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I have had cholesterol over 200 since I was 22. I am now 57.
It has been as high as 265. In December it was 255 at my last physical. However, until I was in my late 40’s my HDL was always much higher than average. My Dr suggested I try a statin. I have tried five or six different ones. They all made my muscles hurt. Especially my upper leg muscles.

Most recently he asked me to try Nexlezit. Not a statin. However, it made me sick to my stomach and gave me diarreha.
I always try to watch what I eat, but recently I gave up Bread. I have lost about 7 lbs since making this change.
I eat Fage zero fat Greek yogurt for breakfast with real blueberries I add. For lunch I bring an apple, carrots, mixed nuts, raisins, tomatoes, olives, and a granola bar in some combination.
Dinner is meat and vegetables or salad.

I saw 199 lbs on the scale over the weekend for the first time in several years. I am 5’ 9”. 38” waist(starting to feel loose)

Any suggestions with diet?

Well as far as diet goes, see what works for you. The Keto/Atkins thing is difficult to stick to because there are sugars and carbs in so many foods. Some people claim to get a “keto flu” for a few days as your body adjusts - minor flu like symptoms. I never had any such side effects. Keto stands for Ketosis which is when the body is forced to burn fat because it lacks the carbohydrates to burn (and would burn them first if you ate them). That’s basically how it works; starve the body of carbs and it is forced to burn fat.

The upside to it is you can eat as much protein as you like. You don’t count calories you just count carbs. There are 1000s of Keto advice websites and videos out there some better than others of course. One guy I liked to watch his videos suggested eating a salad an hour before the meal.

So yeah dropping bread from diet is the biggest hurdle.
And sugars. Problem with fruits are the sugars in them. I love fruit and as the spring and summer come I may surrender that part of the diet. I can’t imagine not eating peaches, plums, cherries, melons etc when the season arrives. Some people do the “Paleo diet” which allows them to eat anything as long as it isn’t processed food. They claim it works for them. Also FWIW I take a handful of raw vitamin/mineral supplements every day. Plus fish oil and Co-Q-10 which was recommended because of the statin.

There is a fish restaurant nearby, before Covid I’d go for lunch and order a salmon meal with broccoli and a make-your-own side-salad, and they’d charge me a few dollars extra for an extra piece of fish. Now, can’t make your own salad and have to order as take-out only. Rice basically not allowed which sucks because I do like sushi, and rice in general with fish and meats. If I’m in a fast food mood I’d go to El Pollo Loco and get a plate and add on maybe 3 or 4 chicken legs. They charge $1 a leg. So I fill up on protein. I get sliced meats at the deli counter and snack on turkey slices. Hard boiled eggs are easy, I boil a dozen and keep them in the fridge to snack on. Also find myself eating a lot of cole slaw. Not always ideal but it tastes good. Can make it at home and control the amount of sauce I mix in.

For digestion, I take sugar-free metamucil capsules in the AM and the PM. They are just pure psyllium husk I think, no carbs (or what they call zero net carbs, meaning the carbs are soluble in the GI tract not used for energy). The metamucil you mix in water or juice has sugar and/or carbs. Funny thing about the metamucil label it says “take 3-5 capsules 4-5 times a day” which I thought was overkill. I take 3 in the AM and 3 at night. Keeps me a lot more regular which can otherwise be a problem on a keto diet.

There is a sugar substitute I buy off Amazon. It’s a liquid version of those yellow packets. So 2 drops into my coffee or tea. Otherwise I don’t sweeten anything and I can’t eat baked goods. I’ve tried all kinds of keto-alternative cookies and cakes IMO they all suck. Which is probably a good thing since it could be a ‘gateway food’ to real cake. LOL. Did have some cauliflower rice pilaf, wasn’t too bad.