Nutrient poor high carbohydrate diets, can lead to symptoms of beriberi, and that thiamine deficiency can occur even when supplements are given. I'm sure there are other articles that are good, but I have found thiamine hard to understand because the mechanisms it uses are so varied. Here is the one I found very helpful:
Lonsdale, D., 2006. A review of the biochemistry, metabolism and clinical benefits of thiamin(e) and its derivatives. Evid Based Complement Alternat Med 3, 49–59. https://doi.org/10.1093/ecam/nek009
In this article the author reports: "Necropsy studies have suggested that TD is underdiagnosed in life because the classical clinical presentations are either uncommon or unrecognized. Marginal TD [thiamine deficiency] was found in 31% and definite deficiency in 17% of 36 non-demented, community-dwelling patients admitted to an acute geriatric unit. There is no doubt that severe TD is lethal but marginal deficiency can give rise to symptoms that are commonly mistaken for functional disease. A very early experiment in human subjects showed that marginal deficiency produced a multitude of symptoms that might, under ordinary clinical conditions, be regarded as functional in nature. The symptoms disappeared quickly when a thiamine sufficient diet was restored."
Interesting to consider MARGINAL thiamine deficiency and then looking for it in our patients.
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