Chronic fatigue syndrome (CFS) is a condition marked by extreme tiredness that doesn’t improve with rest. It affects daily life and can be challenging to manage.

How Do You Know If You Have Chronic Fatigue Syndrome?

Everyone feels tired occasionally, but CFS is different. It’s an overwhelming exhaustion that doesn’t improve with rest, making even basic activities difficult. Despite resting or sleeping, relief doesn’t come.

Here are some examples of what it’s like to have CFS:

• You have trouble carrying out simple daily tasks such as grocery shopping or doing laundry, which has been happening for months.
• You can’t concentrate and feel like you’re in a brain fog.
• You’re having trouble sleeping through the night.
• Whatever the activity, it takes longer to recover than it should.
• You find yourself staying home to rest far too often.
• Sometimes, it’s exhausting to think about getting out of bed and dressing up.
• Fatigue lowers your quality of life.

There are many potential causes for fatigue, and symptoms of CFS can overlap with symptoms of other conditions. The only way to verify your diagnosis is to see a healthcare professional.

Chronic Fatigue Syndrome Symptoms

Symptoms can develop slowly or start suddenly, ranging from mild to severe. They can come and go or last for weeks, months, or years.

Symptoms of CFS may include:

• A drop in activity level and fatigue that lasts six months or more
• Extreme physical and mental fatigue that gets worse if you’re active yet doesn’t improve with rest or sleep
• Sleep problems such as trouble falling asleep, frequent waking, and feeling sleepy during the day
• Muscle and joint aches and pains, headache, sore throat
• Tender lymph nodes in the neck or armpits
• Chills and night sweats
• Dizziness or weakness upon standing
• Problems with memory, concentration, and slow reaction time
• Sound and light sensitivity
• Heart palpitations, shortness of breath

CFS vs. Fibromyalgia

CFS and fibromyalgia are chronic, complex conditions of an unclear cause that can significantly impact quality of life. Both affect women more than men. Both involve a variety of symptoms, including fatigue and widespread pain. However, the predominant symptom of CFS is chronic fatigue, while fibromyalgia is pain. It’s possible to be diagnosed with both.

Possible Causes of Chronic Fatigue Syndrome

The exact cause of CFS is not clear. It may be a combination of genetic and environmental factors that include:

• Infections, such as Epstein-Barr virus or Coxiella burnetii (C. burnetii)
• Immune system changes
• Physical or emotional stress that affects body chemistry
• Possible genetic link

CFS affects about 1 million people in the United States. Anyone can develop CFS, but risk factors include:

• Female sex: Women are affected three times as often as men
• Age: Often occurs between the ages of 10 and 19 or 30 and 39, but the average age at onset is 33
• Race: Rates may be higher among Black and Latinx people than among other groups

How Is Chronic Fatigue Syndrome Diagnosed?

There are no specific tests for CFS, so the diagnostic process can be lengthy. Your healthcare provider will likely start by taking a medical history and performing a physical exam. To check for other conditions that can cause similar symptoms, the following steps may include:

• Blood and urine tests
• Referral to a sleep specialist, neurologist, rheumatologist, or other specialist
• Keeping a journal of activities and symptoms

Diagnosis requires having these three symptoms:

• Substantial reduction in the ability to engage in pre-illness levels of activity (lasts more than six months, plus new fatigue not related to exertion and not relieved by rest)
• Post-exertional malaise (when symptoms worsen for a time after light physical or mental activity)
• Unrefreshing sleep

It also requires one of these symptoms:

• Cognitive impairment (problems with concentration, memory, and reaction time)
• Orthostatic intolerance (dizziness and weakness while standing up)

Is Chronic Fatigue Syndrome Real?

CFS is real, despite a controversial history. Lack of understanding has led some to theorize that the condition is psychological. Its name, definition, and diagnostic criteria have changed over the years. Many questions remain, but there is evidence that it’s a biological illness, not a psychological disorder.

Chronic Fatigue Syndrome Complications

Living with CFS can affect your overall quality of life, including a substantial impairment of work or school activities, social isolation, reduced mobility, chronic pain, anxiety, and more. Living with a chronic illness can affect your mental health and increase the risk of depression.

Chronic Fatigue Syndrome Treatment: Managing Symptoms

There’s no standard treatment for CFS. However, you can manage specific symptoms. A healthcare provider may refer you to other providers, such as a sleep specialist, who can provide additional help with symptom management.

