Dr Mitch Rice emphasises that high cholesterol often stems from liver insulin resistance rather than diet alone, recommending a focus on metabolic health markers and lifestyle changes to improve lipid profiles.
Dr Mitch Rice says many patients are left baffled when their cholesterol stays high despite cutting out obvious dietary suspects such as red meat, eggs and full-fat foods. His view, reflected in wider medical literature, is that the deeper problem is often not what people eat at one meal but how the liver is handling energy over time.
That matters because the standard cholesterol panel can obscure more than it reveals. Total cholesterol is a calculated figure rather than a direct measurement, and two people with the same number can have very different cardiovascular risk. The more useful questions are how much LDL, triglycerides and HDL a person has, whether the triglyceride-to-HDL ratio suggests poor metabolic health and whether insulin resistance is part of the picture. Lipid and liver metabolism research shows insulin resistance can increase VLDL output, raise LDL particle burden and reduce HDL, creating a more harmful profile even when the headline numbers appear unremarkable.
Rice argues that liver insulin resistance is the main engine behind many stubborn cholesterol problems. In that state, excess carbohydrate is converted into fat in the liver, packaged into VLDL particles and eventually transformed into more LDL in the bloodstream. At the same time, LDL receptors become less effective, so the liver clears less of that cholesterol back out of circulation. The result is a double hit: more production and less removal.
He also pushes for apolipoprotein B, or apoB, to be measured alongside or instead of LDL alone in people with signs of metabolic dysfunction. ApoB gives a direct count of the number of atherogenic, or plaque-forming, particles in the blood. That can matter more than the amount of cholesterol carried inside them. Labcorp’s description of related insulin-resistance testing, including its LP-IR score, underlines how lipoprotein patterns can help identify people whose metabolism is beginning to slip long before diabetes develops.
The practical answer, according to Rice, is to improve insulin sensitivity rather than obsess over isolated foods. Reducing refined carbohydrates and added sugar, taking a short walk after meals and building muscle through regular resistance training can all help lower the glucose load reaching the liver. That approach aligns with broader evidence from fatty liver and insulin-resistance research, which links better metabolic health with improved lipid profiles and less liver fat over time.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
