This week Matt sat down with Dr. Aunna Herbst, Chief Medical Officer and co-founder of SALT Health. In the episode she highlights ways to prioritize your health and mental wellness, the importance of sleep, exercise and diet in improving your overall well being as well as an overview of functional medicine. Dr. Herbst started the first functional medicine clinic in the world at Cleveland Clinic before moving to Bentonville to start SALT Health.

Learn more about SALT Health here: https://salt-health.com/about/primary-care/

We need to learn how to prioritize our health and our mental wellness. And you do that and you have the energy and you have the stamina, you can move mountains,

excellence, professionalism, innovation and collegiality. These are the values the Sam M. Walton College of Business explores in education, business and the lives of people we meet every day. I am Matt Waller Dean of the Walton College, welcome to the be epic podcast. I have with me today Aunna Herbst who is the Chief Medical Officer and co founder of SALT health. And she is a physician who founded a business to really disrupt the healthcare industry to some degree. And we're going to talk a little bit about that. So Aunna, thank you so much for taking time to visit with me, I appreciate it.

Thank you for having me honored.

I think there's a lot to learn from this conversation, both about health and about entrepreneurship. I would like to start with the mission that you have, and the concept. I was really intrigued when I first learned about it. And the more I've learned about more intrigued I've been, but would you mind telling us a little bit about what you're doing and why this is a different concept than most medical practices? Yeah,

so there's a couple of layers to this. But the generalized mission of salt health was to offer what I consider excellent health care, with an emphasis on medicine, preventive wellness, as well as optimizing an individual health care. So what I mean by all of that is, I wanted to be able to show that you can do primary care, and take the time to hear the patient's story, take the time to get to know the patient in their family, deliver really good health care be accessible, and not make it extremely expensive. You know, I think we have a much shorter, true mission statement on the website. But that was, you know, that's always been my dream. And that's that's what we've developed here itself.

How did you get interested in that?

So long story, make it really short. So I was a patient once and always had my eye on medical school, but was at one point too ill to go to school to medical school that was eventually got better. During that process of getting better. I had discovered and implemented a lot of new lifestyle changes, dietary changes, I really got into the world of what they call naturopathic type practices, alternative medicine practices that that did help me to a degree however, I think I'm a little too left brain so I wasn't able to fully embrace that world. I needed some some happy medium between the two worlds, I saw the potential on both sides, allopathic and the naturopathic world. And so when I got better, and my health got better, I started a small business, which was what I would consider the first health coaching because it was a lifestyle counseling businesses what I called it and I basically just help people with things like sleep and clean eating and you know, relationship forming and the importance of that and your health. And that's what I was doing. And then as that sort of grew, and my health got better and better. And then I went off to med school. I was a mom at the time to small children. So anyway, I dove into that adventure. And then I decided how am I going to bring these two worlds together the naturopathic world that I learned while I was getting better, and that I did my thesis in and I did a study in. But I needed some way to bridge my two, my two trainings and functional medicine became the way to do that. And I really embrace the root cause investigation to medicine. I like looking at systems based approaches. I like the science, but I also appreciate, you know, the clinical evidence that's out there as well. And so anyway, functional medicine has been a way for me to to bring those two together. So that answers how I got

there. Why is it called functional,

functional because we're trying to optimize functions. So we look at biochemistry and pathophysiology, genetics environments, and we put all of that together. So the idea is to help restore homeostasis, or balance in the system for the body.

Pathophysiology I've never even heard that term

says looking at the bodily functions combined with things like pathogens and enzymatic functions and how they interplay. So you're kind of mixing the pathology world and then the physiology world and putting them together. It's a blended word. I think it's really important because biochemistry you can take a medicine you can take an herb, you can eat a nutrient, you can eat an apple, you can eat some you can introduce things into our body and that changes biochemistry. You can also have disrupted sleep and it changes physiology. So I think all of those things work together and then when you combine it with you know, genetics and genomics and epigenetics and all of those new things that are on the on the forefront of medicine, you can really start to individualize the approach to your patient. So when you went to the doctor, you know, in an ideal world, they would say you're deficient in these things. And if you had this, your systems would work better. And because you had this genomic variant, it interferes with this system. So we want to add this to make that work better. And so you would leave and say, Man, that was so personalized, that's functional medicine.

