TNF and infection: Multiple factors on the MSIDS map, including, but not limited to, multiple infections and environmental toxins, along with a high carbohydrate diet with hyperinsulinemia [128] and imbalances in the microbiome can create inflammation through stimulating these pathways, resulting in elevated levels of chemokines as well as cytokines, including IL-1, IL-6, TNF-α, and IL-17 [48,129,130,131,132,133].