Activity Management

Activity management (or pacing) involves identifying your limits for physical and mental activities. Writing in an activity/symptom journal can help uncover the activities that have the most significant impact. This way, you can make a plan to balance activities with ample time for rest.

You can also find ways to make those activities more accessible, such as by alternating tasks, dividing tasks into smaller segments, and sitting rather than standing when possible.

Lifestyle Adjustments

While not directly treating CFS, certain lifestyle changes may help you feel better. For example:

• Create good, consistent sleep habits.
• Maintain a balanced diet for overall good health.
• Perform stretching and moving exercises.
• Use organizers, calendars, and apps to help with memory problems.
• Listen to your body so you don’t overextend yourself.

Medications

If needed, a healthcare provider may recommend medications for certain symptoms, such as:

• Mild pain relievers
• Sleep aids
• Anti-anxiety and antidepressant drugs

Some providers may prescribe stimulants, which are usually used to treat attention deficit hyperactivity disorder (ADHD), to target the fatigue of CFS. These drugs should be used cautiously, as they can lead to a “push-and-crash cycle” that can potentially make matters worse.

CAM Therapies to Supplement CFS Treatment

When it comes to complementary and alternative medicine (CAM) therapy for CFS, research is lacking. That doesn’t mean you won’t find some helpful.

Remember that even natural ingredients can be harmful in excess and many can interact with other medications. Before adding extra vitamins or herbal supplements to your diet, speak with a provider.

Other therapies that may help manage symptoms and improve overall well-being include:

• Massage
• Meditation
• Deep breathing
• Muscle relaxation therapy
• Movement therapies such as yoga, tai chi, and stretching
• Acupuncture

Chronic Fatigue Syndrome Support and Resources

If you’re having trouble coping with CFS, you’re not alone. Living with chronic fatigue and pain takes a toll. Here are a few places to seek information and support:

• American ME and CFS Society
• CDC Patient Toolkit
• Smart Patients Myalgic Encephalomyelitis (CFS) Community
• Solve ME/CFS Initiative

Outlook for Chronic Fatigue Syndrome

CFS is a long-term debilitating condition. Still, some people do return to their previous levels of functioning. Others make only a partial recovery. While many do not fully recover, they can continue finding ways to keep symptoms under control. Children and teenagers may have a better chance of full or partial recovery than adults, and there may be a benefit to early diagnosis and good management.