You mentioned sleep. I'm 57. I don't think I figured out that sleep was important. Until two years ago, I tried to go to bed early. And some days I do a good job. But I stayed up late watching the Alabama Georgia game, nice game. But I noticed like today, I don't have the same level of energy. I think I'm not as quick in terms of thinking about remembering names. For example, when I'm short on sleep,

yeah, we get some restoration, the more you get sleep, another fun fact, if you get less than five and a half hours of sleep per actually number of studies, your level of inflammation goes up quite a bit. So they've measured in people that have eight hours, six hours and less than five and a half. And it's it's a CRP, which is a C reactive protein, it's an inflammatory marker, and it goes up.

Do most people need eight hours?

no, they actually have have really discovered that not everybody is wired the same. So anywhere between six to eight, for most people, some people even nine, but typically, it's it's not less than five and a half, because that's actually detrimental to pretty much everybody in all the studies. But the the six and a half to eight and a half seems to be the sweet spot for most people,

you know, students, a lot of times don't get enough sleep. No, I was speaking to our new MBA students. I guess it was in August. I mentioned to them, you know, that they should try to get plenty of sleep. And, you know, I think they found that odd that I would bring that up, you know, but I know that, you know, when you're in the MBA program, many of them are working full time, or part time, and there's a lot to learn. You know, and so, sometimes you don't get enough sleep. But I always argue you're probably better off cutting everything back. Because your retention will be higher.

Yep. So I'm just gonna say your, your retain way more if you sleep a little more.

It's funny. So, you know, you talk about pathophysiology, biochemistry, genetics, environment, etc. Diet. So yeah, that's another thing i i was in my 50s. Before I realized that was a big deal.

Yeah, it's actually number one, we actually have a registered dietician on the team that everybody sees, because I think it's that important.

Okay, so that's interesting. So you, when you see a patient, you have dietician

with you, they see them on the first visit.

Wow, what do they look at? They'll do

a dietary history for me, we learn you know, what their food allergies are what they just have aversions too, because you can't really implement a healthy eating pattern or lifestyle was someone that can't stand, you know, green leaf leaves, or they think everything that bitter is gross. And so you have to meet them where they are. But I think a lot of health and wellness starts with what we're putting into our body, it's, you know, it's our biggest fuel. Anyway, learning their history learning, you know, where they are, what their budget is, what their time is, do they have time to prep food, do they not, we have to find some way to teach them and help them and support them, you know, implement a good healthy eating pattern. And then when tests come back, if I see deficiencies and so forth, and the dietitian can help me implement, you know, nutrients into the diet that help replace deficiencies as well.

I had cancer and went through radiation, chemo and surgery and so forth. But that never really came up. I wonder if my eating may have played a role in getting cancer? I didn't know.

It's definitely can play a role turns on those genes, right?

So certain foods can actually trigger genes to do

yes, but some foods are more inflammatory than others. Some foods are more toxic than others. So you have a predisposition, for example, and you already have a lot of inflammation, you're not sleeping, well, you're not eating well, you have a genetic predisposition to develop even autoimmune for instance, it doesn't even have to be cancer. If you give it the right environment, certain genes turn on or off or they are manipulated. Say you turn on an oncogene cancer gene, it starts to replicate quickly, and if it's fed the right fuel, it will wreck the eating faster. A good example and it's not the only example but sugar is we know this already. Really pretty nasty food product when it comes to cancer, because that's even how we check on PET scans, right? They give you a concoction, it's very high in sugar content or glucose contents. And cancer cells love glucose. And so they suck it in. And then that's what lights up on the PET scan results. So we can see where there might be some cancer cells spread around. So that just gives you a good example of you know, maybe that might be feeding some of those little little cancer cells. So anyway, yes, diet plays a huge role in in our outcomes. from a health standpoint, I

think, you look at all these different things. So when a patient comes in, you start talking about sleep and exercise and diet, and genetics and so forth. It's probably a surprise to a lot of your patients, I would think

