It's not love that keeps my marriage alive - it's SEX: The clergyman's wife who says desire has helped them through dark times

 

Annie Atkins says her celibate husband was the sexiest man she had ever met when they met, aged 20

• Annie Atkins says sex was the reason she married her husband Shaun
• Ms Atkins says her and clergyman husband seem to be in the minority 
• A survey has shown that 55 per cent of adults are happy with their sex lives

The other day, my husband Shaun and I went to a friend's drinks party. As the wine flowed, we got talking to a group of 50-something couples and the polite chatter turned to how we had all met our partners.

'And why did you marry each other?' we were asked in turn.

Spontaneously - and without conferring - Shaun and I both simultaneously said 'Sex,' and then laughed.

The couple who had asked us, both marriage counsellors, looked deeply shocked: 'We've never heard anyone say that before.'

Apparently, most couples say utterly drippy things such as: 'We wanted to support each other.'

Perhaps our reply was particularly shocking because Shaun is a clergyman. But the truth is that we vowed our lives to each other so we could make love to each other - for life.

While sex once seemed easy, it can tail off in later life thanks to the menopause, fears over our ageing bodies and the sad truth that familiarity can breed contempt

As this conversation, and a survey released last week by marriage counselling service Relate, showed, we seem to be in a minority.

" While sex once seemed easy, it can tail off in later life thanks to the menopause, fears over our ageing bodies and the sad truth that familiarity can breed contempt"

Relate's survey revealed that more than half the population has not had sex in the past four weeks, and 55 per cent of adults are unhappy with their sex life.

This is apparently because we're all so bombarded with messages about how sex 'ought to be' - in films, books such as Fifty Shades Of Grey, magazines and websites - that we're starting to avoid it altogether for fear of seeming less than perfect.

And this pressure can be especially prevalent for the over-50s. While sex once seemed easy, it can tail off in later life thanks to the menopause, fears over our ageing bodies and the sad truth that familiarity can breed contempt.

Well, lack of perfection has never bothered me - in fact, as we've got older, sex has become better and better.

The couple, who met at Oxford, married at 22, after Annie fell for Shaun's steely reserve and passion

People often say love inevitably changes from the heady, adrenaline-charged romance and lust of youth to something much more staid in middle age; that you can't stay 'in love' all your life. I passionately disagree.

Life-long love goes through different phases, but part of the endless fascination of it is that you never know where it might go next.

After all, what makes love-making within a marriage so endlessly interesting and fun is not endless variety, but the endless challenges in loving just one person.

The couple, who have five children, have been through hard times including Shaun's breakdown

People might be surprised to hear me - a regular on Radio 4's Thought For The Day and mother of five children - talk so openly about the crucial importance of love-making.

But it's the bond that has kept us together, the thread running through our shared lives, particularly when times have been difficult.

After being fortunate enough to find my perfect lover in my early 20s, I can't imagine ever wanting to be celibate.

Shaun and I met in our second year at Oxford University, both aged 20.

One morning a few months later, when we still barely knew each other, I took a break from an essay to visit him for coffee.

He utterly stunned me by telling me he was 'madly in love' with me.

That day I wrote to my parents: 'Just before lunchtime, I fell in love.'

Unlike Shaun - who, as a committed Christian, had kept himself scrupulously pure, not even kissing a girl - I'd had boyfriends through my teens, but had never wanted to have sex with any of them. With Shaun, I felt very differently. He woke something in me that I'd never felt before.

With his quiet, steely reserve and flashes of Irish poetry and passion, he was, quite simply, the sexiest man I'd ever met.

We wanted each other so much that he proposed to me later that year and we agreed to marry as soon as we reasonably could - straight after our Finals, aged 22.

Waiting for our wedding night to make love was far more difficult than getting a degree.

So, naturally, we told the shocked couple at the drinks party that we married for sex.

Ms Atkins was so attracted to Shaun she found the wait for their wedding night harder than getting her degree

Otherwise, why bother? Why not just be friends?

After all, it's sex that makes this relationship different from all others. However much we love our family and children and parents and friends, it is only the two of us who share that part of our lives together.

One of the great fallacies of married life is that during the downs, love-making must decline. In my experience, that's when sexual intimacy, even if not sex itself, is more crucial than ever.

