Uff-Da!

Ah, I get to say it again. Just remind yourself that YOU are your own health manager. The doctor is your paid consultant. A manager typically listens to the advice offered by his/her paid consultants including the reasoning behind it, but is ultimately responsible for the decision on whether to take that advice or not. Some doctors can't handle that kind of relationship, preferring a situation where their orders will be blindly followed. In that case, the patient has to decide if it is time to change doctors.

IMHO you have a good chance of getting your numbers down a lot with just dietary changes. 52 of those LDL points came from the triglycerides. If you could get your trigs down to 100 or less (which you could likely do given your indication you've had a high carb diet), your LDL would still be 131. That's still a bit high, especially if you have other heart health risks like family history, high blood pressure or the like. But with additional lifestyle changes, it is within reason that one could do it. It is certainly worth a try.

One problem with starting the meds first, then trying to change your lifestyle is that then you will have no way of knowing how much impact changing your lifestyle was having. And of course, your doctor is likely to attribute the whole improvement to the Lipitor.

In addition to cutting the bad carbs, saturated fats and trans fats, try to increase legumes, oat bran and other sources of soluble fiber in the diet. It can help usher dietary cholesterol out of the intestinal track before it is absorbed and will thus help keep your serum cholesterol down.