I think a lot of people seek us out because we do the functional medicine. So they're a little bit savvy to that, that side of medicine. But yeah, no, I think a lot of people are quite surprised, even though they think they can I have a handle on what they might be getting into. It's a big dynamic. We have a health coach, we have a dietician, we have the clinicians, and when you take a you know, 45 minutes or an hour long history, from birth to their current age, it throws people off, you know, they're like, Why do you have to know that I have high blood pressure, what does it matter how, where I was born, how was born and what trauma I had as a kid. But a lot of that does matter, I find, it also gives me clues to maybe things that might have, you know, tip the scales or things I might need to investigate that could be a continual nuisance to the system that's that needs to be taken away or help so that you can restore balance. So I think that's really important is to get a full history. Yeah, yeah, I think it does throw people off a little bit.

Now exercise, we're actually trying to figure out how to encourage students to sleep, eat well, exercise, etc, manage their stress, we're working on that we're doing a number of things. It's unusual for university to think about that. It seems like it's impressive,

because my experience is the healthier I am and the more I take care of myself and put those things as a priority, the better business person I am, the better physician I am the better. Mom, I could be when you're juggling all of those sorts of responsibilities. You have to be at the top of your game. So you really need to put those things as your priority. And I wish somebody taught me that in undergrad or in graduate school. That'd be nice. Yeah, so yeah, I think that's amazing. Even if you could implement one, they say, you know, 1/10 of a change in your lifestyle, you know, can give you quality of life for 10 or more years. So the earlier you start the better pick one that you can hone in on while you're in school and capitalize on it. There's all

different types of exercise. Like, we have a hilly campus, yes, yes, you do. And some people live in, in dorms that are at the closer to the basketball arena. And so those students have to walk up a steep hill, they may do that multiple times one of my kids did it. And it really a lot of times strengthens their legs, they find out they Yeah, they may get sore at first. You know, the first couple weeks of school and they realize, Wow, this stills probably good for me. And so we have something on campus. There's a guy we hired named Amman, Jordan. And his title is director of active transportation. And the concept in the Walton college is one of the guinea pigs for this. So we're encouraging faculty and staff and students to ride their bikes to work. Where I live, it would be unsafe for me to ride my bike all the way because I'd be on a busy highway. And so instead, I ride my bike to a certain point where there's the Greenway. I drive my car and I start riding it that way. And so it's only seven miles then to get here, which isn't a ton and I don't, I don't try to go super fast. I'm just trying to enjoy being outside and go back.

I ride my bike to work.

Do you live in Bentonville? Yeah, I

live in Bentonville. It's not very far. It's not like I'm doing some major marathon but it's a couple miles there and back. And my only rule is I don't ride and when it gets below 40

why I don't like cold weather either. Right? I'm with you. I don't like that at all. A little bit.

You know, it's nice and like you said if they could add that in walking around campus going upstairs instead of taking the elevator. It all adds up.

Right next to the business school complex here. We have the largest parking garage in the state of Arkansas. It's called the Harmon garage. People pay a lot of money to park there its expensive, including students. I mean, this thing's nine stories high doesn't look like it, because it's built into the ground Hill, you know, a new parking space in a parking garage costs. I think it's like $40,000. And not to park there. But that's how much it costs to build. If you take the whole building divided by the number of spaces, its expensive, yet, people could, and this is part of active transportation, intentionally park a mile or half mile from campus, and then walk the rest way not to save money on parking. But literally just to get exercise. do save money on parking, it's well worth it. But, but you get the exercise, but that's part of active transportation. We have outings sometimes where faculty and staff for example, after work, we might ride our bikes on a seven mile path and go somewhere and just have a visit with one another. It's a way to spend time together and to get to know people. Also be more active.