NO AGE LIMIT

Nearly a third of women and over half of men over 70 are still sexually active

Throughout our many years together, Shaun and I have encountered tough times as well as good.

After our first child was born, I went off sex for several weeks. At the time I felt guilty - I believed I was letting Shaun down and I honestly didn't know whether I would ever be interested in making love again.

I explained and apologised. He told me not to be so silly and just held me each night in a friendly hug, which probably restored me far faster than anything else could have done.

Annie admits she understand how older couples can become shy about making love... +8 View gallery

But claims that making love to her husband is the closest form of togetherness they have +8 View gallery

A passionate sex life has kept the couple strong though difficult times, boosting their self-esteem

I've never felt that way since - not even after the births of the next four - but it communicated to me very memorably that sometimes the most loving way to make love is to give an undemanding cuddle.

Some years ago, Shaun had got into a rut in his parish and he retreated into himself. He barely spoke for several weeks, let alone touched me.

I was so wretched and lonely I wanted to die, and for that brief time I could understand what drives women to take lovers.

What makes love-making within a marriage so endlessly interesting and fun is not endless variety, but the endless challenges in loving just one person

Happily I didn't, and when we eventually were together again, we were as close as ever.

 
"What makes love-making within a marriage so endlessly interesting and fun is not endless variety, but the endless challenges in loving just one person"

But our troubles were not yet over. Several years ago, Shaun suffered a devastating, work-induced breakdown. When our wonderful and sympathetic GP suggested helping him through the first few weeks with an anti-depressant, my heart sank.

The whole family was going through terrible trauma as a result of it all. It's honestly true that making love was the only activity for some time that had put a spontaneous smile on my face.

I dreaded the drug and its side effects. Would Shaun lose all desire for me? Was I not even to have that pleasure any more?

Happily, that didn't happen, but in a bid to boost his self-esteem, I felt the least I could do was to take the initiative frequently in the bedroom.

I remember reading a magazine article not long afterwards about a couple who vowed to make love to each other every day for a year and thinking: ‘Only once a day?’

As I write, I am going through a fragile phase. Our daughter has been struggling with a long-term illness and I’ve been missing my dear late mother every day.

Even through her husband's breakdown and her mother's death, Annie says sex gives the couple intimacy +8 View gallery

Even through her husband's breakdown and her mother's death, Annie says sex gives the couple intimacy

So I don’t feel particularly sexy, but nonetheless I value sex more than ever.

When Shaun makes love to me, I feel whole again. By night, it gives me a far deeper sleep; in the morning, more energy for the day. It’s the closest form of togetherness we have.

There are many ways to make love. A flower, a passionate text, a passing kiss — each can be thrilling and memorable.

And if people are genuinely so intimidated by the ubiquity of apparently perfect sex and cowed into celibacy as a result, I feel sorry and sad.

After all, if we were perfect lovers there would be nothing more to learn, and perhaps there really would then be no reason to continue.

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The hard reality of marriage

The World Internet Conference (WIC) Wuzhen Summit kicked off , Cyber governance should not be controlled by group politics, highlighting China’s role in building a community with a shared future in cyberspace

 

The 2023 World Internet Conference (WIC) Wuzhen Summit opens in Wuzhen, east China's Zhejiang Province, Nov. 8, 2023. Photo: Xinhua

Cyber governance should not be controlled by group politics, zero-sum thinking

On Wednesday, the 2023 World Internet Conference (WIC) Wuzhen Summit was kicked off in Zhejiang Province, East China. With the theme "Creating an Inclusive and Resilient Digital World Beneficial to All: Building a Community with a Shared Future in Cyberspace," the summit will last until November 10.

Over the past 10 years, the WIC Wuzhen Summit has witnessed the advancement of China's internet industry. Since the first WIC Wuzhen Summit, nearly 12,000 participants from 172 countries and regions have attended the summit. China has now become the world's largest internet market, with the most internet users and mobile internet users, as well as the most active internet technology and application innovation ecosystem.

During the past decade, the WIC Wuzhen Summit has contributed Chinese wisdom to the transformation of global cyberspace governance and provided Chinese solutions. Shen Yi, director of the Research Institution for Global Cyberspace Governance at Fudan University, told the Global Times that "China, based on respecting the core interests and concerns of all parties, fully leverages its advantages and experiences in information technology, digital economy, and cyberspace governance, attracting like-minded countries and enterprises worldwide to jointly explore solutions to various challenges in global cyberspace governance through equal consultations."