In this post, I will quote from ‘Paths of Fire: An Anthropologist’s Inquiry into Western Technology’ (1996) by Robert McCormick Adams. “Beyond this general sense of growing insecurity and uncertainty, what distinguishes the world context within which modern technology finds its primary applications? Perhaps most disturbing is the widening gap between the most and least-developed parts of the world. Major countries formerly in the middle of this range – China, Brazil, Mexico, India, and Indonesia are representative examples – have of course moved decisively toward the developed end of the contiuum. But similar progress is not in evidence in most of Africa and in other parts of Asia and Latin America. In effect substituting capital investment in automation for labor, hightech industries in developed countries are having some success in driving down the direct labor content of their costs to as little as 10 percent or less. With such reductions, the transfer of technology and manufacturing facilities to less-developed countries can be slowed or even brought to a halt in many but not all fields. But the result is a zero-sum game, raising prospects of irreconcilable political conflicts in the future. Residual rates of un and underemployment among less-than-highly-skilled workers in developed countries are resistant to significant reduction, while the poorest countries find great difficulties in attaining a position on even the lowermost rungs of an ascending industrial ladder. Remaining to be discussed as an unfolding competitive strategy is the use of patents and patenting. As a first-order approximation, they may be the best available surrogate for data on R & D activity – data which, in any other form, are more difficult to obtain and often seriously biased or inaccurate. But as noted in earlier chapters, aggregate series of patents also are flawed as an index to significant inventive activity in every historic period. Individual patents were never necessarily introduced into use at all, or for the purposes originally specified for them in patent applications. Inherent in the administrative and legal processes through which patents are granted and defended are reifications that subtly distort the notion of “invention” itself. Like technologies themselves, they “depend upon one another and interact with one another in ways which are not apparent to the casual observer, and often not to the specialist.” Especially in the conditions of rapid technological progress and intensified competition now obtaining, their significance is becoming more and more limited. Advances have been so rapid in some fields like biotechnology that the distinction between basic science and technological R & D has almost disappeared. New products are introduced, altered, and replaced before the formality of a patent can be secured. Having a significant headstart in producing a new and complex product largely displaces the need for either patent protection or any form of secrecy. In addition, patenting inevitably involves a trade-off. Necessary for the issuance of a patent is the disclosure of essential information on the product or process for which legal protection of rights to its exclusive use is sought. In very rapidly changing fields like semiconductors and microelectronics, this trade-off is not necessarily advantageous. Earlier and more complete market penetration may be gained in a race for what will be at best short-term superiority by failing to disclose (in fact, by seeking to obscure) research discoveries that have been incorporated in a product than by seeking formal legal protection for them. Spiraling costs of litigation are still a third factor. While there has been an apparent decline in patenting activity over the last two decades, a more complex picture emerges when this trend is disaggregated. Patents continue to be a widely employed source of protection in industries producing chemicals, plastics, synthetic fibers, and devices whose design would be relatively easy to duplicate. Particularly in industries whose products take the form of complex systems, however, the attitude is different: “Our respondents from industries producing aircraft and guided missiles, canonical complex systems, reported that it would cost a competent imitator three-fourths or more of what the innovator invested to come up with something comparable, that considerable time would be involved as well, and that it did not matter much whether or not there were patents. Producing complex systems effectively requires that many components and details be got right, and this is difficult to learn to do even if one has a model to take apart, or a blueprint to follow. These industries, and others like semiconductors, also involve complex production processes with tooling and equipment often finely tuned to product design. Simply getting the production line in place and running right can yield the inventor a substantial lead over potential followers.” The enormously active biomedical field has special patenting complexities of its own. Medical devices have attracted the interest of many small start-up firms, which have recognized opportunities to develop specialized applications of microprocessors in a relatively relaxed regulatory framework. Patent protection is largely unavailing since many alternatives usually can serve the same therapeutic end, but there is the compensating advantage that a particular approach can undergo continuing improvements during the course of testing and subsequent production. The rate of product obsolescence is high, and firm failures greatly outnumber successes. The large, well-entrenched firms comprising the pharmaceutical industry, by contrast, are accustomed to lengthy time horizons and very large R & D commitments. While the international environment is certainly competitive, the usual role of consumer preferences as the ultimate arbiter of market mechanisms is sharply reduced and somewhat distorted. This is certainly the case if patients are considered as the consumers, most of whom lack knowledge of the efficacy, risks, and alternatives to their choices, and in fact leave the choices themselves in the hands of their attending physicians. The role of clinician thus often blurs the usual distinction between developers of and customers for new technologies. From another direction, public and private third-party payers are more often the actual purchasers than the consuming public. Commensurate with their often very large purchasing power, they are increasingly exercising price leverage upon medical technology suppliers. The regulatory environment, by extending the duration of testing and heightening development costs, also places a premium on rapid, worldwide penetration of mass markets in order to assure profit and cost recovery before generic products become available. Little incentive is provided to direct R & D toward therapies for rare illnesses, or for illnesses found mainly in less-developed countries without hard currencies. Change with regard to patent protection, in short, has been complex, differentiated by sector and even micro-sector, and closely tied to marketing and financing conditions. The roles of science and technology are not easily distinguishable from one another, and both intercommunicate closely with corporate interests and strategies. Public policy and regulatory interventions, under the pressure of many interest groups and often subject to unanticipated second-order effects, are seldom comprehensive and wholly effective. And no effective means is yet in sight to hold in check the unprecedented share of GNP devoted to the gigantic health-care industry, among the many components of which technology may well be the one growing most rapidly. All in all, the world context of industrial strategies is a volatile, highly competitive, correspondingly unsettling one. There is no