That's great. I think these are all really amazing things. What a blessing for the students to have people that are looking out for their well being. My other tip for future entrepreneurs and business folks alike would be meditation or deep breathing every day or some kind of downtime, 10, 15, 20 minutes, downtime, slow that cortisol so that fight or flight that we all run around. And I really think that's been something I've started since residency. And it's been something I do very consistently, should it be

in the beginning of the day, in the middle of the day, which

depends on who you are and what you've read. I find that twice a day works. I do it in the morning, and then I do it midday, I do about 15 minutes each time. 18 minutes, sometimes in the afternoon, but they say that if you can do it, at least once a day, you'll lower the cortisol, a lot of us have that we're overstimulated with caffeine, we're you know, going 90 miles an hour, we've got five things on our, you know, data planner, we've got people calling us even when we're walking and exercising, nowadays, we're texting and we're planning and we really never take a second to let that fight or flight stuff settle down. And so we have much more chronic high blood pressure at an early age, we find we have a lot more pain, we don't sleep well because we're good. And then when you finally lay down at night to sleep, half the time your brain is downloading. So that causes some problems too, as well. So anyway, I think deep breathing or what I call nap or just sitting out in nature or just being quiet, nothing stimulating no phone, no talking no TV. I really think that's important as well.

I want to talk just briefly about your business. Functional Medicine is not typical around here. I've never seen it or been around it. And yet you opened a practice in Bentonville, called Salt Health. How did you pick Salt?

It was a conversation. It's basically stems from a mineral that's in the earth. That's just basic, it's needed for life. That's really where the conversation was stemming. I want something that's just real and foundational and fundamental. And that's why we came up with salt.

You started this business, you moved from another city,

Cleveland, I was at Cleveland Clinic, I actually went up there to help them start the first center for functional medicine in the world. Actually, in 2015. I was recruited from Oklahoma, where I was in practice doing a combined primary care family practice and functional medicine. And Oklahoma in rural Oklahoma actually, right out of residency, I was there five and a half years. And then I got a call from Cleveland Clinic. And they said, hey, you've been teaching, you've done research, you're doing insurance based model of family practice and functional medicine. And that's what we're trying to do. Could you come up and help us start it? So I did. How was that? It was great, because part of my passion behind functional primary care is the blending of those two worlds is that we need better research. And we need better data driven clinical research. And that was one of their primary goals was to do some pretty good studies, NIH funded studies where they could show that this functional medicine sort of approach to disease could decrease the financial burden on both patients and on insurance companies and on new the system in general, but also could provide really great outcomes, long term quality of life outcomes. And so I was really excited to be part of that part. And then I was also excited to go to help set up the first you know, Center for Functional Medicine, which is pretty neat, too. So then I took that experience, which was a wonderful experience for me. And then I took my family practice experience that I had in Oklahoma and I decided to blend those and make this model here. And so I was doing just straight Functional Medicine at Cleveland Clinic I really missed the family medicine part, I missed the primary care part. And I really felt like we were missing that because you can give people all kinds of tools and help them get to root cause. But when you send them back out into the real world, and they don't have a physician that understands that diet plays a role, like you said, or sleep plays a role or nutrient deficiencies play a role, then you're missing it, and they lose it. And it just goes away. And they're like, I don't have anybody to take care of me. And so I felt like that was something that was missing. And so I wrote a book about integrating functional medicine with primary care, in both insurance and cash base models and, and how important it is to spend time with patients and hear their story and optimize function. And that's what this is all about.

When you came and started this business, your practice in Bentonville? How long did it take you to start getting patients? And when did you actually start the business? Well, in

2018, my two partners and I started talking about our dreams and funny mine was the same as theirs, so I had written a business model about 15- 19 years prior 15 years ago, before we started talking about it, and it was very similar to their idea. And they knew me from Oklahoma as well. So we merged our ideas. And then salt started. And we opened up our doors here in Bentonville in 2019. And then we moved into our current building in 2020, right in the midst of COVID, early spring of COVID, if I remember, right, yeah, it was in June. So right after COVID really hit hard. So we've been here a couple years now 2022 -- 3 years, maybe

you said people sought you out because of they were interested in functional medicine.