Replacing cyber hegemony with a community with a shared future in cyberspace, replacing exclusive clubs with principles of extensive consultation, joint contribution, and shared benefits, and resolving challenges in security, development, and cultural exchange with cyberspace governance are the embodiment of Chinese wisdom and the core of China's widely welcomed concepts, experts said. China's vision is welcomed because it represents the common interests and shared needs of the majority of countries. Developing countries are not willing to accept the hierarchical treatment in the field of the internet by developed countries. China's solutions to cyberspace governance are truly based on mutually beneficial, equal, and sustainable cooperation.

Some American media outlets criticize China's internet regulations from an ideological perspective. These criticisms are related to the principles upheld by the US in handling internet governance issues, such as the principle of hegemony, and the "America First" doctrine. Li Haidong, a professor at the Institute of International Relations at the China Foreign Affairs University, said that, "Any country that challenges the US' dominance and rule-making power in the digital world would be criticized, distorted, and vilified by the US. China does not welcome this, nor do other countries."

Since the Cold War, the US has never concealed the fact that it is a hegemonic country. Its goal is to build cyber hegemony, achieve the asymmetric expansion of American and its core allies' power, and squeeze the sovereignty and interests of other countries. Shen believes that the unrestrained and bottomless surveillance of global cyberspace, without boundaries, by the US exceeds the reasonable needs of national security and undermines trust in cyberspace. The US cyber hegemony threatens the security and stability of global cyberspace and poses a serious challenge to the sovereignty, security, and development interests of other countries.

Currently, the iteration cycle of emerging network technologies and applications is becoming shorter, and non-traditional security issues, represented by network security, are becoming more prominent. Today, it is impossible for any country to dominate the world alone. The sincere cooperation and coordinated response of all countries in the world are the trend. Li believes that if the digital world is filled with zero-sum thinking and politicized small circles, the internet will no longer be a bridge connecting all parties and promoting mutual understanding, but a weapon to suppress competitors and create crises and turmoil in other countries.

The WIC Wuzhen Summit proves that China emphasizes the integration of the internet world and attaches great importance to its inclusiveness. This inclusiveness is not only for China's development but also for that of the world. Washington's pursuit of small circles in the internet field undoubtedly undermines the integration of the internet. We call on the US to do less to disrupt the order of the internet world. The internet should not be influenced by the logic of group politics and zero-sum games.

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People take pictures at the 2023 World Internet Conference (WIC) Wuzhen Summit on Nov.8, 2023. Photo:Li Xuanmin/G

Wuzhen Summit kicks off at 10th anniversary, highlighting China’s role in building a community with a shared future in cyberspace

The 2023 World Internet Conference (WIC) Wuzhen Summit kicked off on Wednesday in the ancient water town of Wuzhen, East China's Zhejiang Province, where global cyberspace luminaries are set to discuss internet industry-related topics and provide insights on addressing the most pressing global cyberspace challenges - ranging from artificial intelligence (AI) governance, cyberspace hegemony to the widened digital gap - at the three-day monumental gathering.

The summit, marking its 10th anniversary this year, is an impressive showcase of the vibrancy of China's internet economy, which reportedly has expanded five times in the past decade. The milestone moments of the Chinese internet industry and knock-out tech products are on display in the exhibition hall, underscoring China's phenomenal lead in the tide of global digitalization and the pivotal role the sector has played in propelling global economic growth.

Chinese President Xi Jinping addressed the 2023 WIC Wuzhen Summit via video on Wednesday.

In his speech, Xi stressed that the international community needs to deepen exchanges and practical cooperation to jointly advance the building of a community with a shared future in cyberspace to a new stage. He called for prioritizing development to let the fruits of internet development benefit more countries and more people, the Xinhua News Agency reported.

Calling for building a more peaceful and secure cyberspace, Xi stressed the need to respect cyber sovereignty and each country's way of internet governance and the need to oppose seeking hegemony, bloc confrontation and arms race in cyberspace.

Xi called for building a more equal and inclusive cyberspace. He stressed the need to better promote the shared values of humanity.

