A comparison of VitaWeightTM and Forceval® Dr David Ashton September 2013 VitaWeight™ Versus Forceval®
All surgical weight-loss patients need to take vitamin and minerals (micronutrient) supplements for life. Standard products, readily available at high-street pharmacies, are wholly inadequate, both in terms of the concentrations of micronutrients and in the specific formulations. In other words, they simple don’t have enough of the micronutrients and/or they have the wrong micronutrients.
Forceval® is a vitamin and mineral supplement commonly prescribed for surgical weight-loss patients in the UK and other European countries. Unfortunately, even Forceval® is inadequate in a number of important respects. The concentrations of some essential vitamins and minerals are simply inadequate for the post-surgical patient, whilst other important ingredients are missing altogether.
In Table 1, the concentration of vitamins and minerals in the VitaWeight™ formulae are compared with Forceval®. The essential differences between the two are as follows:
VitaWeight™: the basic dosage is one multivitamin capsule plus one calcium capsule. They should
be taken separately (at least a few hours apart) as the calcium may interfere with the absorption of iron1.
Forceval®:
calcium and iron are included in the same capsule which may reduce the proportion of iron absorbed.
Vitamin B12
Expert guidelines for supplementation in post-surgery patients recommend 350-500 µg/day of crystalline B122. VitaWeight™: 350µg in one capsule – more than 100 times that of Forceval®. The great advantage of
this is that patients taking VitaWeight™ don’t need B12 injections.
Forceval®:
3µg in one capsule so patients will require quarterly B12 injections.
Vitamin B1 (Thiamine)
Vitamin B1 (Thiamine) deficiency after bariatric surgery is uncommon (0.02%), but the consequences may be extremely serious as in Wernicke-Korsakoff Syndrome (WKS). WKS has been reported after LAGB, RYGBP and BPD/DS3-5.
VitaWeight™: 10mg in one capsule (1000% of the RDA for Vitamin B1) Forceval®: Vitamin K
Vitamin K1 is involved in blood coagulation, whereas K2 helps to direct calcium into bone and blood, rather than arteries, muscle or other soft tissues6. Studies now indicate that vitamin K2 also works to prevent certain cancers and bone loss7,8. VitaWeight™: Vitamin K1 and K2 are included. There are several active forms of vitamin K2: MK4,
MK7, MK8 and MK9 and the VitaWeight™ formula includes the MK-7 form which is the most relevant to health.
Forceval®:
Vitamin K is not included in the Forceval® capsule.
Vitamin D
Vitamin D2 has a much lower potency and a shorter duration of action when compared with vitamin D3. In fact, vitamin D2 has a potency less than one-third that of vitamin D39. VitaWeight™: VitaWeight™ includes the D3 (cholecalciferol) form rather than the D2
Inositol
Inositol has been shown to be closely involved in insulin signalling and increases insulin sensitivity10. In women with PCOS it has been shown to reduce testosterone, acne and hirsutism and may also reduce the risk of diabetes11,12. VitaWeight™: Included within the VitaWeight™ formula Iron
The ASMBS recommendations for iron dosage are 18-27mg/day2. VitaWeight™: The VitaWeight™ formula has ferrous bisglycinate. This is important because the
bisglycinate salt is less irritating to the gastric mucosa and therefore has significantly fewer side effects such as nausea, epigastric pain and vomiting13. In addition, we have a significantly higher dose of iron.
Forceval®:
Boron makes an important contribution to bone health both directly through its actions on osteocalcin28, but also indirectly through its effects on other vitamins and minerals such as calcium, vitamin D and magnesium29-32.
VitaWeight™: The VitaWeight™ calcium capsule also includes boron. Forceval®: Calcium
ASMBS Guidelines specifically recommend calcium citrate2 as it can be taken with or without food and does not constipate. Importantly, it is the one calcium compound that does not require acid to break it down. This is relevant for post-surgery patients who may produce less acid than previously and who may also be taking acid-blocking medications (PPI’s or H2 blockers). Calcium citrate has been shown to have a better absorption profile than other calcium salts, especially calcium carbonate14.
Reports of hypocalcaemia after gastric bypass are inconsistent. Some studies report perfectly normal calcium levels after several years of follow-up and one study reports normal calcium absorption15-18. This is because if dietary calcium is not available or intestinal absorption is impaired by vitamin D deficiency, calcium homeostasis is maintained by increases in bone resorption. Recent studies have shown a possible increase in cardiovascular disease with in women with daily calcium supplement intakes above 1400mg19,20. Major reductions in calcium levels are not observed after sleeve gastrectomy or adjustable gastric banding21,22,17.
