FIRST & FOREMOST WHITEPAPER: OUR INNOVATIVE FORMULA

By: Sarah Pettry, MS, RDN 

May 2022

Executive Summary:

This whitepaper provides a general overview of the design and product attributes of First & Foremost, an evidence-based, nutrition supplement program that is designed to provide comprehensive nutrition and optimal bioavailability. First & Foremost offers a dayparted multivitamin supplementation program that delivers the right nutrients in the right dosage at the right timing, in a patent-pending formulation.

Table of Contents:

1. Introduction
2. A Dietitian-Designed Formulation
3. Our Approach to Comprehensive Nutrition
4. Key Nutrients Missing in the American Diet
5. Right Nutrients — The 26 Vitamins & Minerals in First & Foremost
6. Right Dosage — Recommended Dietary Allowance (RDA) & Why It Matters
7. Right Timing — Our Dayparted Approach

1. Introduction

First & Foremost is an evidence-based, nutrition supplement program that reflects a better approach to bioavailability. Our dayparted, patent-pending program provides 26 essential nutrients at the right time (morning, afternoon, evening) to ensure your body fully absorbs the nutrients you need. Designed by dietitians and backed by science, First & Foremost provides a healthy foundation for everyday nutrition. We’re here to explain the methodology of our formulation and how we deliver nutrients with better bioavailability.

2. A Dietitian-Designed Formulation

First & Foremost is designed by a team of Registered Dietitians, who are trained and licensed to administer medical nutrition therapy. In fact, they’re the only health profession qualified and certified to give nutrition guidance and advice to others. Because of our specific expertise, Registered Dietitians know how hard it is to get the vitamins and minerals you need, and how your body processes each of them differently depending on what you recently ate or drank, your activity level, how old you are, and more.

Building on our unique understanding of bioavailability, we were inspired to develop a new kind of supplementation program. First & Foremost was born out of our collective frustration with multivitamins that promise optimal health but under-deliver on essential nutrients and absorption — too often, they sacrifice absorption for convenience or contradict the science-backed principles of absorption. The purpose of a supplement is to supplement your diet — to bridge any gaps in your daily nutrition — and we felt that the current options missed the mark. In addition, we find the supplement space to be confusing, misleading and frustrating for consumers. With First & Foremost, we have a comprehensive supplement that we would wholeheartedly recommend — and take ourselves.

3. Our Approach to Comprehensive Nutrition

The scientific connection between food and health has been documented for decades, with significant evidence supporting that a healthy diet and lifestyle can help optimize good health and reduce the risk of chronic diseases. Even as we strive to obtain all the essential nutrients through foods and beverages on a daily basis, maintaining a healthy dietary pattern every day is difficult. Hence, the key benefit of a dietary supplement.

We heavily researched each of the 30 essential vitamins and minerals to develop a clear understanding of their roles and functions within the body. Our team of dietitians reviewed thousands of research studies, textbooks, and scientific resources like the National Institute of Health (NIH). We analyzed the intakes of all essential nutrients, using the micronutrient usual intakes estimates based on nationally representative data from the National Health and Nutrition Examination Surveys (NHANES). We studied each nutrient's RDAs, forms, inhibitors (from foods and nutrients), deficiencies, and toxicities. Nutrients come in many different forms, some work better than others, and some compete for absorption with one another. Poring over the research helped us determine the ideal form, amount and pairings for each nutrient. You can see some of our high-level research at fandfnutrition.com/nutrients, and more information lives in each nutrient deep-dive here.

4. Key Nutrients Missing in the American Diet

As dietitians, it was important to us to provide the nutrients that are under-consumed or missing from the American diet — that is a key purpose of a supplement. Our research showed that a significant number of Americans do not meet their recommendations for several micronutrients, leading to inadequacy of immune health nutrients. For example, 45% of American adults had inadequate intake of vitamin A from food, 46% for vitamin C, 95% for vitamin D, 84% for vitamin E, and 15% for zinc. 

Some nutrients are considered Dietary Components of Public Health Concern for Underconsumption by the USDA, identified due to their typical intake in the U.S. — and especially important because low intakes are associated with health concerns. As of the 2020-2025 Dietary Guidelines for Americans, the micronutrients of concern include:

• Calcium
• Potassium
• Vitamin D
• Iron

We also placed high importance on developing a comprehensive nutrition combination, ensuring we included nutrients that are either omitted from supplements or included in minimal or inefficient amounts. For example, due to its weight, calcium is often left out of multivitamins or provided in minimal amounts not sufficient enough to meet one’s daily needs. The same goes for magnesium and choline. In the spirit of comprehensiveness, we include all of these nutrients in our formulation.

5. Right Nutrients — The 26 Vitamins & Minerals in First & Foremost

After thorough research, we chose to include 26 of the 30 essential micronutrients to provide a comprehensive approach to supplementation — many of these nutrients are dependent on each other for various functions within the body, so it’s best to provide a complete foundation in one cohesive program. Our research also indicated that while there are a handful of nutrients Americans haven’t been getting enough of, there are 4 essential nutrients that Americans consume too much of. We excluded these 4 from our formulation (see list below chart). Here’s an overview of the nutrients we included:

As mentioned, there are four essential nutrients we excluded because we felt they were unnecessary to supplement. Research indicates that Americans consume enough of them, and we didn’t want to risk overconsumption: 

• Sodium - This nutrient is consumed in sufficient amounts each day, primarily from processed foods in the form of sodium chloride (aka table salt).
• Fluoride - Most people in the U.S. consume adequate amounts through foods naturally containing fluoride, fluoridated tap water, and food products made with fluoridated tap water. According to the NIH, “an analysis of NHANES data in 2001–2002 and 2011–2012 found that rates of dental fluorosis (from very mild to severe) increased during this 10-year period, from 29.7% to 61.3%.” 
• Chloride - Nearly all dietary chloride consumed in the diet is from sodium chloride (table salt), which the average American meets or exceeds this nutrient need each day. The average adult consumes an estimated 2,000-8,000 mg of chloride each day (Gropper, pg 468).
• Sulfur - As a part of all protein-containing foods (meat, fish, poultry, eggs, milk, legumes, nuts), the measure of deficiency is unknown, and a protein deficiency would occur before a sulfur deficiency (Understanding Nutrition; pg 410).