Participants highlighted the "open, inclusive and equal" approach the summit has been delivering for 10 consecutive years. They noted that it mirrors the call from China that as a responsible major power, building a community with a shared future in cyberspace promotes common development, instead of the US approach which emphasizes "decoupling" and blockades to preserve its internet hegemony by depriving other's development rights.

This year, representatives from over 100 countries and regions gathered at the three-day summit themed "Creating an Inclusive and Resilient Digital World Beneficial to All - Building a Community with a Shared Future in Cyberspace." Participants include Chinese tech behemoths such as Baidu, Alibaba, and Tencent, as well as Russian cybersecurity firm Kaspersky, US company IBM and Indian software company Infosys.

There is an air of palpable excitement among representatives, with foreign delegates enthusiastically updating themselves about the new, state-of-the-art avant-garde gadgets developed by Chinese firms.

Jahogir Nasirov, a professor from Russia-Tajik Slavonic University, said that he is eager to "see more innovations at the summit and bring back to my country, Tajikistan." It is the first time that Nasirov attended the summit.

"We can see that China is developing very fast in internet and other related industries. The usage of AI has been really effective [in China]… So it will be good for other communities [to learn some experiences] and draw some practices from China," Nasirov told the Global Times on Wednesday.

Fan Yuan, chairman of Anheng Information Technology Co, his 10th time at the summit, told the Global Times on Wednesday that the event is the first large in-person international industry occasion after three years of the COVID-19 pandemic, and he feels delighted to meet with a number of foreign peers on the sidelines of the summit to exchange views on trending tech topics.

Call for more international cooperation

At the Light of Internet Expo, a side event of the 2023 WIC Chinese companies, the applications of AI algorithms and AIGC (AI generated-content) products are in the limelight, from interactive digital humans, medical treatment, clothing design and quality scrutiny to scenarios in people's daily lives. Throngs of tech-savvy visitors are lining up to take a fresh bite at the latest tech breakthroughs, the Global Times noticed on the spot.

Global attendants said the summit is being held at an important juncture as global cyberspace is confronted with a new round of challenges amid the fierce global tech race. These include global security concerns brought about by the fast development of AI, US-initiated tech wrestling and inequality in internet development as a result of certain countries' hegemonic practices.

"We need a platform, with an international perspective, to build trust and reach more global consensuses in both technological and mechanical fronts... That would lead to more technological innovation to the benefit of all countries and regions," Fan said.

China's proposal to build a community with a shared future in cyberspace echoes the call of the time, and shows the country's responsibility to facilitate global tech cooperation, rather than the US' move to instigate divisions and impose unilateral restrictions that hinder global tech development, analysts said.

China's reasoning is one that promotes "extensive consultation, joint contribution and shared benefits." This is truly needed for the world at this moment, especially considering that a rising major power has gained a technological advantage but insists on its original aspiration to consult, construct and share with other members of the international community and guide the future internet and AI governance, Shen Yi, deputy director of Fudan University Cyberspace Research Center who is also attending the conference, told the Global Times on Wednesday.

"Building a community of a shared future equates to constructing an open, inclusive and safe cyberspace environment. China's development of the internet and the digital world is at the forefront of the world, so the country is set to play a more pivotal role in promoting global cooperation and bridging the digital divide," Wu Yunkun, president of QI-ANXIN Technology Group Inc, told the Global Times.

Take AI governance, a heated global topic, as an example.

China is a leading player in drafting AI regulations. The country has rolled out multiple measures this year that coordinated the sound development of the AI sector while safeguarding national security. It also launched the Global AI Governance Initiative in October, stressing fairness and nondiscrimination in AI development.

AI-related issues need to be coordinated in the international arena and developed in harmony. There are differences between stakeholders in different countries, and it is hoped that the 2023 WIC will work out "an optimal balance of regulation that is in synergy with national preferences," Normann Witzleb, an associate professor at the Faculty of Law of the Chinese University of Hong Kong, told the Global Times on Wednesday.

This year, the 2023 WIC will organize 20 sub-forums on a wide range of hot issues, a number of which put extensive emphasis on AI development, related industries and cooperation. A report on developing a responsible generative AI ecosystem will also be issued on Thursday.

