Why there is weakness after eating and how to deal with it
Food intake as with the process of digestion is not only filling the body with necessary and sometimes unnecessary substances, but also a certain expenditure of energy for grinding and processing of products falling into the stomach. Against this background, weakness after eating seems to be the usual state of the body, caused by the increased work of many organs and systems. On the one hand, this is true, but with another such a condition can be a symptom of an actively developing disease, and therefore requires special attention.
Studies show that such a condition as weakness after eating, at least once in a life experienced by everyone, if only because this symptom accompanies such a common pathology as the VSD. He also does not have a distinction in age and sex, although he meets with children less often than in adults.
The appearance of weakness after a meal is promoted by a large assortment on the shelves of stores of various products rich in carbohydrates and food additives stimulating hunger or thirst, which in turn leads to overeating, carbohydrate snacks, and hence digestive disorders. No one is insured from buying these "delicacies" dangerous for the stomach and the whole digestive system. To such ill-considered purchases pushes us and our children to ubiquitous advertising and colorful packaging.
The risk of a feeling of weakness after eating increases the associated diseases, one of the symptoms of which it, in general, is.
Causes of the weakness after eating
Weakness after a meal can be caused by banal overeating or absorption of a lot of heavy fatty foods, and do not have to be an expert to understand that without consequences there will not be enough. High energy costs and difficulties with digestion of food can cause dizziness and weakness after eating, accompanied by a feeling of heaviness in the stomach and drowsiness.
Dizziness can be caused by the use in a large number of foods rich in a substance from the group of biogenic amines tyramine, which provokes a narrowing of the vessels in the brain. Such products include cheeses, citrus fruits, preserves, fermentation products (kefir, beer, kvass, etc.).
If after eating you have symptoms such as nausea and weakness, perhaps you should visit the gastroenterologist as soon as possible. Such symptoms may indicate the development of various gastrointestinal diseases, such as gastritis, pancreatitis, stomach and duodenal ulcer, lazy stomach syndrome, cholecystitis, etc.
Particular attention should be paid to the condition of the digestive tract, if the above symptoms are accompanied by vomiting and fever. Such a reaction of the body can be an indicator of serious problems: exacerbation of the stomach ulcer, appendicitis, dyspepsia, beginning peritonitis (inflammation of the peritoneum). And here already the delay in death is similar.
Weakness and drowsiness after eating can be the result of excessive consumption of foods rich in carbohydrates. But if these symptoms become regular, the question arises of an examination for diabetes mellitus. The following symptoms can become an absentee confirmation of an unpleasant diagnosis: thirst, observed on an ongoing basis, frequent urge to urinate, slow healing of wounds and scratches, and sharp weight loss.
But the beast is not so terrible as it is painted. You can live with this diagnosis. The main thing is to recognize the disease in time and not let it go to the stage when constant insulin delivery is required. Diabetes mellitus, however, like gastritis, pancreatitis and other serious diseases, is primarily a diet, a rejection of many goodies and some habits. But you can not help it, you want to feel healthy and happy - learn to love the right food.
Weakness and palpitation after eating are often the first signs of the development of cardiovascular diseases. The fact is that in itself tachycardia (increased heart rate) is accompanied by such symptoms as weakness, sweating, shortness of breath. If a person has such conditions after eating, this indicates a deviation from the norm.
Such symptoms can cause not only heart and vessel diseases, but also abnormalities in the functioning of the digestive tract, obesity, problems with thyroid gland, diabetes, and disorders in the central nervous system.
If you are thrown into the sweat, and you feel a noticeable weakness after eating, this may be due to an ordinary hormonal surge. The influence of hormones is most affected by women, especially during menstruation and puberty.
It is hormonal restructuring and lowering blood pressure that accompanies the process of digestion of food, are the main cause of weakness after eating during pregnancy.
Hyperhidrosis, combined with weakness after eating, can be noticed by people with metabolic disorders diagnosed with vegetative dystonia (VDD), as well as patients with Frey syndrome who are sweated not only after taking hot food, but even from one thought about it .
Shortness of breath and weakness after eating are an alarming symptom, but in themselves they can not point to a particular disease. They are a signal about the existence of some deviation in the work of internal organs. An exact diagnosis of the disease, which was signaled by weakness and shortness of breath, can be established by a therapist on the basis of a complete or partial examination of the body.
