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 on their website.
Episode Transcript
Aunna Herbst 0:00
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.
Matt Waller 0:12
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 and 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.
Aunna Herbst 0:53
Thank you for having me honored.
Matt Waller 0:55
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
it the 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?
Aunna Herbst 1:24
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 and
their family, deliver really good healthcare 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 at SALT.
Matt Waller 2:09
How did you get interested in that?
Aunna Herbst 2:12
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.
Matt Waller 3:58
Why is it called functional?
Aunna Herbst 4:00
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.
Matt Waller 4:16
Pathophysiology I've never even heard that term.
Aunna Herbst 4:20
So it is 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.
Matt Waller 5:25
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
Aunna Herbst 5:41
nice game.
Matt Waller 5:42
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.
Aunna Herbst 5:54
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.
Matt Waller 6:17
Do most people need eight hours?
Aunna Herbst 6:21
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,
Matt Waller 6:41
you know, students, a lot of times don't get enough sleep.
Aunna Herbst 6:45
No
Matt Waller 6:46
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.
Aunna Herbst 7:27
Yep. So I was just gonna say your, you will retain way more if you sleep a little
more.
Matt Waller 7:33
And it's funny. So, you know, you talk about pathophysiology, biochemistry, genetics,
environment, etc. Diet. So yeah, that's another thing I was in my 50s. Before I realized
that was a big deal.
Aunna Herbst 7:47
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.
Matt Waller 7:55
Okay, so that's interesting. So you, when you see a patient, you have dietician with
you
Aunna Herbst 8:02
They see them on the first visit, yep.
Matt Waller 8:04
Wow, what do they look at?
Aunna Herbst 8:07
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 leafies,
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.
Matt Waller 8:59
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.
Aunna Herbst 9:15
It's definitely can play a role turns on those genes, right?
Matt Waller 9:19
So certain foods can actually trigger genes to do
Aunna Herbst 9:23
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.
Matt Waller 10:35
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.
Aunna Herbst 10:53
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 kind of 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 to 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, tipped 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.
Matt Waller 11:48
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.
Aunna Herbst 12:06
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. 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.
Matt Waller 12:48
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
Aunna Herbst 13:14
Yeah,
Matt Waller 13:15
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.
Aunna Herbst 14:19
I ride my bike to work.
Matt Waller 14:20
Do you live in Bentonville?
Aunna Herbst 14:23
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.
Matt Waller 14:33
Well I don't like cold weather either. Right? I'm with you. I don't like that at all.
A little bit.
Aunna Herbst 14:39
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.
Matt Waller 14:47
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, you
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.
Aunna Herbst 16:08
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.
Matt Waller 16:38
Should it be in the beginning of the day, in the middle of the day, at the end of
the day?
Aunna Herbst 16:41
Well it 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 mmm. 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.
Matt Waller 17:45
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?
Aunna Herbst 18:01
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.
Matt Waller 18:17
You started this business, you moved here from another city.
Aunna Herbst 18:21
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 in 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.
Matt Waller 18:57
How was that?
Aunna Herbst 18:59
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 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 and 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 based 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.
Matt Waller 20:44
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?
Aunna Herbst 20:56
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.
Matt Waller 21:40
You said people sought you out because of they were interested in functional medicine.
Aunna Herbst 21:44
At 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 two 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.
Matt Waller 22:36
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?
Aunna Herbst 22:49
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.
Matt Waller 24:32
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?
Aunna Herbst 24:51
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.
Matt Waller 25:49
So what would you recommend, as a last comment in terms of something for our students
that you wish they would know?
Aunna Herbst 25:59
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.
Matt Waller 26:41
Dr. Herbst thank you so much for taking time to visit with us and share your wisdom
with our students. We really appreciate it.
Aunna Herbst 26:50
You're welcome. Thanks for having me.
Matt Waller 26:52
On behalf of the Sam M. Walton College of Business, I want to thank everyone for spending
time with us for another engaging conversation. You can subscribe by going to your
favorite podcast service and searching. Be epic. B E E P I C
