantly exposed to toxins from their workplace can be actually causing some of the difficulty with their breathing. You know, some of the other factors that fall into the category of toxic environment

• 34:48Speaker 03

  would be, you know, chemical exposures, mold, undetected mold. And these things can cause all kinds of physical symptoms that may not be readily apparent to even a specialist. For example, toxic mold exposure can cause things like skin disorders, which a well-meaning dermatologist may not pick up, even though they're looking for things that they can treat. And I think part of the reason is that in medicine, we have become so specialized and so siloed that if you go see someone who specializes in cardiology, they're going to well meaning try to find something wrong with your heart. And if they can't, they're

• 35:33Speaker 03

  going to be like, we don't really see anything wrong, maybe you should go see Dr. X and they'll be referred to a different specialist and that specialist again, they're going to try to find something they can find.

• 35:44Mike Carruthers?

  What's your sense about how big a problem is this? That's what I really want to try to understand. Is this 50% of doctor visits? Is this 1/10 of 1% of doctor visits? How often does this happen?

• 35:59Speaker 03

  There's about 80 million people in this country who are diagnosed with what are called medically unexplained symptoms. That's a lot of people. Many of them do not come to the attention of someone who can take a look at that. As I said, 25% of those who go see primary care doctors, they're not going to come up with a diagnosis. And even among specialists, it's not a whole lot better. So it's a cost in terms of one's self doubt, meaning if doctors are telling you there's nothing wrong with you, but you know you have physical symptoms, it's self doubt. So it can impact you psychologically. It has

• 36:38Speaker 03

  a tremendous impact on work performance because there's a great amount of time spent away from work to try to diagnose these issues and try to find a provider who can come up with them. And in terms of the cost to the healthcare system, if you get referred to doctor, doctor, doctor, and sometimes procedures that are not necessary, it's a tremendous cost for the medical care.

• 37:07Mike Carruthers?

  When it is a psychological problem or a social problem, does often fixing the social problem or the psychological problem fix the physical problem? And how would you even know or tell?

• 37:21Speaker 03

  Yeah, again, these are really great questions. So I'll give you an example. I see a lot of folks who are referred from gastroenterologists who come to my office with a diagnosis called irritable bowel syndrome. And it's kind of a nonspecific term of people who are having alternating difficulties with diarrhea and constipation. But oftentimes, the underlying issue with IBS is an anxiety disorder. And if you treat the anxiety disorder, their gastrointestinal symptoms improve dramatically. So how do I know? I know because I take a complete history, I find out what's happening in their life,

• 38:06Speaker 03

  I find out what's happened in their past life. There's a significant percentage of individuals who present with GI symptoms, who have a past history of trauma or neglect. And so, you know, looking at these things and arriving at a more broad-based approach to coming up with a diagnosis, yes, I actually can improve their underlying physical symptoms. Same thing, for example, with someone who comes in with an autoimmune disorder. Folks with autoimmune disorders have real physical symptoms. Their symptoms are based on the fact that their immune system, which is supposed to

• 38:46Speaker 03

  protect us from invaders, so to speak, overreacts. And instead of just addressing an invader or an injury, it begins to attack one's own healthy tissues. We know from all the data that's out there that stress is a major factor in worsening symptoms of autoimmune disorders. Because stress causes inflammation and inflammation is linked to many disorders, including autoimmune disorders. And if you can find ways of reducing the stress in their life, either through medication or psychotherapy, their autoimmune symptoms improve. It's not going to cure the underlying cause,

• 39:31Speaker 03

  but it can dramatically decrease their symptoms so that they become more functional and can actually use less medication that's prescribed by their rheumatologist, for example.

• 39:43Mike Carruthers?

  So I want to understand something about pain. Can your brain create pain? Or it just makes pain feel worse if you have real physical pain?

• 39:56Speaker 03

  Generally, people don't imagine that they have pain. Generally, there is some type of real reason. I stubbed my toe. I have a bad tooth.

• 40:08Speaker 03

  You know, my head hurts. Usually, they are real. But the way one interprets the physical sensation can impact the course of how this may progress or be treated. Here's an example of how people may perceive pain in a different way. I stubbed my toe. Ow, you silly, whatever you want to call yourself. You really shouldn't have done that. That's dumb. And you get angry at yourself. Versus someone has a history of breast cancer. They've had surgery for the breast cancer. And hopefully, they're in remission. Six months later, they end up doing some exercise and they pull a muscle

• 40:53Speaker 03

  and they have pain in the area of their scar. The question, it may be, it won't be something like, oh, you silly, you did exercise and you exacerbated the pain in that muscle. It's, oh, my God, I hope the cancer hasn't come back. So it's the interpretation of the pain that may be very different. And the way people who now specialize in that area look at pain and management of pain very much encompasses one's psychological state. If you're depressed, your pain's going to feel worse. And if you're not depressed, you're still gonna have pain, but it may not be as bad.