A common cause of weakness after eating is the so-called dumping syndrome, in which unnaturally rapid gastric emptying takes place. Usually it is preceded by resection - an operation to remove a large part of the stomach with the subsequent restoration of the digestive tract, but sometimes its manifestations are seen in outwardly healthy people.
Dumping syndrome is typical for almost all the symptoms described above. The pathogenesis of this condition depends on the processes occurring in the body during the processing of food products.
There are 2 types of the syndrome of accelerated gastric emptying:
- Early (comes almost immediately after eating, not later than 20 minutes after eating), which is caused by the formation of a food lump and increased osmotic pressure in the intestine.
- Late (occurs after a certain time after a meal, usually 2-3 hours later).
The early dumping syndrome is characterized by:
- noticeable weakness,
- strong palpitations,
- decrease in blood pressure and related dizziness,
- pallor of the skin and spots on it.
And also the appearance of cold sweat, shortness of breath, nausea with urge to vomit.
In the case of late dumping syndrome, the already existing complaints are joined by:
- causeless hunger,
- visual disturbances in the form of glare and spots before the eyes, inability to focus the view at one point, darkness before the eyes,
- lowering of blood glucose,
- rumbling in the abdomen,
- general malaise.
At the same time, the skin turns red, and nausea and shortness of breath recede. Their appearance at the stage of late dumping of the syndrome can provoke only overeating.
Weakness after eating and accompanying symptoms in different combinations can be the result of strict diets, fasting and diseases developing on this soil: irritable stomach syndrome (functional indigestion), bulimia (psychologically caused uncontrolled food intake), anorexia.
Similar symptoms can accompany food allergy. If you notice that nausea and weakness after eating arise only after consuming protein foods, sweets or baked goods, plus it is accompanied by headache and ringing in the ears, it is necessary to immediately identify the allergen and exclude it from the diet.
Since weakness after eating can indicate different conditions and diseases, the pathogenesis of this symptom can only be viewed from the point of view of those processes in the body that accompany the very procedure of food processing. The process of food processing begins in the mouth. The organism needs additional energy not only for the grinding of products, but also for their assimilation.
The idea of digestion begins with the emergence of a feeling of hunger. The body begins to prepare for food intake, the brain gives a signal and the blood begins to flow to the digestive organs. By the law of conservation, in a closed environment, if there is an excess somewhere, then in another place we will observe a deficit. Blood is cast from the brain and lungs, they experience oxygen starvation (after all, oxygen is supplied to the organs through the blood), hence symptoms such as dizziness and shortness of breath, against a background of general weakness (because other organs also suffer).
The ingestion of heavy, intractable food into the digestive tract is fraught with the formation of chyme. Such a hard food lump, forming in the stomach, unable to cope with it, moves further into the small intestine, where it exerts strong pressure on its walls. This "violence" provokes the adrenal gland release into the blood of special substances of catecholamines. With its excess associated symptoms such as weakness after eating, dizziness, fatigue, sweating, shortness of breath.
We go further. Absorption of nutrients from the food in the intestine is accompanied by an increase in the blood glucose level, which feeds the brain. For him, this serves as a signal to stop the production of orexin. This substance not only pushes us to find food, but also gives a charge of vivacity and activity. It is clear that a decrease in the level of this substance leads to a decline in strength, i.e. Weakness and drowsiness.
As we see, the activity of orexin cells reduces sugar, or glucose, which is why the greatest drowsiness and weakness is observed when eating foods rich in carbohydrates, especially sweets. Using cookies, sweets and sweet drinks for a snack in the afternoon, we actually provoke the inhibition of certain processes in the body. If we consider our body as a working mechanism, then orexin in it will play the role of a gas pedal, and sugar and other carbohydrates are brakes.
That is why, one of the principles of proper nutrition is the rule not to consume carbohydrates in the morning and in the afternoon, or at least significantly limit their quantity. But high-quality protein is a kind of antidote for carbohydrates, significantly reducing their negative "soporific" effect.
Diagnostics of the weakness after eating
Will anyone argue with the statement that serious diseases are more often prevented than cured, and a timely diagnosis makes treatment more effective? Knowingly, wise people said that God takes care of God. So in case of weakness after eating. If you catch yourself in time, you can prevent the development or ease the treatment of many diseases, a companion of which is a similar weakness. Or at least to develop an optimal menu and the regime of the day, contributing to the normalization of the state after eating.