First, yeah, I really attracted the functional medicine side. But from a business standpoint, I was trying to change the way we practice primary care. And that's my hopes and my dreams. And so I really wanted to educate the community in the public about the fact that we don't just do functional medicine, we do primary care. I mean, I see colds and flus and illnesses and hypertension, and diabetes, and all of that, but with a little bit different lens, a little bit different approach. And I think that at first was difficult, because I was one I moved into a community where I knew nobody, no referral source nothing. And to it was a whole new model like, you do what? And so anyway, that I feel like was a challenge. But at first it was people that were seeking out functional medicine, and then slowly, I think word of mouth, and we've grown in the community, which has been really great. You moved

into your new office around COVID Did that concern you because of the increased expense of a new facility or because no one knew what was gonna happen?

No, nobody knew. And of course, it was a it's heavy on our heart. But I also felt like that was a really good area for us to step up. Because as a primary care physician, I know that when I was in practice in Oklahoma, most physicians offices were really burdened and busting at the seams and hard to get into especially for emergency urgent cares, especially during cold flu season. And so I decided to go ahead and open up for walk ins for COVID treatment or support. So like if they, you know, you'd get COVID. And at the beginning, we were scared, we didn't know what to do. And we couldn't get in to see the doctor and nobody would see us in person. Nobody would listen to our lungs, nobody would reassure us. And so, you know, I said, How about we we do this, and we'll have kind of a back entrance. And we'll keep one room designated for that and bleach it down every time. And so we did and that's what we ended up doing for the community is saying, hey, doors are open, not just to members, but anybody that needs a walk in acute visit. And I feel like that was one area in COVID, that we sort of dropped the ball. If we can step in early and support the patient. However they needed support, whether it was an inhaler, or some nutrients or just reassurance that somebody is out there listening and looking at you. I feel like they did better in my opinion. And so that's what we did. So actually, in my mind, in a weird way, it was really actually helpful to us here at Salt to growth, because it showed that we could do you know, we could help in a primary care way. I don't want to say COVID is a blessing because it's been kind of a bit of a mess for most people. But in a way, it was a good growth for us. It also helped the team come together and like, hey, we can work together and figure this out.

So from what I understand, you really build your capacity in Bentonville. From what I've heard. So congratulations. Great success. So what do you do from here are you going to expand in Bentonville? Expand to other locations?

That's the dream is to to have another model or two another facility or two. I think in the short term though, we want to make sure one of my big Parts of the mission statement was excellent care, and we don't want to have, we want to be able to have pertinent and appropriate access for our current members and for people coming in. And so you know, we could continue to grow and keep busting at the seams and working people 90 to nothing, but I preached lifestyle with my patients and my staff. And if they're feeling the burden, if patients are not able to see us, as long as they want to see us or spend 20-30 Minutes with Us 45 minutes at a visit, then we're not doing what I said we were going to do. And so that's why, you know, slowing it down, and just really making sure we're delivering good care. Once we figure that out, and we have everything worked out and things are moving along, and I feel like my staff is healthy, and we've made a nice systems balance, then we can move forward and continue growing.

So what would you recommend, as a last comment in terms of something for our students that you wish they would know?

I think that we need to learn how to prioritize our health and our mental wellness and our overall well being that should actually be a course, in my opinion, I think it should be a priority. And when you do that, and you have the energy and you have the stamina, you can move mountains, separate the waters, you can make anything happen because you feel good. And then you can give back and it just is a beautiful cycle that you can start but that all starts from really, really appreciating and honoring yourself, your health, your mental wellness, your relationships. I think it's really, really important. So my tip is to just give yourself permission to make that a priority.

Dr. Herbst thank you so much for taking time to visit with us and share your wisdom with our students. We really appreciate it.

You're welcome. Thanks for having me.