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Thiamin-related neuropathy is especially important to consider in patients with a history of: Alcohol use Bariatric surgery Chronic vomiting Chronic diarrhea Eating disorders Severe dietary restriction High carbohydrate intake with poor nutrient density Long-term diuretic use Malabsorption Celiac disease or gluten-related gut damage Unexplained neuropathy with fatigue or weakness When thiamin deficiency is suspected, testing may include whole blood thiamin, thiamin diphosphate, erythrocyte transketolase activity where available, and blood lactate when severe deficiency is suspected

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Reactive oxygen species (ROS) arising from oxidative stresses, especially under interrupted mitochondrial oxidative phosphorylation, trigger apoptosis that is counteracted by GSH

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