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In developed countries, situations at greatest risk for deficiency include eating a diet restricted in fruits and vegetables, smoking or long-term exposure to secondhand smoke, and drug and alcohol abuse
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Most published data comes from animal and laboratory studies, and human clinical trials are lacking, so human efficacy is not established [1]
Pregnant women at greatest risk for deficiency include vegans and vegetarians, those with autoimmune pernicious anaemia or malabsorption syndromes such as Crohns disease (an inflammatory intestinal disease) or coeliac disease, and those with a history of gastric bypass for weight loss, strict dieting, anorexia, or bulimia
Biddinger SB, Haas JT, Yu BB, Bezy O, Jing E, Zhang W, Unterman TG, Carey MC, Kahn CR (2008) Hepatic insulin resistance directly promotes formation of cholesterol gallstones
These effects are typically temporary and tend to improve as the body adjusts to the medication
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