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What to avoid Certain combinations should be avoided or approached with extreme caution

This screening should be thorough and appropriate for individual patient risk factors and demographics

Risk factors for deficiency include long-term antacid medications use, metformin therapy, GI disorders, surgery, and vegetarian/vegan diets

While the vast majority are compliant and very safe, he said, the small number of spas that allow unauthorized procedures and employ unlicensed workers keeps him up at night. There is a bit of an underbelly to this industry, where youve got folks who should not be doing the treatment that theyre doing, Thiersch said

This puts anyone following a strict vegan or vegetarian diet at a very high risk for deficiency