apparent lack of new opportunities to be exploited, but the risks – including risks of unforeseen second-order consequences – have also grown enormously. Immediate and long-term clashes of interest are increasingly severe and difficult to contend with, and the real power and initiative in deploying new technologies has moved largely into the hands of corporate boards. Both as a unit of analysis for a study like this one and as a master of its own technological household, the nation-state, even the United States as the industrially most powerful nation-state, becomes more and more deeply embedded in, and difficult to hold separate from, its wider, international context. Japan, having emerged as our most successful – some would say most dangerous – technological competitor, has nearly doubled its share of both world output and exports of high-tech manufactured products within little more than a decade. It displaced the United States as the leading high-tech exporter in the mid-1980s and today occupies the dominant position in fields in which the United States long thought itself securely pre-eminent. No longer merely successful at commercializing foreign technologies, Japan has increasingly demonstrated its capability to operate at the technological frontier in key fields like fiber optics, advanced and composite materials, fermentation processes, computer peripherals, memory chips, and computer-numerically controlled machine tools. While the strength of Japan’s position in this rivalry must be recognized, we should also take note that this strength is essentially confined to a fairly narrow sector of its industrial economy. Only some 13 percent of Japan’s working population is employed in its extremely successful, high-tech, hardware-exporting industries. Many primary and secondary industries, as well as the entire service sector employing 56 percent of the population, meet only relatively low standards of competitiveness. Moreover, the resilience of an emergent U.S. competitive response is evident in many scattered corporate reports and should not be underestimated. Under the new conditions of corporate interdependence and intensified competition, there are few impediments to the borrowing and adaptation by U.S. firms of the most advantageous features of Japanese industrial practice. Hence, any attempt to predict the overall long-term outcome of the rivalry would be unjustifiably speculative. Our primary interest, however, is concentrated precisely on the advancing front of technology. Whether or not the United States is successful in borrowing and even improving elements of the Japanese approach, its initial, systemic features deserve to be considered. The coherence of Japanese industrial strategy in the high-tech fields sustains comparison with the American system of production that first emerged as an international presence in the 1850s – which, after all, was for a long time even narrower in its impact. In the earlier case, U.S. industry had been able to pioneer its new and innovative approaches to mass production within a much more isolated milieu. It was powerfully assisted by the rationale of meeting military exigencies that the Congress was prepared to accept as overriding considerations of cost, and by what proved to be an atmosphere of public tolerance with regard to limitations of consumer choice that had no European counterparts. The long production runs of standardized products that became the distinguishing characteristic of American mass production now are giving way, as we have seen. Customized production preserves many of the same cost advantages as a result of greatly improved, more flexible strategies for automation, product innovation, inventory reduction, and the overall organization of production. These are all innovative strategies that are mostly Japanese in their origins, and that together constitute the essential manufacturing elements of the “Japanese System.” Underlying these features, however, has been for many years an equally vital contributor to Japanese competitive performance in the form of a substantially higher rate of consumer savings. The outcome of a host of essentially cultural factors associated with lifestyles, intergenerational relationships, and much more, it has meant that Japanese capital costs are about one-third of what they are in the United States. As a result, capital investment per employee can be approximately double that of the United States in manufacturing, accounting in considerable part for significantly higher Japanese labor productivity in the economic sectors important for international competition. It also helps to explain Japan’s tolerance for long time horizons for the recovery of investment capital, and hence for sustained investment in product development. Perhaps it can be considered a modern counterpart of nineteenth-century American tolerance of cheaply finished, standardized products. Still a third major element that contributes to the Japanese system has been a consistent emphasis on quality: “Quality, they say, is no longer simply the assurance of durability and reliability (the product works); that was the old way of thinking about it. Quality today is change, that is, ceaseless improvement, the continuing incorporation of new features that redefine the product and its uses and, so doing, make the consumer feel he wants it. Quality is the invention of needs. In such a game, speed means market share. Whereas in the automobile industry, for example, the lead time for new models was running four years and more, the Japanese reduced it to two. This kind of entrepreneurial advantage (in the Schumpeterian sense) can be translated into durable gains, and losers find themselves on a treadmill, running hard to stay in place.” The relationship of an aggressive, nationally coordinated, long-term R & D program to all of these developments is obvious. As a percentage of gross national product, Japanese industrial R & D more than doubled between 1965 and 1986, increasing over this period from less than one-tenth to more than one-third of comparable U.S. expenditures. Japan has long had the great advantage of being able to limit itself to a comparatively minor defense budget – on the order of 1 percent of gross national product. Thus it has been able to devote a correspondingly much larger part of its R & D resources to the improvement of its manufacturing base as well as its consumer products. But a fundamentally different valuation of the role of technology in planning for economic success is also apparent. Japanese firms, for example, are said to employ far more engineers on the factory floor than do their U.S. competitors, both to de-bug new production equipment and to improve manufacturing process know-how and extend its applications. More than two-thirds of Japanese firm-financed R & D is devoted to process research and improvement rather than new products, exactly the reverse of the proportions in the United States. 67 Japanese responses to a 1992 survey of leading technology-intensive firms, for example, indicated that more than 90 percent of their senior technical executives were members of their firms’ boards of directors, as contrasted with less than one-quarter of their counterparts in the United States. Also testifying to a closer integration of R & D into management are contrastive Japanese and U.S. diversification strategies: “Over the last two decades, while some of the leading U.S. industrial corporations have looked to acquisitions to diversify their businesses and technologies, Japanese firms increasingly have made their R & D organizations the centers of diversification efforts. Firms in such mature industries as shipbuilding, steel, and textiles have exhibited an especially strong drive to technological diversification to provide opportunities for the growth their core businesses can afford no longer.””