6. Right Dosage — Recommended Dietary Allowance (RDA) & Why It Matters

With 26 nutrients selected, we then needed to determine the appropriate dosage and form for each nutrient. We chose the Recommended Dietary Allowance (or Adequate Intake) amounts as our baseline to support your diet each day. The NIH defines the Recommended Dietary Allowance (RDA) as “the average daily level of intake sufficient to meet the nutrient requirements of nearly all (97-98%) healthy people. Adequate Intake (AI) is established when there is insufficient evidence to develop an RDA and is set at a level assumed to ensure nutritional adequacy.” 

Using these research-backed amounts establishes a foundation for the 26 essential micronutrients that we know will benefit nearly all healthy people (defined as those without underlying health conditions). Relying on our thorough research, we determined our dosage based on the nutrient requirements, safety, bioavailability, and form that best complements the average American diet. 

The hundreds of roles vitamins and minerals play within the body have led many people to conclude that “more is better” when taking supplements. However, just as insufficient intake can cause harm, so too can excess intake. For example, excess of one mineral can create an inadequacy of another, and over-supplementing is usually the culprit. This is another benefit to supplementing with your RDA/AI amounts. 

Here is how we approached the dosage for our Female 19+ program:

7. Right Timing — Our Dayparted Approach

The final piece of our differentiated formulation is daypart. The timing of a nutrient’s delivery — that is, time of day, with or without food, and its pairing with other nutrients — is the underpinning of our bioavailability value proposition. 

Our Female 19+ and Male 19+ formulas provide 26 essential nutrients in 3 separate occasions, omitting the few essential minerals (sodium, chloride, fluoride, sulfur) that most Americans already consume in excess daily or for which deficiency is not known. Because of the factors that influence nutrient absorption, we split our formulation into three dayparts, which we’ll dive into below, with the nutrient form specified:

7a. Why Three Dayparts?

We wanted to create a comprehensive program to meet your RDAs. The one-a-day multivitamin can’t be comprehensive, because it is difficult to include all 26 nutrients in beneficial amounts in just 1 or 2 gummies or capsules per day. Most supplements provide little-to-no calcium or magnesium because these two nutrients are heavy and take up substantial space in the formula. However, we believe you can’t consider a supplement complete and comprehensive without these minerals.

Even splitting a multivitamin into two dayparts is not efficient, because of contraindications. For example, iron is inhibited by many minerals. And at dosages in excess of 250mg, calcium begins competing with magnesium and iron for absorption, so you don’t absorb enough of any of them. Yet calcium is a Nutrient of Public Health Concern in the U.S., and it is an important nutrient to supplement, as dietary intake is decreasing year over year.

By separating the nutrients across three dayparts, we're able to provide both a comprehensive formulation and enhanced absorption. Take calcium, for instance. The percentage of calcium absorbed from supplements (as with calcium from foods) depends not only on the source of calcium but also on the total amount of elemental calcium consumed at one time; as the amount increases, the percentage absorbed decreases. Absorption from supplements is highest with doses of 500 mg or less [1]. For example, the body absorbs about 36% of a 300 mg calcium dose and 28% of a 1,000 mg dose [2]. Therefore, separating out the vitamins and minerals that inhibit each other and formulating a three-a-day program offers the ability to provide the right dosage for all 26 nutrients to provide better bioavailability. 

Our Dayparted Program:

1. Morning’s featured nutrient is magnesium, joined by calcium, zinc, manganese and vitamin E. These nutrients are known to adversely interact with high doses of calcium and Iron — as iron is in the afternoon, and because we use smaller doses of calcium*, there is no conflict. 
1. *We put calcium in all three dayparts, always less than 500mg, so there’s not enough calcium in a single occasion to be considered a “high dose.”
2. While magnesium is typically taken in the evening to aid in sleep, taking magnesium consistently in the morning helps to balance blood pressure and stress responses throughout the day.
2. Afternoon provides the bulk of your minerals, the featured nutrient being iron. Because iron has many potential nutrient and food interactions, we put it in the afternoon occasion, between meals and separated from many antagonistic nutrients in the program that would inhibit absorption. 
3. Evening includes the bulk of your B vitamins, choline, half of your day’s calcium, and a few other minerals and vitamins. This occasion is centered around overnight recovery, allowing your body to rebuild and recover from the day. 

Sources:

• Reider, C. A., Chung, R. Y., Devarshi, P. P., Grant, R. W., & Hazels Mitmesser, S. (2020). Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES. Nutrients, 12(6), 1735. (https://doi.org/10.3390/nu12061735)

• U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. (DietaryGuidelines.gov)

• Advanced Nutrition and Human Metabolism; 7th edition; S. Gropper, J. Smith, T. Carr. Page  468
• Understanding Nutrition; 12th edition; E. Whitney, S. Rolfes. pg 311-445. 
• NIH Fluoride - https://ods.od.nih.gov/factsheets/Fluoride-Consumer/
• NIH Magnesium - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761127/
• Harvard University. https://www.health.harvard.edu/heart-health/key-minerals-to-help-control-blood-pressure