• 41:33Mike Carruthers?

  What do you recommend, though, to people who don't know who you are until now? If I've got a doctor telling me, "We can't find anything. This really hurts." Who do I call? What do I do?

• 41:47Speaker 03

  Again, that's a very good question. I'm glad you asked it. I think that people in general know themselves and their bodies better than any doctor. Yeah, we go to school for a long time and we specialize and we think we're really smart. And, you know, hopefully we are. But I think that, in general, patients know their bodies better than anybody. And if you're being told by a physician or a provider, there's nothing wrong with you. You know, "Stop worrying about it." I had one patient whose doctor said, you know, "Go read a book." Which was absurd, right? I mean, it's good to read a book, but it had nothing to do with why her blood pressure was elevated.

• 42:29Speaker 03

  You have to look at reviews. In other words, if one doctor's telling you this and you don't appreciate what they're telling you because you know there's something wrong with you, you don't have to go back to that doctor. You know, patients are paying our salaries and we deserve to do the best we can. And if you, as a patient, are not getting the answer that you want, you are not, you don't necessarily have to go back to that provider. So what I like to say to patients is, you know, you wouldn't hire a plumber without looking at their reviews, right? There are plenty of sites now available where you can review physician,

• 43:13Speaker 03

  patients' reviews of physicians and their qualifications. And we have lots of resources now that we didn't used to have. Make sure that when you do go to a physician, because time is limited, write down your questions, write down your concerns. If the doctor or provider says we can't find anything, it is reasonable to ask, are there other procedures or tests that we might do that would help us if the answer to that is no? Again, very reasonable to ask the question, is there a specialist that you might consider, referring me to who you think might look in a different direction?

• 43:54Mike Carruthers?

  Are there things people can do themselves? Must they always seek out a doctor? Or are there things they can do at home?

• 44:04Speaker 03

  There are lots of things that you can do. So without getting into a whole lot of biology, there is a part of your sympathetic nervous system called your parasympathetic nervous system. And that's the part of our nervous system that helps us calm down and regulate. And there are things we can do to stimulate that part of our nervous system, such as exercise. One of the best things you can do to reduce stress. There's a quote from a Cleveland Clinic specialist in gastroenterology that says, the best thing you can do for gastrointestinal symptoms is exercise. Adequate sleep. I think people really underrate the importance of a good night's sleep. If you don't sleep well, it causes all kinds of problems,

• 44:49Speaker 03

  including increased inflammation. Eat a healthy diet. And when I say diet, I don't mean you should go on a diet to lose weight. I mean, there are foods that you can eat that can improve your mental health and physical health and actually decrease inflammation in your body. And finally, social outlets. If you have healthy social relationships, that has also been shown to help us live longer, decrease chronic illness, and decrease stress.

• 45:19Mike Carruthers?

  Well, this is very enlightening for people who have had problems and been told, you know, we can't find anything, or, you know, maybe it's stress, and it's all very vague. And there's really something to this that I think is important for people to understand. My guest has been Dr. Susan Trackman. She is a specialist in psychosomatic medicine and author of the book, It's Not Just In Your Head. And there's a link to her book at Amazon in the show notes. Great, Susan, thank you for being here.

• 45:51Speaker 03

  I very much appreciate you having me.

• 45:57Mike Carruthers?

  You ever notice when you watch professional tennis, or you go to a gym and watch somebody lift weights, you often hear a lot of grunting. It sounds a little weird, and if you're standing nearby, it's hard not to roll your eyes. But the fact is, grunting may actually help. Research has found that making a forceful sound while exerting yourself can increase strength and power. In one study, people generated significantly more grip strength when they grunted than when they stayed silent. The secret isn't the noise itself, it's what the noise does. Grunting usually comes with a forceful exhale that helps tighten your core, stabilize your body, and recruit more muscle power.

• 46:41Mike Carruthers?

  In other words, that strange sound may be your body's built-in performance enhancer. So the next time you hear somebody grunting at a gym, remember, it may sound weird, but there's a good chance those people are actually getting stronger because of it. And that is something you should know. Hey, I would really appreciate it if you would tell somebody about this podcast, since you've just listened to a whole episode. You have a pretty good sense of what it's about. You could tell somebody and get them to listen, and then we get another listener. And in this business, every listener counts. I'm Mike Carruthers. Thanks for listening today to Something You Should Know.

• 47:22Speaker 06

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