Folate is a B vitamin that your body needs to work properly. Folate is especially important if you’re pregnant. Folate deficiency occurs when your body doesn’t get enough folate. Symptoms include fatigue, weakness, mouth sores and neurological issues. Folate deficiency can be prevented by eating a diet rich in foods that contain folate.

What is folate deficiency?

Folate deficiency is when your blood lacks the amount of vitamin B9 (folate) it needs to function properly. Folate deficiency can cause a wide range of symptoms and complications.

What is folate?

Folate is a B vitamin found naturally in many of the foods you eat. These foods include leafy greens, citrus fruits, nuts, beans, peas, seafood, eggs, dairy, meat, poultry and grains. Your body needs folate to make new red blood cells and DNA, the genetic material in your cells. Folate is especially important during pregnancy. Folate helps in the growth and development of the fetus and can help prevent birth defects.

What is folic acid?

Folic acid is a manmade (synthetic) form of folate. Your body can’t store large amounts of natural folate. But your body can easily absorb folic acid. As a result, it’s added to some of the foods you eat. Grains such as rice, bread, pasta and some cereals are enriched (fortified) with folic acid. Folic acid is also available as a dietary supplement.

What complications can occur due to folate deficiency?

When you don’t get enough folate, several complications can occur.

Folate deficiency during pregnancy

Folate deficiency during pregnancy can cause severe complications. Folate is important for the growth of the fetus’s brain and spinal cord. Folate deficiency can cause severe birth defects called neural tube defects. Neural tube defects include spina bifida and anencephaly.

Folate deficiency can also increase your chances of placental abruption, a condition where your placenta separates from your uterus. In addition, your baby may be premature (preterm birth) and/or have a low birth weight. Studies have also shown low folate during pregnancy could lead to the development of autism in your child.

Folate deficiency anemia

Folate deficiency can also lead to folate deficiency anemia. Anemia can happen when your body doesn’t have enough healthy red blood cells. Your body needs red blood cells to carry oxygen to your body tissues. Folate deficiency anemia can also cause your body to produce abnormally large red blood cells that don’t function properly.

Other complications of folate deficiency can include:

• Infertility.
• Certain cancers.
• Cardiovascular disease.
• Depression.
• Dementia.
• Decreased cognitive function.
• Alzheimer’s disease.

What are the symptoms of folate deficiency?

One of the first symptoms of folate deficiency is extreme tiredness (fatigue). Other symptoms may include:

Anemia symptoms

• Paleness.
• Shortness of breath (dyspnea).
• Irritability.
• Dizziness.

Oral symptoms

• Tender, red tongue.
• Mouth sores or mouth ulcers.
• Reduced sense of taste.

Neurological symptoms

• Memory loss.
• Difficulty concentrating.
• Confusion.
• Problems with judgment.

Additional symptoms of folate deficiency may include:

• Lack of energy.
• Muscle weakness.
• Depression.
• Weight loss.
• Diarrhea.

What causes folate deficiency?

One of the most common causes of folate deficiency is not eating a healthy, balanced diet. A healthy diet includes foods that naturally contain folate or are enriched with folic acid. Other causes of folate deficiency can include:

• Digestive system diseases: Your digestive system doesn’t absorb folic acid well if you have a disease such as Crohn’s disease or celiac disease.
• Excessive alcohol use: People who drink large amounts of alcohol sometimes substitute alcohol for food. As a result, they don’t get enough folate.
• Overcooking your fruits and vegetables: When you overcook, the heat can destroy the naturally occurring folate in your produce.
• Hemolytic anemia: A blood disorder that occurs when your red blood cells are destroyed and can’t be replaced fast enough.
• Certain medications: Some anti-seizure drugs and ulcerative colitis drugs interfere with the proper absorption of folate.
• Kidney dialysis: A treatment for people with kidney failure.

How is folate deficiency diagnosed?

Your healthcare provider will ask about your medical history and your symptoms. They can diagnose folate deficiency through a blood test. The blood test measures the amount of folate in your blood. A low level of folate indicates a folate deficiency.