But ignoring this symptom can have the most unpleasant consequences in the form of a neglected insulin-dependent form of diabetes mellitus, exacerbations of gastritis or stomach and duodenal ulcers, the development of other diseases, especially those associated with gastrointestinal function. If you react to the situation in a timely manner, you can prevent dangerous complications, such as perforation of the ulcer or inflammation of the peritoneum.
Diagnosis of weakness after a meal is reduced not to the very statement of this fact, but to the search for the cause of this symptom and the identification of accompanying diseases. To do this, during the appointment, the doctor clarifies all the circumstances that preceded the appearance of weakness: when appeared, what foods a person used and in what quantity, what symptoms are present besides weakness, how often are bouts of weakness after eating. In addition, the hereditary predisposition to food allergy is excluded or established.
In addition to interviewing the patient, the doctor can perform a measurement of temperature and BP, as well as palpation of the epigastric region. This method of examination can already give some information about the health of the digestive tract.
More complete information about a possible problem is provided by instrumental diagnostics. First of all, the GIT should be examined. Identification of pathologies of the gastrointestinal tract is handled by a gastroenterologist.
The most popular methods in this field of research are ultrasound of the abdomen and fibrogastroscopy, which allows to see the pathology from the inside, and also to measure the acidity of the gastric juice. On the basis of instrumental studies and an anamnesis, the gastroenterologist gives his conclusion.
If there is a suspicion of a dumping syndrome for the diagnosis, in addition to a patient's questioning, a radiograph of the stomach may be needed. There can be provocative tests to confirm the response to glucose. Laboratory studies of the level of insulin and albumins are carried out.
In addition, the doctor can prescribe some tests : a general and advanced blood test, urine and feces, and a blood test for sugar to detect the development of diabetes and other metabolic diseases. It may be necessary to consult an endocrinologist who specializes in pathologies of the endocrine system responsible for the normalization of metabolism.
Some difficulties in diagnosis may be pancreatitis. In addition to ultrasound and X-rays, specific studies can be assigned: endoscopy, laparoscopy, and a two-time study of blood and urine for the presence of enzymes.
If dyspnea and tachycardia are present, additional examination methods, such as chest X-ray, electrocardiogram, MRI, etc., may be prescribed.
Treatment of the weakness after eating
Weakness after eating is not a disease. This is just a symptom of some pathologies in the body. It turns out that you can get rid of this uncomfortable symptom only by taking measures to treat the cause that causes it. And since there can be many such causes, it is not possible to describe in detail the treatment of all diseases and pathological conditions in one article.
Let us dwell in more detail on drugs that can alleviate the condition of the patient with the most common diseases and conditions associated with overeating. In the treatment of various diseases of the gastrointestinal tract, enzyme preparations that facilitate digestion and digestion of food in the digestive tract have been widely used. If there are problems with the stomach and pancreas, these drugs are always prescribed as part of complex therapy of diseases.
By the way, these same medicines can be advised to those who can not control their appetite, is prone to overeating, or simply as an auxiliary for digestion during feasts with an abundance of hearty, fatty dishes accompanied by nausea and weakness after eating.
The most popular and popular enzyme preparations are Festal, Mezim, Creon, Pancreatin, Pancreasim, Existol, Semilase.
"Pancreatin" - probably the most popular because of its effectiveness and cheapness means to facilitate digestion of food. It would seem that an enzyme preparation with a specific name should also have indications associated with impaired synthesis of enzymes for digestion in the pancreas. This is true, but problems with the pancreas are just one of the indications for taking the drug. In addition, doctors advise taking "Pancreatin" in chronic gastrointestinal pathologies, liver diseases, after surgery on the pancreas, stomach or duodenum, after irradiation of the gastrointestinal tract, with a single or constant overeating. It is also shown to people whose lifestyle does not predispose to active movement, and also to those who have problems with the chewing apparatus, when preparing for x-rays or ultrasound of the digestive tract.
"Pancreatin" contains enzymes (protease, amylase and lipase), identical to those produced by the human pancreas. The source of these enzymes is cattle and swine. With oral administration, the enzyme preparation fills the deficiency of these substances in the body and promotes the rapid cleavage of proteins, starch and fats and their conversion into amino acids, oligosaccharides and fatty acids necessary for human life.
