A heart patient’s guide to the three stages of chronic stress

gas gauge empty

by Carolyn Thomas    @HeartSisters

McGill University’s Centre for Studies on Human Stress at L’Hôpital Louis H. Lafontaine in Montréal is a remarkably helpful resource for those of you who are so chronically stressed day to day that you no longer think this state of being is even abnormal anymore.

Anybody who has undergone ongoing chaos in the workplace, a family health crisis, a divorce, a death in the family, serious financial worries, too darned many deadlines, and many other of life’s realities can recognize the symptoms of chronic stress – but did you know that this low-grade stress is extremely damaging to our hearts?

In fact, the World Health Organization has predicted that by 2020, stress-related disorders like heart disease and depression will be in the top two leading causes of disability in adults. According to the Centre for Studies On Human Stress, there are three distinct stages of chronic stress.  See if any of these sound familiar: 

Stage 1 : The ‘Pepto Bismol®’ stage

In this early stage of chronic stress, you are repeatedly exposed to situations that activate your stress response, so each time you mobilize energy.

  • your heart rate and breathing increases
  • your blood sugar levels and blood pressure increase
  • your digestion slows

After a few days of interrupted digestion you may start to experience heartburn, diarrhea and/or constipation – hence we call it the Pepto Bismol® stage.

You may also experience some of the following:

  • emotional distress: irritability, resentment, anger, anxiety, and a depressed state
  • muscular problems: tension headache, back pain, jaw pain, etc.

Stage 2: The ‘Rume’ and Coke stage

Here, things are getting a little out of control and are somewhat chaotic. It seems as though one stressor relentlessly follows the other. The stress response system is constantly activated and constantly extracting stored energy.

You may notice that…

  • you abound with nervous energy
  • you are constantly worrying and expecting the worst (that’s the ‘ruminating’ of the title)
  • you take on too much, are always rushing, and are often late
  • you feel overwhelmed and overworked
  • you feel over-aroused and short-tempered
  • you feel anxious, and/or tense most of the time
  • you can’t turn off your mind when you go to bed
  • you increase your intake of tobacco, alcohol, and unhealthy foods
  • your memory starts to fail you
  • you often get colds and the flu

Stage 3: The ‘Glass of Water’ Stage

By now, you are living in all-out chronic stress. The glass of water is for all the pills you have to take just to get through the day (and night) after repeated activation of the stress response system. At this stage, your personality can change dramatically.

Some of the most common health problems linked to longterm chronic stress are:

  • heart disease (high blood pressure, high cholesterol)
  • insomnia
  • depression
  • burnout

When the stress response system is activated, energy is mobilized. But you need to replenish those energy stores. After a while, your body no longer does this efficiently. In the short-run, your body tries to ‘help’ by storing energy in the form of fat in the mid-section. But this added weight is not good for the heart; an apple-shaped waist is considered a key risk factor for heart disease.

Unmanaged chronic stress, especially stress-related anger and hostility, can affect our health. It may cause:

  • high blood pressure
  • irregular heart rhythms
  • damage to our coronary arteries
  • higher LDL (bad) cholesterol levels
  • the development and progression of coronary artery disease (atherosclerosis)
  • a weakened immune system

NOTE FROM CAROLYN:   Lots more about stress as a cardiac risk factor – and the significant stress of a cardiac diagnosis – in my book “A Woman’s Guide to Living with Heart Disease”  (Johns Hopkins University Press, 2017)


See also:


8 thoughts on “A heart patient’s guide to the three stages of chronic stress

  1. Hello. I’m in the ‘Pepto Bismol’ stage right now, this is a completely accurate description of my day to day life, but I am so used to living like this that it doesn’t seem unusual anymore, the human body is not used to living with this chronic stress day after day year after year without something — like our HEART for example — suffering the end result one day. THANK YOU for this reminder, I’m only 38, it’s not too late to finally make changes and start serious stress-reducing strategies.


  2. Oh great. Now I’m feeling stressed about being so stressed out, I’m especially in the “Rume & Coke” stage right now. Thx for this wake up reminder that it is NOT normal to continue like this day after day.


  3. Pingback: Stress Depression Link | My Blog
  4. There are many misconceptions about heart disease: “The biggest misconception is that heart disease only happens to the elderly,” said Elizabeth Schilling, CRNP with the Center for Preventive Cardiology Program at the University of Maryland Medical Center.

    At least one out of every 20 people below the age of 40 has heart disease, according to the American Heart Association. So, it is a wise decision to keep a constant monitoring of your health. Why take a chance if we have the option? I was in the similar misconception that heart disease was far away waiting for me to get aged.


  5. Pingback: Coping with Emotional Stress: Self Help
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