How is folate deficiency treated?

Your healthcare provider will treat your folate deficiency with a folic acid supplement. Most adults need 400 micrograms (mcg) of folic acid each day. Your healthcare provider will let you know how much you should take.

Your healthcare provider will also advise you to eat a healthy, balanced diet. A balanced diet includes fruits, vegetables and other foods that contain folate or are enriched with folic acid.

What can I expect if I have folate deficiency?

If you increase your folate intake, the effects of folate deficiency should start to reverse. It’s important to eat enough foods that contain folate or are enriched with folic acid. In addition, take a folic acid supplement. If you don’t get enough folate, complications such as anemia will be ongoing.

How can I prevent folate deficiency?

The best way to prevent folate deficiency is to eat a healthy diet that includes foods that contain folate or folic acid. Folate can be found naturally in:

• Peas, beans and legumes.
• Citrus fruits.
• Dark green leafy vegetables.
• Liver.
• Seafood.
• Eggs and dairy.
• Meat and poultry.

Folic acid can be found in enriched or fortified:

• Bread.
• Flour.
• Pasta.
• Rice.
• Cereal.

The amount of folate you need every day depends on your age and other factors. Most adults should get 400 micrograms (mcg) of folate daily. If you’re pregnant, you should take a folic acid supplement to make sure you’re getting enough folate each day. The average daily recommended amount of folate you need are:

Age/Life Stage Recommended Amount of Dietary Folate Equivalents (DFEs)
Birth to age 6 months 65 mcg DFE
Infants ages 7 to 12 months 80 mcg DFE
Children ages 1 to 3 years 150 mcg DFE
Children ages 4 to 8 years 200 mcg DFE
Children ages 9 to 13 years 300 mcg DFE
Teenagers ages 14 to 18 years 400 mcg DFE
Adults ages 19 years and up 400 mcg DFE
While pregnant 600 mcg DFE
While breastfeeding 500 mcg DFE

If you’re taking any medication that interferes with folate absorption, you should also take a folic acid supplement.

What is cerebral folate deficiency?

Cerebral folate deficiency is a very rare disorder that occurs when there’s a shortage of folate in the fetus’s brain. Babies born with cerebral folate deficiency develop normally during infancy. Then, they begin to slowly lose their mental skills and movement abilities about age 2. Intellectual disabilities, speech difficulties, seizures and difficulty coordinating movements (ataxia) can be severe. Cerebral folate deficiency is caused by a gene change (mutation).

What’s the difference between B12 and folate deficiency?

Vitamin B12 and folate are both important for the formation of your red blood cells and DNA. A deficiency in either vitamin can lead to fatigue, weakness and anemia. Unlike folate, B12 isn’t found in plants. B12 is mainly found in meat, eggs and dairy products. Vegetarians and vegans are at a high risk of B12 deficiency. Severe vitamin B12 deficiency can lead to complications such as depression, paranoia, delusions, memory loss, incontinence and loss of taste and smell.

What is MTHFR polymorphism?

MTHFR stands for methylenetetrahydrofolate reductase. Some people have a genetic change (mutation) in their MTHFR gene. If you have this mutation, you aren’t able to convert folate to its active form, 5-MTHF. This genetic mutation affects about 25% of Hispanic people, 10% of white people, 10% of Asian people and 1% of Black people. If you have this genetic mutation, you may benefit from using a folate supplement that contains 5-methyl-THF, the active form of folic acid.

A note from Cleveland Clinic

Folate is a vitamin that helps your body make red blood cells and DNA. Folate is especially important when you’re pregnant, as it aids in fetal development. While folate deficiency is rare, it can cause severe complications such as birth defects and anemia. So it’s important to eat a diet rich in fruits, vegetables and other foods that contain folate or folic acid. In addition, you can take a folic acid supplement. Your healthcare provider can advise you on the amount of folate you should be getting each day.

Robson Street is a major southeast-northwest thoroughfare in downtown and West End of Vancouver, British Columbia, Canada. Its core commercial blocks from Burrard Street to Jervis were also known as Robsonstrasse. Its name honours John Robson, a major figure in British Columbia’s entry into the Canadian Confederation, and Premier of the province from 1889 to 1892. Robson Street starts at BC Place Stadium near the north shore of False Creek, then runs northwest past Vancouver Library Square, Robson Square and the Vancouver Art Gallery, coming to an end at Lost Lagoon in Stanley Park.