In pharmacies, you can find a drug of different manufacturers, available in the form of tablets of varying dosage from 10 to 60 pieces per package. There are 2 varieties of the drug "Pancreatin" and "Pancreatin forte".
Method of application and dosage. Take the drug should be taken with food or immediately after the end of the meal, in no case splitting it into parts. Reception of the drug should be accompanied by the use of a large amount of fluid. This is necessary for the enzymes in the formulation to be released and begin to act directly in the duodenum, and not later.
This method of use allows you to achieve the maximum effect of the drug after 30-40 minutes. The number of tablets taken at a time is usually 1-2, but the dose may be increased at the doctor's instructions, depending on the degree of development of the enzyme deficiency and the age of the patient.
In the event that the pancreas is not able to produce enzymes at all, a maximum dose of the drug is prescribed: 5 tablets "Pancreatin 8000", which corresponds to the physiological need of the digestive tract in enzymes.
"Pancreatin" is able to successfully remove unpleasant symptoms of overeating, such as heaviness in the stomach, drowsiness, nausea and weakness after eating. In this case, usually 1 tablet, taken immediately after a meal, is enough.
The drug has very few contraindications to use. This, as usual, hypersensitivity to substances in the drug, the acute form of pancreatitis, as well as exacerbation of its chronic form. The drug is approved for use in childhood and pregnancy / lactation. In this case, an individual dosage can be set.
The administration of the drug is rarely accompanied by any side effects. Occasionally, there may be stools, nausea, unpleasant sensations in the abdomen, minor changes in the blood test, an allergic rash.
Precautionary measures. It is undesirable to take the drug together with antacids and iron preparations, as well as with alcohol. It is acceptable to use "Pancreatin" in small doses after a feast with a small amount of alcohol.
In childhood, taking the drug provokes an increase in the likelihood of constipation.
Foreign analogue of "Pancreatin" is "Mezim". Drugs differ only in a fixed dosage of individual enzymes in the latter. "Pancreasim" is a domestic analogue of the drug described above.
"Creon" is also an analogue of "Pancreatin", but it is already available in the form of capsules. This form of release, according to doctors, is more effective in this case. The usual dosage is: 1 capsule before eating.
The drug "Festal", in contrast to the previous ones, is supplemented with bile components, which strengthens the action of lipase and hemicellulose, which helps to break down the cellulose. It promotes more effective absorption of vitamins and fats.
To usual indications of enzyme preparations in this case it is possible to add not infectious diarrhea, flatulence, irritable bowel syndrome.
In connection with the presence of bile and hemicellulose in the composition of the drug, it also has specific contraindications for use. These are liver diseases, such as jaundice, hepatitis, liver failure, in addition to cholelithiasis, an accumulation of pus in the gallbladder (empyema), and obstruction of the intestine.
Take the drug usually in a dosage of one or two tablets 3 times a day. Children's norm is established by a doctor.
Reception of the drug may be accompanied by some side effects, identical to "Pancreatin".
Precautionary measures. The drug is available in the form of a dragee, and the content in the shell of glucose can adversely affect the condition of patients with diabetes.
With caution, strictly according to the doctor's indications, "Festal" is taken during pregnancy or breastfeeding.
The analogue of "Festal", located in the same price category, is the drug "Enzistal".
"Somilase" is a polyenzyme preparation, in the composition of which we can find a solzyme related to enzymes for the splitting of fats, and α-amylase. The principle of the drug is slightly different from the previous ones. The lack of enzymes is replenished by the splitting of fats.
Indications for the use of the drug in addition to inadequate functioning of the gastrointestinal tract and pancreas in connection with diseases, are the age-related changes in the digestive system.
The method of administration and dosage of the drug are the same as those of "Festal".
The plus of the drug "Somilase" is the almost complete absence of contraindications to the use and side effects. Nevertheless, the drug should be taken only after consultation with a medical specialist.
As for diabetes, the conversation can be long, and groundless, because the appointment of drugs for this disease requires the competence of the endocrinologist. One can only say that the treatment of this health disorder is long and is based on adherence to a special diet with restriction of sources of glucose and cholesterol.
The same can be said about cardiovascular diseases, which are treated by a specialist doctor.