A 10-year boom

A bluebook for the WIC was released on Wednesday, which showed that China's internet development ranks second in the world after the US. Internet application in certain less-developed countries participating in the Belt and Road Initiative (BRI) also recorded a relatively high growth rate, according to the report.

Wuzhen, the water town, is an epitome of the fast-lane development of China's internet industry, and of its amassing contribution to the world economy, in particular to the developing countries.

"It's like traveling by a time machine," said Zhou Hongyi, founder and chairman of 360 Security Technology. Zhou, participating at the forum for the 10th consecutive year, told the Global Times that the rapid rise of China's internet sector, as well as the population dividends, has helped cultivate a large number of globally competitive Chinese companies like 360.

In 2014, when the first edition of the Wuzhen Summit was inaugurated, products like smart wearable devices and autonomous vehicles were a market hit, attendees said. One decade later, those products are visible everywhere, reflecting the sky-high growth rate at which the sector has been advancing.

Liu Dingding, a Beijing-based tech analyst, told the Global Times on Wednesday that China has definitely championed the global digitalization streak in the past decade, and that in turn has not only drastically driven development in the world's second-largest economy, but also fueled development dividends across the world. And that still carries great significance amid lingering uncertainties and a global economic slowdown.

From 2012 to 2022, the scale of China's digital economy jumped from 11 trillion yuan ($1.51 trillion) to 50.2 trillion yuan, with internet application, the number of netizens and AI development leading the world, Xia Xueping, president of the China Cyberspace Research Institute, said at the summit.

Entrepreneurs noted that compared with 10 years ago, the responsibility of Chinese internet companies has seen a major shift, and the internet economy is progressing in a more regulated and sound way.

"From the perspective of a Chinese company, we were talking about user traffic a decade ago. But now, we focus on hardcore and bottlenecked technologies, and are refining our role in the country's industrial upgrade," Zhou noted.

 

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Espionage case disclosed where young man became civil servant under instruction of foreign spy

Security authorities in Shanghai recently disclosed a fresh new espionage case targeting personnel working with the government, in which a young man enrolled into the civil service at the encouragement of a foreign spy.

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Chinese President Xi Jinping on Wednesday addressed the 2023 World Internet Conference Wuzhen Summit via video.

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US political elites are far narrow-minded than general public when it comes to pandas

Giant panda Mei Xiang enjoys an ice cake at the Smithsonian's National Zoo in Washington, D.C., the United States, on July 22, 2023. Photo: Xinhua

Can cute pandas still be seen in the US? With the recent announcement by the Smithsonian's National Zoo in Washington that giant pandas "Mei Xiang," "Tian Tian," and their 3-year-old cub "Xiao Qi Ji" will be sent back to China this month, American public opinion quickly seized on the "sensitive issue," reporting with astonishment that if the loan agreement for the four giant pandas at Zoo Atlanta expires next year and the pandas also return to China, there could be no pandas in the US for the first time since 1972.

Some American media reflexively attribute this situation to political factors, claiming that "China appears to be gradually pulling back its pandas from multiple Western zoos." This is pure sensationalism aimed at driving the false narrative that China is no longer friendly toward the US-led West so that to create or strengthen the opinion that "China is becoming more closed." Despite the clear statement from Brandie Smith, the director of the Smithsonian's National Zoo in Washington, to the media that negotiations are researcher-to-researcher and not politically driven, many mainstream American media outlets appear disinterested in this statement.

The giant pandas "Mei Xiang" and "Tian Tian" arrived in Washington in 2000. During their stay in the US, they gave birth to a total of four panda cubs, including "Xiao Qi Ji," born in 2020. The initial loan agreement signed between China and the US was for a period of 10 years. Subsequently, both parties extended the agreement twice, for five years each time. In 2020, China and the US jointly announced another extension of three years of their cooperation, prolonging it until December 7, 2023.

As the agreement is about to expire, "Mei Xiang" and "Tian Tian" are now in their 20s and are facing some age-related health issues. They are no longer suitable for living abroad. For them, 23 years of life in the US is already a substantial period. Returning to their habitat is obviously a better choice. Anyone who genuinely loves and cares for giant pandas, whether Americans or Chinese, will understand this decision and wish "Mei Xiang" and her family all the best.