As of 2006, the city of Vancouver overall had the fifth most expensive retail rental rates in the world, averaging US$135 per square foot per year, citywide. Robson Street tops Vancouver with its most expensive locations renting for up to US$200 per square foot per year. In 2006, both Robson Street and the Mink Mile on Bloor Street in Toronto were the 22nd most expensive streets in the world, with rents of $208 per square feet. In 2007, the Mink Mile and Robson slipped to 25th in the world with an average of $198 per square feet. The price of each continues to grow with Vancouver being Burberry’s first Canadian location and Toronto’s Yorkville neighbourhood (which is bounded on the south side by Bloor) now commanding rents of $300 per square foot.

In 1895, train tracks were laid down the street, supporting a concentration of shops and restaurants. From the early to middle-late 20th century, and especially after significant immigration from postwar Germany, the northwest end of Robson Street was known as a centre of German culture and commerce in Vancouver, earning the nickname Robsonstrasse, even among non-Germans (this name lives on in the Robsonstrasse Hotel on the street). At one time, the city had placed streetsigns reading “Robsonstrasse” though these were placed after the German presence in the area had largely vanished.

Robson Street was featured on an old edition of the Canadian Monopoly board as one of the two most expensive properties.

As if getting infected with COVID-19 isn’t hard enough, doctors now believe some with more severe cases aren’t fully recovering.

Some are experiencing chronic fatigue syndrome, something that is often misdiagnosed. But a Rochester doctor just published a book that could help.

“It went from I felt terrible, I was told nothing else they can do,” said Melanie Lusnak.

She knows all too well the debilitating effects of chronic fatigue syndrome which she believes started in highschool. But was difficult to diagnose since she also suffered from anxiety and depression.

“I wanted to get up and go to work,” she said. “I wanted to extra activities, hang out with my family, go shopping, but I couldn’t move. I couldn’t get out of bed. I felt like there was a 100-pound weight on me.”

According to the CDC, more than a third of people who tested positive for COVID-19 aren’t fully recovering from the virus and are experiencing long term symptoms including chronic fatigue.

That profound exhaustion and lack of mental clarity are what Lusnak suffered from, for more than a decade, until she met Dr. Joel L.. Young, the medical director of the Rochester Center for Behavioral Medicine.

In fact, he just published the book ‘Understanding Chronic Fatigue’ highlighting a treatment that is working for many of his patients.

“What I presented in the book, is a study we performed here in Rochester, Michigan, looking at 30 folks treated with lisdexamfetamine, and we found folks with chronic fatigue very well compared to placebo,” he said.

Dr. Young says the medication he often prescribes for ADHD patients is helping people who are trying to cope with CFS although the FDA hasn’t approved it as an official treatment.

“My goal in writing this book is to reach people who suffer from this, offer them some hope not only with medications but lifestyle changes as well,” Dr. Young said.

Like Melanie, who says she finally feels like herself again.

“When anyone asks me how Dr. Young helped me, it sounds corny but I say he saved my life,” she said.

Dr. Young recommends talking to your doctor to find what works for you. Although Melanie did not have COVID-19, she knows the challenge of chronic fatigue.

Amber Heard is seen cuddling up to Elon Musk in the private elevator to Johnny Depp’s penthouse in exclusive new images that will drag the Tesla mogul deeper into the couple’s explosive legal battle.

Musk insists the 33-year-old actress had already split from Depp by the time they began seeing one another and their relationship didn’t become romantic ‘until some time later’.

However the Pirates of the Caribbean star accuses the pair of starting an affair one month into his 2015 marriage and has subpoenaed the billionaire for his text messages as part of a $50 million defamation case against Heard.

Now, surveillance camera images obtained by DailyMail.com capture his ex-wife cozying up to Musk as they ride the elevator at the luxury downtown LA apartment complex where she once lived with Depp.

The Space X inventor, 48, can been seen in one image draping his arms around Heard, who appears to be wearing just a swimsuit and what appears to be a towel.

She reciprocates the affection by bending over to place her hands on the leg or waist of Musk, who is in a dark T-shirt and pants or jeans.

There are no timestamps or clues as to when the pictures were taken however security guards have previously gone on record to state that Musk visited Heard on multiple occasions before and after she filed for divorce in May 2016.

Depp, 55, moved out of the Eastern Columbia Building a month after the split but Heard carried on living there until December 2016, DailyMail.com understands.

