Neurological disorders, particularly diabetic neuropathy, have been treated with vitamin B1 (thiamine) for decades; however, the bioavailability of orally administered, water-soluble thiamine salts is low compared to fat-soluble analogs. For treatment to be successful, high levels of thiamine are needed in both blood and tissues. In 1954, Fujiwara discovered a group of lipid-soluble thiamine derivatives, subsequently named allithiamines because they occur naturally in Allium family vegetables – roasted, crushed garlic, onions, leeks, shallots, etc. Of these, benfotiamine is the most effective and has an excellent safety profile. Oral administration of benfotiamine raises thiamine levels in blood and tissues to a much higher degree than the water-soluble salts. Benfotiamine also inhibits three major biochemical pathways implicated in diabetes-induced vascular damage and neuropathy. In addition to diabetic neuropathy, benfotiamine appears to be of value in treating diabetic retinopathy and nephropathy. It has also been shown to have beneficial effects in patients with end-stage renal disease and alcoholic neuropathy.