Recommendations for calcium supplementation after bariatric surgery vary widely, with no consensus as to the correct dosage. VitaWeight™: The VitaWeight™ formula has 200mg of calcium citrate, but combined with
magnesium, vitamin K1 and boron to optimise bone health. Since sleeve and bypass patients are recommended to take three capsules per day, the minimum dose of calcium is 600mg. This should be monitored at intervals.
Forceval®:
Does not follow the ASMBS guidelines and instead uses calcium carbonate
Magnesium (Mg)
Magnesium is increasingly recognized as an important contributor to bone health23-25. Apart from direct effects on the structure and the cells of the skeleton, Mg deficiency acts indirectly by affecting the homeostasis of the two master regulators of calcium homeostasis, i.e., parathyroid hormone (PTH) and 1,25(OH)2-vitamin D thus leading to hypocalcemia26. A study of women with osteoporosis in Israel reported significantly increased bone mineral density with 250 mg/day of magnesium supplement when compared to a control group who did not take magnesium supplements27.
VitaWeight™: VitaWeight™ has a generous concentration of magnesium (both capsules contain Table 1: A comparison of micronutrients in VitaWeight™ versus Forceval® Nutrient VitaWeight ™ Forceval® (1 capsule) (1x Multivitamin + 1x Calcium) Vitamin A Vitamin D3 Vitamin E Vitamin K1 Vitamin K2 (M-7) Vitamin C Thiamin B1 Riboflavin B2 Niacin B3 Vitamin B6 Folic Acid B9 Vitamin B12 Pantothenic Acid B5 Inositol Magnesium Manganese Selenium Magnesium Chromium Molybdenum Citrus Bioflavenoids ≠ none present Note that the values shown are for 1 capsule of Forceval® versus one VitaWeight™ Multivitamin capsule + 1 calcium capsule. Scientific References
1. Inhibition of haem-iron absorption in man by
2. Aills L, Blankenship J, Buffington C et al. Bariatric Nutrition: Suggestions for the Surgical Weight Loss Patient.
ASMBS Allied Health Sciences Section Ad Hoc Nutrition Committee. 2008;4(5 Suppl):S73-108.
3. Bozboa A, Coskun H, Ozarmagan S, et al. A rare complication of adjustable gastric banding:
Wernicke’s encephalopathy. Obes Surg 2000; 19:274-5
4. Makarewicz W, Kaska L, Kobiela J et al. Wernicke’s syndrome after sleeve gastrectomy. Obese Surg
5. Escalona A, Perez G, Leon F, et al. Wernicke’s encephalopathy after Roux-en-Y gastric bypass. Obes
6. Bugel S. Vitamin K and bone health in adult humans. Vitam Horm. 2008;78:393-416.
7. Kakizaki S, Sohara N, Sato K, et al. Preventive effects of vitamin K on recurrent disease in patients with
hepatocellular carcinoma arising from hepatitis C viral infection. JGastroenterol Hepatol. 2007;22(4):518-522.
8. Bolton-Smith C, McMurdo ME, Paterson CR, et al. Two-year randomized controlled trial of vitamin K1
(phylloquinone) and vitamin D3 plus calcium on the bone health of older women. J Bone Miner Res. 2007;22(4):509-519.
9. Armas LAG, Hollis BW and Heaney RP. Vitamin D2 Is Much Less Effective than Vitamin D3 in Humans
10. Constantino D, Minozzi G, Minozzi F, Guaraldi C. Metabolic and hormonal effects of myo-inositolin
women with polycystic ovary syndrome:a double-blind trial. European Review for Medical and Pharmacological Sciences 2009; 13:105-110.
11.et al. Myo-inositol may prevent gestational diabetes in PCOS
treatment of cutaneous disorders in young women with polycystic ovary syndrome.2009; 25:508-13
13. Patil SS, Khanwelkar CC, Patil SK et al. Comparison of efficacy, tolerability, and cost of newer with
conventional oral iron preparation. Al Ameen J Med Sci 2013; 6(1) :29-33
14. Sakhaee K, Bhuket T, Adams-Huet B, Rao DS. Meta-analysis of calcium bioavailability: a comparison of
calcium citrate with calcium carbonate. Am J Ther 1999;6:313–21.
15.Micronutrient deficiencies after laparoscopic
gastric bypass: recommendations.2008 Sep;18(9):1062-6.
16.t al. Routine supplementation does not
warrant the nutritional status of vitamin D adequate after gastric bypass Roux-en-Y.2013;28:169-72.
and calcium metabolism following gastric bypass and laparoscopic adjustable gastric banding.2008; 18(9):1144-8.
18.True fractional calcium absorption is
decreased after Roux-en-Y gastric bypass surgery.2006;14:1940-8.
