Whole grains keep their bran and germ, so they carry more fiber, selenium, potassium and magnesium. Refined grains are milled to strip both out. They lose much of that fiber and nutrition, and they do not keep blood sugar steady. So in our patients, who are already metabolically sick, refined grains are unhealthy and belong off the plate.
Refined grains are unhealthy in the population we treat: people who are already metabolically sick. Should you totally do away with refined grains? For our patients, yes. In this article, we look at what separates whole grains from refined grains. We also show how to replace refined grains at every meal.
- Whole grains vs. regular grains: What’s the difference?
Whole grains keep more of their fiber and minerals than refined grains. But they are still starch, and wheat, barley and rye still carry gluten and gliadin.
In chronic pain, gluten and gliadin drive a leaky gut and autoimmune trouble. For our patients, vegetables are a better source of fiber, without the blood sugar spike.
What are the different types of grains?
Grains and whole grains, also called cereals, are the seeds of grasses grown for food. They come in many shapes and sizes, from large kernels of popcorn to small quinoa seeds.
- Whole grains. These unrefined grains have not had their bran and germ removed by milling. So all of the nutrients stay intact. Whole grains are better sources of fiber and other important nutrients, such as selenium, potassium, and magnesium. Whole grains are either single foods, such as brown rice and popcorn, or ingredients in products, such as buckwheat in pancakes or whole wheat in bread.
- Refined grains. Unlike whole grains, refined grains are milled. Milling strips out both the bran and germ to give them a finer texture and longer shelf life. The refining process also removes many nutrients, including fiber. Refined grains include white flour, white rice, white bread, and degermed cornmeal. Many breads, cereals, crackers, desserts, and pastries are made with refined grains, too. These processed foods will not keep your blood sugar levels steady. That is why you will be hungry again soon after eating them.
- Enriched grains. Enriched means that some or many of the nutrients that are lost during processing are added back in later.
Most refined grains are enriched. Many enriched grains are also fortified with other vitamins and minerals, such as folic acid and iron. Fortified means nutrients that don’t occur naturally in the food are added. Enriched grains lack fiber and are not an optimal choice. That is because, while they have traces of nutrition, many important vitamins and nutrients are lost during processing.
What to eat instead
Chances are you eat lots of grains already. For our patients, the answer is not to trade white bread for brown bread. It is to build meals around foods that keep blood sugar steady:
- Red meat, fish and eggs
- Leafy greens and other vegetables
- Nuts
- Plain yogurt and cheese
- Real olive oil
It’s not always easy to tell which grains are in a product, especially bread. For instance, brown bread may be white flour with added coloring. Check the ingredient list for wheat, flour, enriched flour, rice and corn, and leave those products on the shelf.
How to replace grains at every meal
Try these tips to take grains off your plate:
- Start the day with eggs, meat or plain yogurt instead of cereal or oatmeal.
- Skip toast, bagels, muffins and pastries.
- Wrap sandwich fillings in lettuce instead of bread, rolls or tortillas.
- Replace rice with cauliflower rice or extra vegetables.
- Thicken soups and stews with vegetables instead of barley or rice.
- Serve ground meat on its own. It needs no bread crumbs or rice for body.
- Use crushed nuts or grated cheese in recipes instead of bread crumbs.
To eat, or not to eat, refined grains?
For the patients we treat, the answer is not to eat them. Refined grains are unhealthy in a population that is already metabolically sick, so replace them rather than balance them against whole grains.
A lot of products contain both whole grains and refined grains. Foods made from at least 50 percent whole-grain ingredients by weight may have a whole grains claim on the label, per the Dietary Guidelines. The rest can be refined flour. A whole-grain label does not make a product right for our patients.
So do you actually need to worry about refined carbs?
For our patients, refined grains are unhealthy and belong off the plate. Even so, the average refined grain intake is “well above” the Dietary Guidelines’ own limits among men and women in most age groups.
Say you notice that your own diet leans heavily toward refined carbs. Swapping white bread for whole-wheat bread is not enough. Replace the bread, rice and pasta with protein and vegetables instead.
We do not recommend any refined grains. Skip refined grains and bread. In chronic pain, gluten and gliadin drive a leaky gut and autoimmune trouble.
Related reading
References
- Choose My Plate: What foods are in the Grains Group? Retrieved from https://www.choosemyplate.gov/eathealthy/grains
- Self (2019): What Exactly Are Refined Carbs? Retrieved from https://www.self.com/story/what-are-refined-carbs
- The Mayo Clinic (2019): Whole grains vs. regular grains: What’s the difference? Retrieved from http://diet.mayoclinic.org/diet/eat/whole-grains-vs-regular-grains?xid=nl_MayoClinicDiet_20160421
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
