SCOPE: Low-grade inflammation is a hallmark of cardiometabolic risk. Bilberries (Vaccinium myrtillus) are rich in polyphenols with potential anti-inflammatory properties. We studied the impact of bilberries on inflammation and gene expression profile in peripheral blood mononuclear cells in subjects with metabolic syndrome. METHODS AND RESULTS: In randomized, controlled dietary intervention, the participants consumed either a diet rich in bilberries (n = 15) or a control diet (n = 12). The bilberry group consumed daily an equivalent dose of 400 g fresh bilberries, while the control group maintained their habitual diet. No differences were found between the groups in body weight, glucose, or lipid metabolism, but bilberry supplementation tended to decrease serum high-sensitivity C-reactive protein, IL-6, IL-12, and LPS concentrations. An inflammation score was significantly different between the groups (p = 0.024). In transcriptomics analyses (three participants with improved oral glucose tolerance test in the bilberry group), Toll-like receptor signaling, cytoplasmic ribosomal proteins, and B-cell receptor signaling pathways were differently regulated. QPCR analyses (n = 13 and 11 in the bilberry and control groups, respectively) showed decreased expression of MMD and CCR2 transcripts associated with monocyte and macrophage function associated genes. CONCLUSION: Regular bilberry consumption may reduce low-grade inflammation indicating decreased cardiometabolic risk in the long term.