But with regard to the dumping syndrome, you can give some tips that facilitate the patient's condition and allow to normalize the digestive process in order to exclude the appearance of weakness after eating.
As in the case of diabetes, and in the situation with diseases of the gastrointestinal tract, the diet comes to the fore. For each disease there are limitations on the quality and dosage of food. Most often resort to fractional nutrition, when the number of meals a day increases, and portions are correspondingly reduced, as well as to the exclusion from the menu of heavy foods that provoke the formation of food lumps.
Dieting with dumping syndrome implies getting a full-fledged fractional food. Food should be high in calories, it should contain all the necessary vitamins, but the amount of liquid and carbohydrates should be limited. Foods rich in fiber should be eliminated as much as possible from the menu.
In the case of mild course of the syndrome, diet therapy is often limited. If, in addition to nausea and weakness after eating, dizziness is observed, for the removal of these syndromes, you can recommend preparations "Immodium", "Motilium", "Okreotid", as well as enzyme preparations.
"Immodium" reduces the frequency of contractions of the intestinal wall, due to which its contents move at a slower rate. The drug is indispensable for moderate-onset syndrome along with atropine medications that reduce gastrointestinal motility. "Okreotid" reduces the likelihood of complications after operations on the stomach and other organs of the digestive tract. "Mollium" directly removes the unpleasant symptoms that accompany the dumping syndrome.
In the severe course of the dumping syndrome, the anesthetic "Novocain" is prescribed before meals. In this case, after each meal, doctors do not recommend actively moving, but on the contrary advise to rest.
If all measures taken do not work, surgical care may be required, which consists in reconstructive gastroejunoduodenoplasty, which slows the movement of food to the small intestine.
Weakness after a meal can be caused by a violation of the digestibility of food, and hence vitamins in their composition. Therefore, the therapy of this condition includes the intake of vitamin complexes.
Physiotherapy treatment is prescribed for those diseases caused by a state of weakness after eating. It can be mud therapy, mineral water treatment, physiotherapy exercises, climatotherapy.
Alternative treatment of weakness after eating
Both medicamental and alternative treatment of weakness after eating is based on the elimination of the cause of its causing, and therefore, should only be carried out according to the results of medical diagnosis. When the disease is established, it makes sense to begin its treatment, which will eliminate weakness and other symptoms.
So with pancreatitis and gastritis, fresh potato juice has a positive effect, you need to drink it from 1.5 to 3 glasses a day.
Helps with many diseases of the gastrointestinal tract and propolis. It is used in the form of an alcohol tincture, an aqueous solution or in a natural form. The simplest thing for complications of the disease and the appearance of symptoms of nausea and weakness after eating is to chew a bit of propolis slightly more than a pea for some time.
Sea buckthorn oil also significantly alleviates the condition of patients with stomach, duodenum and intestines. Take it should be 1 teaspoon for 25-30 minutes before eating.
In the case of diabetes mellitus, alternative medicine recommends using light beans in the amount of 7 pcs., Pre-soaked in the evening in 100 g of water. Beans must be eaten on an empty stomach, washed down with the same water, one hour before a meal.
Helps to stabilize the condition with diabetes and horseradish. It must be crushed and insist on sour milk in a cold place for about 7-8 hours (1 tablespoon horseradish per 1 item of sour milk). Take half an hour before meals in the amount of 1 spoonful.
Such recipes are great, but in addition to stabilizing the digestive tract and preventing weakness, nausea, dizziness after eating, promotes the use of foods and herbs that help improve digestion. To products of such action carry dried fruits, fresh fruit and vegetables, a flaxseed, dairy products, bran.
Treatment of herbs weakness after eating is based on the properties of some herbs useful for digestion. These herbs include dandelion, dill, mint. And also chamomile, elecampane, plantain, St. John's wort, rosemary, ginger root, chicory and ayr, etc. Based on these herbs are medical fees. Some of them can be found even in the pharmacy, for example, effective herbal teas Dr. Selezneva.
Among other homeopathic remedies, with weakness after eating, the following drugs can be distinguished:
"Anacardium-Homaccord" is used to treat various disorders in the functioning of the digestive system. One of the indications for use is the ill-fated dumping syndrome.
The drug is available in the form of drops. The daily adult dosage is 30 drops, divided equally into 3 doses. The child is installed by a doctor.