19. et al. Long term calcium intake and rates of all cause
and cardiovascular mortality: community based prospective longitudinal cohort study.2013;12;346:f228
21.Evaluation of nutrient status after laparoscopic
sleeve gastrectomy 1, 3, and 5 years after surgery.2012 ;8(5):542-7.
effects of sleeve gastrectomy on calcium metabolism parameters, vitamin D and parathormone (PTH) in morbid obese women.2012; 22(5):797-801.
23. Launius B, Brown PA, Cush EM, Mancini MC. Osteoporosis: the dynamic relationship between
magnesium and bone mineral density in heart transplant patients. Crit Care Nurs Q 2004; 27(1):96-100.
24. Vormann J. Magnesium: nutrition and metabolism. Mol Aspects Med 2003. 24(1-3): 27-37. 25. Rude R, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr
26. Castiglioni S, Cazzaniga A, Albisetti W, Maier JAM. Magnesium and Osteoporosis: Current State of
Knowledge and Future Research Directions. Nutrients 2013, 5, 3022-3033
27. Stendig-Lindberg G, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of
peroral magnesium in osteoporosis. Magnes Res 1993; 6(2): 155-63.
28. Armstrong TA, Flowers WL, Spears JW, Nielsen FH. Long-term effects of boron supplementationon
reproductive characteristics and bone mechanical properties in gilts. J Anim Sci 2002;80:154–161
29. Volpe S, Taper LJ, Meacham S. The relationship between boron and magnesium status and bone
mineral density in the human: a review. Magnes Res 1993; 6(3): 291-6.
30. Newnham R. Essentiality of boron for healthy bones and joints. Environ Health Perspect 1994;
31.Is boron nutritionally relevant2008; 66:183-91
32. Price CT, Langford JR and Liporace FA. Essential Nutrients for Bone Health and a Review of their
Availability in the Average North American Diet. Open Orthop J. 2012; 6: 143–149. Published online 2012 April 5.
Reducing pharmaceutical waste from patient care settingsScientists are detecting concentrations of pharmaceuticals in streams and rivers across the nation, according to the U.S. Geological Survey. Epinephrine is a commonly used drug. It is This is due in part to pharmaceuticals entering found on crash carts and used in many surgical the sewer system, through excretion of partially applic
RUSSIA AND THE GLOBAL NATURAL GAS MARKET Russia is the world’s largest reserves-holder, producer and exporter of natural gas and is playing a significant role in development of the European gas market and as an important player in gas deliveries to Former Soviet Union countries. Russia has the world’s largest natural gas reserve base. The estimates for the country’s proved natural ga
A comparison of 
VitaWeight™ Versus Forceval® 
Vitamin K 
Calcium 
Table 1: A comparison of micronutrients in VitaWeight™ versus Forceval® 
Scientific References 
18.True fractional calcium absorption is
decreased after Roux-en-Y gastric bypass surgery.2006;14:1940-8.
19. et al. Long term calcium intake and rates of all cause
and cardiovascular mortality: community based prospective longitudinal cohort study.2013;12;346:f228
21.Evaluation of nutrient status after laparoscopic
sleeve gastrectomy 1, 3, and 5 years after surgery.2012 ;8(5):542-7.
effects of sleeve gastrectomy on calcium metabolism parameters, vitamin D and parathormone (PTH) in morbid obese women.2012; 22(5):797-801.
23. Launius B, Brown PA, Cush EM, Mancini MC. Osteoporosis: the dynamic relationship between
magnesium and bone mineral density in heart transplant patients. Crit Care Nurs Q 2004; 27(1):96-100.
24. Vormann J. Magnesium: nutrition and metabolism. Mol Aspects Med 2003. 24(1-3): 27-37. 25. Rude R, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr
26. Castiglioni S, Cazzaniga A, Albisetti W, Maier JAM. Magnesium and Osteoporosis: Current State of
Knowledge and Future Research Directions. Nutrients 2013, 5, 3022-3033
27. Stendig-Lindberg G, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of
peroral magnesium in osteoporosis. Magnes Res 1993; 6(2): 155-63.
28. Armstrong TA, Flowers WL, Spears JW, Nielsen FH. Long-term effects of boron supplementationon
reproductive characteristics and bone mechanical properties in gilts. J Anim Sci 2002;80:154–161
29. Volpe S, Taper LJ, Meacham S. The relationship between boron and magnesium status and bone
mineral density in the human: a review. Magnes Res 1993; 6(3): 291-6.
30. Newnham R. Essentiality of boron for healthy bones and joints. Environ Health Perspect 1994;
31.Is boron nutritionally relevant2008; 66:183-91
32. Price CT, Langford JR and Liporace FA. Essential Nutrients for Bone Health and a Review of their
Availability in the Average North American Diet. Open Orthop J. 2012; 6: 143–149. Published online 2012 April 5.