Should We Avoid Refined-Grain Foods? | Ask The Expert

We might have heard that whole-grain foods are better for us than refined-grain foods. But does this mean that we should avoid refined flour as much as possible? I've asked Italian dietitian Camilla Bendinelli.

After many years of demonising fats, the focus has shifted to carbohydrates over the past few decades. However, in the same way that we eventually recognised that there are both healthy and unhealthy fats, we were bound to narrow down the argument against carbs too. Now it’s sugars and refined grains that are held accountable for metabolic syndromes and health problems. Today, the word ‘refined’ has many negative connotations – it reminds us of industrial and chemical processes, of something overly and unnaturally polished. 

But are all refined grains the same? What about a slice of homemade bread and a slice of chocolate cake, both made with the same refined flour – could they possibly impact our bodies in the same way? The issue is that we tend to identify culprits and ban them from our meals at all costs. Is this type of obsession the right approach to a healthy diet? Perhaps the most beneficial way to approach our food is to understand the complexity of nutrition and adhere to common sense advice: eating mindfully, welcoming variety in our diets, avoiding junk food, and stopping when we’re full. For now, let’s bust some myths around refined flour.

White vs. whole-grain foods. Different guidelines claim different things – some argue we should make at least half of our grains whole, and others claim we should stay away from all refined-grain products. Where do you stand in this debate?

When filling our diet with foods made of white flour, we miss an opportunity to consume more vitamins, fatty acids, and fibre. We do have many foods available around us to reach our daily recommended amount of these nutrients every day. Of course, it’s great to eat whole-grain foods, but the big mistake is to think that we have to add solely fibrous whole-grain foods to our diet. We don’t need to rely solely on our whole-grain bread or pasta to reach those nutrient goals. There are some proponents of diets filled with fibre-rich foods and supplements, but that creates obsessions. Fibre intake is a daily intake - not a ‘meal’ intake. We don’t need to obsess about calculating the right proportions for every meal. 

Some argue the reason why refined-grain products are bad is that they cause spikes in our blood sugar. I hear a lot of talk about the glycemic index of foods. Is this a legitimate line of reasoning?

First of all, we need to understand what the glycemic index is. It’s the speed at which your blood sugar levels increase when you eat a specific food. The glycemic index tells you how 50g of carbohydrates of a certain food will cause your blood sugar levels to rise. The higher the glycemic index, the more rapidly the carbs will be converted into glucose (the type of sugar our body needs to function). But there are limits to this assessment, and that’s why the ‘glycemic load’ is a more reliable measure. 

The glycemic load measures more accurately how certain foods will impact blood glucose levels by looking at the number of carbohydrates in an average serving of that food. Some foods might have a very high glycemic index, but in reality, they might have very few carbs, so the glycemic load for one portion will be very low. The glycemic index of a watermelon, for example, is 72, which is very high. However, watermelon mainly consists of water, so in the end, the glycemic load for a portion of watermelon is just 4, which means that it will have a very low impact on our blood glucose levels. 

The limit of looking at carbs in terms of the glycemic index is that this measure refers to foods as if we ate them alone – regardless of the portion. There is a huge difference between eating a slice of white bread or an entire loaf! We rarely eat just one food on its own. By eating refined-grain products together with other foods, we cushion the glycemic load and slow down the metabolisation rate. If we eat foods in moderate proportions and not on their own, then eating refined flour won’t cause those big spikes in our blood sugar.

What advice do you give to your patients about whole vs refined grains?

I tell them it’s not worth searching for whole-grain products at all costs. It’s important to understand what we like and what we don’t like, as well as what we can cook with. We should try to find foods that are pleasant to eat whole and consume them regularly, alternating them with other refined foods that we still like to consume. 

What do you think about keto diets or diets that completely exclude grains-based foods? Are there any cases where it is legitimate or advisable to follow them?

Surely every single case must be evaluated by a professional, but the general guidelines suggest ketogenic diets mainly for treatment purposes. For example, they can be advisable when a patient is suffering from drug-resistant epilepsy or some types of migraine.

Sometimes, a ketogenic diet is also recommended in cases of high-grade obesity that have failed all the other existing dietary and psychological therapies. In this case, it’s considered a last resort and has to be carried out for a limited period and always under nutritional and medical supervision.

What would you say to all the people who think it’s impossible to lose weight without reducing carbohydrate intake or avoiding grain-based foods?

This way of thinking derives from the current – and wrong – demonisation of carbs. First of all, one gram of carbohydrates and one gram of protein carry exactly the same amount of calories.

One gram of proteins and carbs carries 4 calories, while one gram of fat carries 9 calories.

It’s true that people who are experimenting with ketogenic, high-protein, or more in general low-carbohydrate diets, seem to have higher results in terms of weight loss. However, there’s a very simple reason for that – these diets determine a considerable loss of liquids from our bodies. 

The issue is that we are used to reading changes in weight on the scale as loss or gain of fat mass. But in reality, the difference in weight resulting from a balanced diet that still includes carbs only has to do with liquids, not fat mass. 

On top of that, diets without carbohydrates are not sustainable – carbs are the main fuel to make our bodies work! – so people following them just end up regularly regaining all of the pounds lost in the form of liquids later on, in a sort of yo-yo effect. 

Should we reduce the intake of bread and pasta as we get older?

If you follow a balanced diet, for example, the Mediterranean diet, you don’t actually need to retouch it as you get older. But not everyone consistently follows these balanced diets in a very orthodox way. There are several reasons why people gain weight as they age. When we get older, many people tend to become more sedentary. And metabolism, after 30, can slow down a little bit. So, it would be a mistake to attribute weight gain to flour-based products only. It’s more about our whole lifestyle.

What do you personally eat? And what do you prefer between whole and refined flours?

I eat grain-based foods regularly. I don’t like brown rice, so I only buy white rice. But I really like wholemeal bread. I choose the products I like the most and create variety and balance in my pantry. I have found foods I enjoy, some made with white refined flour, while others made of whole grains, and I alternate between them. I know I have a balanced diet, so I don’t obsess. Being a dietitian, I could make some quick calculations, but I never do. I never count calories, and I think that’s the healthiest thing to do.