Contraindication to use is hypersensitivity to the components. Side effects are not observed. Patients with pathologies of the thyroid gland can take the drug only in the dosage determined by the endocrinologist.
"Coenzyme compositum" homeopathic ampoules, used in the form of injections. Normalize the metabolism, activate the defenses of the body to combat pathologies of the gastrointestinal tract and other organs and systems, positively affect the production of enzymes.
The injections are done 1 to 3 times a week, using different methods of drug administration. Adult single dose - 1 ampoule. For children younger than 6 years, the dosage is 1 ml, up to 1 year - 0.4 ml, up to 3 years - 0.6 ml.
The solution can also be taken orally (through the mouth), diluting the prescribed dose in water (5-10 ml). The course of therapy can vary within 2-5 weeks.
In addition to the intolerance of the drug other contraindications for this remedy for weakness after eating no. But some side effects are noticed: swelling at the injection site, itching and allergic rashes.
It is not recommended to mix this drug with other medicines in the same syringe.
"Natrium phosphoricum" - a drug for the treatment of diabetes and conditions with difficult digestion of fatty foods. Contains lactose.
The drug is intended for the treatment of adults and children, including infants. A single dose for all ages is one - 1 tablet. But the frequency of application depends on the age of the patient, and the course of the disease. With chronic conditions, the drug is taken 1-3 times a day, with acute - 1 to 6 times.
When taking the drug, hypersensitivity reactions are possible. At pregnancy consultation of the doctor-expert in occasion of use of a preparation can be necessary.
"Gastronal" is a homeopathic preparation that has found its application in the complex therapy of gastrointestinal diseases, accompanied by nausea and weakness after eating.
The drug is indicated for use in adults over 18 years of age. Contraindications for use, in addition to hypersensitivity reactions, are the lack of sugar and intolerance to fructose, which is part of the drug. Side effects are manifested only on the basis of ignoring contraindications.
The preparation in the form of homeopathic granules is used in the usual single dose (8 pcs.) And is retained in the mouth until the maximum dissolution is achieved. You can take the pill before (for half an hour) or after a meal (in an hour). It is recommended to use the drug three times a day for a therapeutic course of 1 month.
The product is not recommended for use during pregnancy and lactation, and after expiry of the shelf life.
Prevention of weakness and other unpleasant symptoms after eating begins with a review of the existing regime of the day and the usual menu. Breakfast, lunch and dinner should be at the same time. During the meal, you need to focus on the process of eating, and not to think about the details of the upcoming meeting and worry about missed moments. It is not necessary to watch television programs during the meal, learn lessons, prepare for exams, read fiction, leaving your stomach one on one with insufficiently chewed food.
Reconsider and your hourly ration. In the morning and in the day, limit the intake of foods rich in carbohydrates so that they do not cause untimely sleepiness. To prevent dizziness and weakness after eating, limit the amount of coffee you drink, especially coffee with sugar.
Increasing the frequency of food intake and reducing single portions will help the digestive tract more easily cope with its work. At the same time, you should eat slowly, carefully chopping food in your mouth and preferring light food, fruits, vegetables. This will help to avoid the formation of food lumps.
If there are no special contraindications, enter into your diet fiber, which will actively help the digestive tract in the processing of food. Pay attention to other products that improve digestion. They are useful for both treatment and prevention of weakness after eating.
Take the habit of drinking a glass of clean water half an hour before the first meal. This will allow not only to start the stomach and intestines that have not yet awakened, but also to purify them from accumulated mucus.
Overeating is the biggest enemy of the gastrointestinal tract. It is the excesses in food and its large volume are the frequent cause of the development of various pathologies of the gastrointestinal tract. A glass of water will help, and in this case, reducing the raging appetite.
If you can not avoid overeating (usually this happens at weddings, anniversaries and other celebrations with an abundance of alcohol and delicacies), enzyme preparations and ordinary activated carbon will help to quickly and effectively get rid of such troubles as dizziness, nausea and weakness after eating.
Speaking about the prognosis of weakness after eating as an occasional repetitive unpleasant condition, adherence to diet and other preventive measures will unequivocally change the situation for the better. If we consider weakness after eating as a symptom of a particular disease, then for a favorable prognosis, serious and long-term treatment may be necessary provided that the pathology is detected in time. Here, one diet is rarely enough.