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Detailed Answer:
I understand that you have been taking a full dose of medication. Can you tell me exactly what you have taken and for how long?

It is true that vegetarians are at high risk of vitamin B12 deficiency and such deficiency can cause nerve damage with the symptoms of tingling, numbness and such. Please describe all symptoms you now have and how long you have been having them.

Vitamin B12 is not found in plant foods you understand and is a nutrient to be obtained daily from supplements or animal products or that individual become and remain deficient. Milk, eggs, liver, chees, fish, and fortified soy milk are sources of B12 in the food supply and without it vision, nerve damage and psychiatric conditions may develop. Reversing such deficiencies require large doses of B12 once a week for a month.

If, as you say, all medications have been taken as prescribed, has your doctor done a "Schillings test" to see if you have what we call "intrinsic factor", a deficiency of this will cause your body to absorb less or very little of the B12 it is given. Such conditions are generally rare, but low levels of B12 not only can cause the tingling in the hands, but eventually affect the heart from increased levels of a byproduct called homocysteinemia.

Regarding the lactase deficiency, this is common in adults and in certain ethnicities. Each individual differs in their tolerance of lactose, or milk sugar. There is a "pill" or "powder" called "Lactaid" that can be taken orally prior to consuming a food high in lactose that will digest the lactose so symptoms do not occur or Lactaid may be added directly to a high lactose containing food such as milk. If this is not done, the vegetarian will run a high risk of calcium, vitamin D and iodine deficiencies.

In summary, if your symptoms that you describe are persisting after taking high weekly doses of vitamin B12, maintaining adequate B12 supplementation/intake daily, please check your absorption capability with a Shillings test and if absorption is found to be low, B12 will have to be administered intramuscularly.

Regarding your lactose intolerance, great attention should be paid to getting adequate calcium from food or supplements and vitamin D from food or supplements. There is debate about the optimum amount of each nutrient to take per day, but generally a person would want to get enough calcium (but not too much) which for a male of your age would be about 1,000 mg per day and vitamin D intake should be 600 IU daily for maintenance or a repletion regime would be 50,000IU/week(10,000 IU D3/day x 5 days x 6 weeks) and then maintenance.

Males require 2.4 mcg/day of B12.

I hope I have addressed your concern. Any further nutritional concerns I am at your disposal.

Thank you so much for the consult. XXXXXXX J. Shattler, BS,MS,RDN

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