Giant pandas are "image ambassadors" of China-US friendship and cooperation and a bridge connecting the people of China and the US. This has never changed and will not change. The giant pandas, including "Mei Xiang" and her family, are beloved by a wide array of American citizens. Long lines outside the panda enclosures at zoos are common, and there are numerous panda-related products. DreamWorks' Kung Fu Panda movie franchise has even produced four installments. Meanwhile, several generations of giant pandas have lived in the US, successfully breeding healthy offspring, which reflects the relentless efforts made jointly by China and the US for panda conservation. It should be noted that this situation is generally similar in the US and other developed Western countries.

Over the past couple of years, some giant pandas have returned to China after their loan contracts expired, while others have had their loan agreements extended. This is normal. The loan standards are in place to ensure the well-being of each giant panda, with contract renewals primarily being a technical matter. However, some Western media outlets have been closely monitoring those contracts that are not being renewed, blowing them out of proportion, and using them to tarnish China's "diplomatic style."

Thus, when China gifted or leased giant pandas to the US, some American politicians and media figures sternly warned, with a straight face, that pandas could be China's "united front tool," cautioning everyone to be vigilant. However, when pandas in the US need to return to China due to lease expirations, some argue that this might signify the "end" of China's "panda diplomacy." In short, they seem determined to tarnish the symbol of warmth, friendship, and cuteness represented by the "giant panda," turning the word "Panda" into something negative and unfavorable. This not only fuels anger but also evokes a sense of sadness.

The Smithsonian's National Zoo in Washington was the first zoo to receive giant pandas after Nixon's visit to China in 1972. It has witnessed the deepening of people-to-people emotions between China and the US in the course of their friendly interactions. In a heartfelt farewell to the panda family "Mei Xiang," the zoo previously organized a nine-day "Panda Palooza: A Giant Farewell" event. Many residents in Washington DC and visitors from across the US flocked to the zoo to bid farewell to the three giant pandas, creating a heartwarming scene. This is a real-life representation of people-to-people diplomacy between China and the US. Those in the American media who only focus on geopolitics and the anti-China politicians who cannot tolerate giant pandas have a much narrower perspective and a less open heart compared to the average American citizens.

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The disconnect of our Political "Elites" and the problems this causes the rest of us

The more we interact with our political "elites" in elected office or running (or funding) the bureaucracy and special interests that serve them, the more apparent their disconnect from regular people has grown worse. These are not people who have experienced the regular hardship or labor of average people in most communities. Instead, their arrogance, elitism, and disdain for regular people is likely to only cause more problems.

Digestive Health & Immunity

 

Prof Dr Raja Affendi Raja Ali, Consultant Physician and Gastroenterologist

Baca dalam BM 

What is the immune system?

Our immune system is made up of many different organs which contribute to our immunity:

Our skin prevents pathogens from entering our body

 

Various internal organs (e.g. bone marrow, spleen, lymph nodes) produce cells/antibodies that specifically target pathogens.

The digestive system helps defend against pathogens entering via the gastrointestinal tract. The digestive & immune systems work together to signal immune cells. The gut is also the largest immune organ in human body. The gut microbiota, which are the microbes living in the gut, enhances immunity by forming a protective barrier and signalling (communicating) with immune cells. Good bacteria (gut microbiota) also helps your body digest food and supports your child’s immune system. Keys to good digestive health:

Consume balanced, nutrient-dense diet rich in fruits, vegetables and whole grains

Eat a variety of food as they provide important vitamins, minerals, and dietary fibre. Some vegetables also contain prebiotics (i.e. indigestible fibres that good bacteria feed on). This will contribute to optimal digestive health, which in turn helps improve the digestive process.

Exercise & hydrate

Helps improve diversity of gut microbiota. Try simple exercises, e.g. brisk walking around the house compound or indoor exercises such as stationary bike workouts, yoga, tai chi, and light stretching exercises.

Drink plenty of water to stay well-hydrated. Exercise and staying hydrated help ensure proper food digestion, bowel movement and also helps maintain a healthy balance of good vs bad bacteria.

Manage stress & get enough sleep

Stress and lack of sleep can negatively affect both digestive health and mental wellbeing. To prevent this, manage stress effectively and get sufficient sleep daily.

