I've been giving this a lot of thought, and I've come to the conclusion that those who are eating a biologically appropriate diet, which most of us are, should not be at all concerned about their lipid panel results, especially LDL. And if we know that LDL doesn't correlate to cardiovascular risk, then should we be worried about total cholesterol or a ratio between LDL and another value such as HDL? Wouldn't all of those values be irrelevant? Something we need to consider is that the SAD, past veg*n diets etc. do a lot of damage and skew your cell membrane composition toward omega-6/PUFAs. Most of us likely start out with non-alcoholic fatty liver to some extent when we begin paleo, so that's another thing that needs to be repaired. Going high saturated fat, low fructose would almost certainly result in a liver fat purge.
If I were 4 years into a biologically appropriate diet instead of less than 1 and I got the results back that I just did with everything looking good but TC being 391 I would be slightly taken aback, because I would have a turnover of nearly all of my cells with the proper o3:o6 ratio and my liver would have long since been purged. I've never seen someone with really high LDL who has been paleo for a while. What's a lot more common is total cholesterol that exceeds the arbitrary 200 point after a long period of paleo. These individuals also happen to have extraordinarily high HDL which is skewing the TC upward. I would wager that this is from coconut consumption.
Now, we of course have lipid panels from many contemporary HGs, including the Inuit and Kitavans and we don't see them breaking 200mg/dl. Should we be alarmed? I think there are definitely those in the paleo community who consume every day more coconut oil than even the average Kitavan. I think this could account for the difference. As for me, I'm allergic to coconut, so I doubt I'll get HDL up to around 100, but it's possible. I also can't attribute my LDL to coconut. Do all humans require coconut and will I develop a coconut deficiency? No, that's ridiculous. It's possible that going wheat-free for years could mitigate my tree nut allergy and I could eventually work it into my diet, but I'm not worried about it if I can't.
I then find myself in a situation where all of the real markers for cardiovascular disease are great but I have this one aberrant value. I could take statins of course, which would likely damage my health but make that number go down. I could also stay within the realm of what is biologically appropriate and consume substantial quantities of soluble fiber, which would bind the bile acids in my intestines and interfere with the reuptake of cholesterol. Do I really want to do that? If you feed your body the correct raw materials in the correct amounts and for some period of time it wants to spike the cholesterol content traveling around in your lipoproteins, do you really want to get in the way? Won't that simply increase the duration of elevated LDL-C and make the recovery process longer? What are my goals? Is my goal to be healthy or is my goal to make my doctor happy? We've reached a sad point where that is unfortunately not the same thing. Similarly, when fed a biologically appropriate diet, do you trust your body or do you trust the medicine-pharmaceutical complex?
All told, my LDL could be accurately described as obscene and yet I sit here without a worry. The most I'll say is that it has piqued my interest and I'll certainly want to get it rechecked in 6 months to see how it's trending, but I'm far more interested in lowering TGs and raising HDL, but even then I'm not going to consume specific things in highly unlikely and perhaps inappropriate dosages, paleo or not, in order to manipulate those numbers. I like the idea of giving my body what it likely needs in sufficient, but not excessive amounts, and letting it do what it wants. If medicine can't tell us what to eat and says that every American needs to pour money into the 25 billion dollar statin coffers, then perhaps they don't have a complete understanding of why my LDL is so high currently and what specific operations it's doing as it floats around my body and attaches to cells. I've become quite attached to this body of mine, and I think I'll trust the fellow.