MinnieMaud Guidelines For Recovery From A Restrictive Eating Disorder

MinnieMaud Guidelines are what have been developed on this site as science-based guidelines for recovery from restrictive eating disorders. Restrictive eating disorders include: anorexia, cycles of restriction and reactive eating, bulimia, orthorexia and anorexia athletica (also known as exercise bulimia).

The “Minnie” refers to the Minnesota Starvation Experiment and the “Maud” refers to the only evidence-based treatment program for eating disorders out there at the moment: Family Based Treatment, also known as the Maudsley protocol.

There is nothing about these guidelines that you won't find in any other inpatient setting where they apply scientific evidence in developing their re-feeding programs. For more on the science, view: Restrictive Eating Disorder Protocols.

In fact, the guidelines are actually set at what energy-balanced, non-eating-disordered cohorts normally eat to maintain their health and weight. That means that the minimum intake guidelines are what you can expect to eat both during and post-recovery. Much more detail and the science is available here: I Need How Many Calories?!! and MinnieMaud Method & Temperament-Based Treatment

Critically, however, you can expect to eat far more than minimum intake during your energy-restoration process in recovery. You will find more information on what recovery looks like, the reasons and data for why the intake guidelines are set as they are, and why extreme hunger is a necessary part of reaching a robust remission in these blog posts:

Phases of Recovery from a Restrictive Eating Disorder

Extreme Hunger I: What Is It?

Bingeing Is Not Bingeing

The Troika

1. Eat the minimum intake for your height, age and sex every single day. It’s a minimum intake and you are both encouraged and expected to eat more. Never restrict food intake.

2. No weighing yourself or measuring yourself. Get forgiving stretchy clothing. Relapse is common if you watch the needle on the scale.

3. No exercise. I address what is meant by this in these posts: Exercise I: As A Way To Restrict? You Bet and Exercise II: Insidious Activity.

In addition to these simple, yet hard to apply, necessities there is also a need to recognize that restrictive eating disorders are neurobiological conditions. You are not cured by restoring weight. The condition can be active or in remission, but it is never cured.

To get to a robust and permanent remission, you have to incorporate, along with weight restoration and physical repair efforts, the fact that the anxiety you feel welling up when you eat unrestrictedly has to be addressed as part of your treatment.

You have practiced maladaptive responses to that anxiety (dieting, exercising, cycling through restriction with reactive eating, etc.) and it helps to have a guide and teacher to help you learn the well-adapted techniques for responding to the anxiety. Cognitive behavioral therapy, dialectical behavioral therapy, exposure/response prevention therapy—all are suitable options to investigate with a counsellor or therapist of your choosing. Over time, it not only gets easier to automatically apply well-adapted responses, but you will find the underlying anxieties ease as well.

The Food Intake Guidelines

Here are the guidelines for when 2500 calories applies as a minimum daily intake for recovery:

  1. You are a 25+ year old female between 5’0” and 5’8” (152.4 to 173 cm) and,
  2. The regular menstrual cycle has stopped and/or,
  3. You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,
  4. Even if you were only underweight/dieted for a very short space of time (a few months) these guidelines apply. And remember “underweight” is relative to your body’s optimal weight and is not a clinical measurement.

Here are the guidelines for when 3000 calories applies as a minimum daily intake for recovery:

  1. You are an under 25 year old female between 5’0” and 5’8” (152.4 to 173 cm) or an over 25 year old male between 5’4” and 6’0” (162.5 and 183 cm) and,
  2. The regular menstrual cycle has stopped and/or,
  3. You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,
  4. Even if you were only underweight/dieted for a very short space of time (a few months) these guidelines apply. And remember “underweight” is relative to your body’s optimal weight and is not a clinical measurement.

Here are the guidelines for when 3500 calories applies as a minimum daily intake for recovery:

  1. You are an under 25 year old male between 5’4” and 6’0” (162.5 and 183 cm) or female with young children or an equivalent and unavoidable level of activity.
  2. The regular menstrual cycle has stopped and/or,
  3. You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,
  4. Even if you were only underweight/dieted for a very short space of time (a few months) these guidelines apply. And remember “underweight” is relative to your body’s optimal weight and is not a clinical measurement.

If you are taller than the guidelines listed above, then add 200 calories to the guidelines that match your age and sex. If you are shorter than the guidelines listed above, then you may eat 200 calories less than what is suggested for your age and sex, however these are all minimum guidelines and everyone is expected to eat well above them for a good portion of the recovery process in any case. Please see this this blog post for more details: Extreme Hunger I: What Is It?

Seek medical advice before entering a recovery effort from a restrictive eating disorder.

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