Include probiotic-rich foods in our diet

This includes food such as cultured milk drinks, yoghurt that contains probiotic live cultures, and fermented food (e.g. kimchi, sauerkraut, tempeh). Studies have found that probiotics promote good digestive health and can both directly and indirectly enhance our immune system.

Take oral nutritional supplements with live probiotic cultures

Supplementing your probiotic intake is usually not a worry. It is good to consult your doctor first to learn if supplementation is necessary and to see the most suitable probiotic supplement for you or your family.

How probiotics help:

• Inhibits pathogenic (bad) bacteria by competing for nutrients.
• Forms a protective barrier preventing harmful pathogens from entering our body.
• Modulates our body’s immune responses (e.g. stimulates production of antibodies, signals immune cells) in response to infection.

Tips for consuming probiotics:

• The probiotic strain in a product or supplement must be clinically proven and supported by studies and data that show the safety and efficacy of the product. E.g. Bifidobacterium lactis BB-12 and Lactobacillus paracasei L.CASEI 431.
• Choose products with minimal or no added sugar.
• Store probiotic products properly to optimise their effectiveness. This helps to maximise the viability of live strains before consumption. Some products require no refrigeration while others need to be refrigerated.
• Consult your doctor for further information.

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Restricted blood flow, Is your heart pumping well?

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The heart has to work very hard if you have aortic stenosis, a condition where the aortic valve narrows and blood cannot flow normally.

OUR heart’s main job is to supply oxygen-rich blood to the body.

Our life literally hangs on how well blood is pumped through our four heart chambers with the help of four heart valves (aortic, mitral, pulmonary and tricuspid), which open and close with each heartbeat.

Imagine the precision and intricacies of a healthy heart – it beats 100,000 times a day during which the mitral and tricuspid valves control blood flow between the heart chambers.

The pulmonary valve controls blood flow to the lungs while the aortic valve controls blood as it flows out from the heart’s lower left chamber to the aorta, the main artery bringing blood to the rest of the body.

A life-threatening condition 

 

When the aortic valve does not function optimally, blood flow is restricted due to the narrowing (stenosis) of the area where blood is moving out of the heart.

Your heart will then need to work harder to pump blood to the rest of your body, affecting your health and limiting your daily activities.

This condition is called aortic stenosis and it’s a progressive disease that ranges from mild to severe.

Often, this condition may go unnoticed as patients go about their daily lives discounting the irregularities in their well-being.

Aortic stenosis is the most common valvular heart disease worldwide, with its prevalence increasing with age.

It is estimated that up to 12.4 % of people over age 75 have aortic stenosis, and about 80% of adults with symptomatic aortic stenosis are male.

Symptoms generally occur when narrowing of the aortic valve is severe.

However, some people with aortic stenosis may not even have symptoms for many years.

If you demonstrate symptoms such as chest pains or discomfort during physical activity, dizziness, fatigue, shortness of breath and an irregular heartbeat, don’t dismiss it.

Consult a physician. 

Understanding the disease

If diagnosed with aortic stenosis, it means your aortic valve is not opening or closing properly.

This limits the amount of blood pumped out to your body and strains your heart.

Over time, the left ventricle of your heart can thicken and enlarge.

Heart muscles will weaken and this can lead to heart failure and complications such as stroke, blood clots, bleeding, irregular heart rhythms and infections of the heart.

Left untreated, it can be fatal. It is important to understand the difference between aortic stenosis, atrial fibrillation and myocardial infarction.

While all are cardiovascular related, they are different and require different treatment approaches.

Atrial fibrillation is a disorder that originates from the atrium (upper chambers of the heart).

When the atrium does not contract effectively, irregular and rapid heart rhythm occurs.

Blood can pool in the heart, running the risk of blood clots which may lead to stroke.

Myocardial infarction, commonly known as a heart attack, occurs when there is a rupture of an atherosclerotic plaque in a coronary artery.

This causes a blood clot that obstructs blood flow.

Very simply put, aortic stenosis is a valve disorder, atrial fibrillation is an irregular heart rhythm and myocardial infarction is a heart attack caused by a blocked coronary artery.

Root cause 

Aortic stenosis is commonly due to a build-up of calcium compounded by contributing factors such as age and existing congenital heart defect.

Some individuals may be born with aortic valve disorders and are more prone to aortic stenosis later in life.

