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Pyruvate dehydrogenase function depends on thiamine (B1)

Mary

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Refeeding syndrome is also a serious concern and a potentially fatal outcome if you've been severely affected a long time and thus depleted of minerals/electrolytes. I ran into severe phosphate deficiency on day 3. Magnesium and calcium were also a serious problem. Fortunately, it made my longstanding hypokalemia disappear but this is another serious problem for many here and it can cause a fatal arrhythmia.

The researcher Chris Armstrong commented on another thread that ME/CFS metabolism resembles starvation and sepsis and warned about refeeding syndrome. I think people would stand to benefit from reading his comments before playing around with active forms of thiamine.
I know this is an old post but it just caught my eye. I had the identical response - my phosphate tanked - after 2 days or so on thiamine., The thiamine initially boosted my energy, it felt so good and then I think on day 3 severe fatigue hit. It reminded me of when my potassium tanked after I started methylfolate. However, it felt like a different kind of severe fatigue (there are so many different kinds!), and also potassium didn't help. I had done reading about refeeding syndrome, and that hypophosphatemia is the hallmark of refeeding syndrome, so I hypothesized that it was my phosphate tanking, and I read that low phosphate can cause severe fatigue.

I read that dairy is high in phosphate so I drank I think 3 glasses of kefir and within a few hours my energy started coming back., Eventually I bought a monosodium phosphate supplement and taking it twice a week or so has kept low phosphate symptoms at bay.

Chris Armstrong's comments about sepsis and starvation are quite interesting. That might explain my (and many of us) high need for certain nutrients which I never had before developing ME/CFS.