Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Vitamin B1, particularly in its active form thiamine pyrophosphate (TPP), has a scientifically supported role in the management of peripheral neuropathy, especially when the neuropathy is related to thiamine deficiency. Thiamine is an essential coenzyme in carbohydrate metabolism and neuronal function. Deficiency, most commonly due to alcoholism, malnutrition, or certain medical conditions, is known to cause “dry beriberi,” which manifests as peripheral neuropathy. Supplementation with thiamine (including as TPP or benfotiamine, a more bioavailable derivative) has shown to improve symptoms in individuals with deficiency-related neuropathies.

However, the evidence for thiamine supplementation in peripheral neuropathy not caused by deficiency (such as diabetic neuropathy) is less robust. Some small clinical trials and observational studies have suggested a benefit, particularly for benfotiamine, in reducing symptoms of diabetic neuropathy, but these studies are often limited by small sample sizes and methodological weaknesses. Systematic reviews and meta-analyses indicate a possible symptomatic benefit, but not a definitive disease-modifying effect, and guidelines do not universally recommend thiamine for neuropathy except in cases of deficiency.

In summary, thiamine is scientifically validated for treating peripheral neuropathy caused by deficiency (evidence level 4-5 for those cases), but outside of deficiency, the evidence is limited (evidence level 2 overall), warranting further research.

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