Other causes include infection of the heart, chronic kidney disease, heart disease risk factors such as diabetes, high cholesterol and high blood pressure, or a result of radiation therapy.

Diagnosis and evaluation

If aortic stenosis is suspected, your cardiologist will recommend diagnostic tests, as outlined below, depending on the assessment of your condition.

> An ultrasound imaging test called an echocardiogram to visualise the aortic valve and assess its structure and condition.

This test identifies weakened muscles and determines the severity of the aortic stenosis.

> An electrocardiogram or ECG measures the electrical activity of the heart and detects any potential issues with the heart’s chambers.

> A chest x-ray determines the condition of the heart and lungs and detects if there is swelling in 
the aorta and/or calcium build-up on the aortic valve.

> If needed, a cardiac computerised tomography (CT) scan or a cardiac magnetic resonance imaging (MRI) may be done.

> Only when needed or when other non-invasive test are inconclusive, a cardiac catheterisation or a cardiac angiogram may be recommended.

Treatment modalities

Lifestyle modifications are necessary, regardless of the stage of your aortic stenosis.

Start consuming a hearthealthy diet.

Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish and whole grains.

Avoid saturated and trans-fat and excessive salt and sugar.

If you are overweight, lose weight through regular exercise; brisk walks each day are recommended.

Manage your stress levels. Indulge in wholesome activities.

If you are a smoker, consider quitting.

In cases of mild aortic stenosis, your cardiologist will prescribe medications which are a non-invasive.

It can provide a temporary relief of symptoms and may reduce risk of complications.

However, medications alone do not address the underlying valve issues.

Patients may risk a decline in their condition over time.

Thus, it is essential to diligently keep your regular heart checkups to monitor the progression of your condition.

In more severe cases, aortic stenosis patients may have to undergo procedures to repair or replace their defective valves such as :

> Balloon valvuloplasty (BAV) 

This is a non-surgical option which involves a balloon being inflated in the aortic valve to improve blood flow. This treatment typically provides only temporary relief of symptoms and patients risk restenosis of the valve over time.

> Surgical aortic valve replacement (SAVR)

This offers a longer lifespan for the replaced valve and is often the conventional treatment for aortic stenosis.

However, being an open-heart surgery, it carries inherent risks especially for elderly patients and those with underlying health conditions.

These surgical valve replacements may also wear out over time and can start to fail and causes stenosis and regurgitation (valve does not fully close and blood flows backward through the valve).

Patients are advised to stay in the hospital for seven days.

> Transcatheter Aortic Replacement (TAVR)

This is a minimally invasive procedure performed between one to two hours as compared to an invasive open-heart surgery.

A small cut is made in the groin, neck or between your ribs so that a thin, flexible tube with the TAVR can be guided and placed in your diseased valve.

The new valve will then work immediately, and the tube is removed.

TAVR is designed to work like your own heart valve as the materials used allow the frame to mold itself to your anatomy.

It’s worth noting that the artificial TAVR valve can be made of porcine or bovine materials.

This procedure is suitable for patients who are considered highrisk or unsuited for open-heart surgery.

Patients can consult their cardiologist for other suitability criteria.

This involves shorter hospital stays of about three days as patients recover faster.

Institut Jantung Negara (IJN) was the first hospital in Malaysia to do a TAVR procedure in 2009.

At that time, some in the medical fraternity shared their uncertainty about the durability or longevity of a TAVR and thought it may only last for five years or less.

They preferred conventional surgery which was known to last for about 10 years.

The TAVR has since grown in acceptance and has been proven to stand the test of time.

For 83-year-old aortic stenosis patient, Siti Rahmah, who was implanted with a TAVR in 2011, it has still been functioning effectively.

She recently shared, “I am very pleased with the progress I have made. It has been 12 years since I did the procedure. I am thankful that I can go about my daily activities quite comfortably. My condition has been well managed.”

Take action

Those at-risk patients and 65 years and above should never undermine the importance of regular heart check-ups to detect irregularities of the heart.

Aortic stenosis is a serious cardiovascular condition.

Left untreated, it can lead to significant health problem while early diagnosis and a personalised treatment can prolong life.

By Datuk Dr Shaiful Azmi Yahaya is a senior consultant cardiologist at Institut Jantung Negara. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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