The Oscar-nominated actor owned five penthouses at the up-scale address, all accessed by the private elevator seen in the images, but later sold them for a combined $10.88 million.

He and Heard agreed to a $7 million divorce settlement in August 2016 and seemed to have put their acrimonious divorce behind them until she penned an op-ed for the Washington Post detailing her experiences as a domestic violence survivor.

The article did not mention Depp by name but he filed for defamation last March, saying it led to speculation that he was the abuser and caused him to lose the role of Captain Jack Sparrow.

His legal action further accused Heard of ‘spending time in a new relationship’ with Musk almost immediately after their wedding in February 2015.

‘Only one calendar month after Mr. Depp and Ms. Heard were married – while Mr. Depp was out of the country, filming in March 2015 – Eastern Columbia Building personnel testified that Ms. Heard received Musk ”late at night” at Mr. Depp’s penthouse,’ the suit alleges.

‘Specifically, Ms. Heard asked staff at the Eastern Columbia Building to give her ”friend Elon” access to the building’s parking garage and the penthouse elevator ”late at night,” and they testified that they did so.

‘Building staff would then see Ms. Heard’s ”friend Elon” leaving the building the next morning.’

Depp doubled down by subpoenaing Musk for any texts, emails, letters or communications he exchanged with Heard during their marriage or anything mentioning alleged incidents of domestic violence.

He specifically wants to know what she told the tech tycoon about the May 21, 2016 blowout fight that resulted in Heard seeking a restraining order, accusing Depp of hurling a phone at her and beating her.

Depp has always argued that he was the victim of an ‘elaborate hoax’ instigated by his ex-wife, who ‘faked’ her injuries with makeup.

Around two months after the break-up Heard was linked to Musk in tabloid reports suggesting they spent a weekend together in Miami.

The following April she was photographed holding hands with the dad-of-six, who divorced Westworld actress Talulah Riley in January 2015.

However the relationship was on and off until the couple finally called it quits in 2018.

Heard’s lawyers have previously described Depp’s allegation of infidelity as ‘frivolous’ and an attempt to ‘silence’ the Aquaman actress.

Sources close to Musk described it as ‘irrelevant nonsense’ and declined to comment beyond reiterating a statement issued by the entrepreneur’s rep last March.

‘Elon and Amber didn’t start seeing each other until May 2016, and even then it was infrequent,’ Musk’s spokesman said. ‘Their relationship didn’t become romantic until some time later.’

Musk made a further cameo last week in London’s High Court where Depp is also suing News Group Newspapers over a 2018 article in The Sun newspaper that described him as ‘wife beater’.

The court was read a text message from Depp to a friend that made an apparent reference to Musk: ‘Brother, I’m sorry to even ask but she sucked mollusc’s crooked d*** and he gave her some sh**y lawyers.

‘I have no mercy left of what I thought was love for this gold-digging, low level, dime-a-dozen mushy, pointless, flappy fish market.’

Actor James Franco is another A-lister caught up in the ex-couple’s legal war after he was pictured riding the same elevator with Heard on May, 22, 2016, the night after her infamous dust-up with Depp.

Heard’s legal team said Franco once lived in the same apartment complex and was simply taking the elevator at the same time.

But Depp’s lawyers hit him with a subpoena last July and want to grill him over what the pair discussed and whether she had any visible bruises.

Depp and Heard met on the set of The Rum Diary, back in 2011, married four years later – then split in a little over a year amid a slew of blood curdling domestic violence allegations and tabloid headlines.

Heard wrote in her December 2018 op-ed: ‘I became a public figure representing domestic abuse, and I felt the full force of our culture’s wrath for women who speak out.’

That prompted Depp to file for defamation in Virginia, where the Washington Post is based, stating: ‘Ms. Heard is not a victim of domestic abuse; she is a perpetrator.’

Heard responded with a 300-page filing of her own, cataloging the years of alleged abuse she suffered at the hands of ‘the monster’. The case is due to be heard in August.

‘Elon Musk and Amber Heard seem not to know that Mr. Depp’s penthouse elevator button that says ‘M’ does not take you to Mars,’ Depp’s lawyer Adam Waldman said of our exclusive pictures.

‘Musk – aka Penthouse Guy – has publicly denied sneaking up to see Ms Heard a month after her marriage to Johnny but that will soon be put to the test, as will her entire abuse hoax.

‘As the evidence mounts up, who was where, and knew what, when?’