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Micheau O, Tschopp J (2003) Induction of TNF receptor I-mediated apoptosis via two sequential signaling complexes

Research has indicated that dietary choices, particularly high-fat diets, significantly influence the gut microbiota, exacerbating DED symptoms through mechanisms such as decreased tear secretion, increased oxidative stress, and heightened apoptosis (Wu et al., 2020)

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You should also see a clinician if you have anemia symptoms, a history of gastric surgery, suspected pernicious anemia, or if lab testing hasnt confirmed a B12 deficiency.