Reasons for the divergent lipid response to walnuts in MetS patients compared to healthy controls are discussed by Casas-Agustench and co-workers [18], who suggest that high cholesterol synthesis, reduced intestinal cholesterol absorption and enhanced cholesterol flux through the liver resulting in LDL receptor down-regulation, may render insulin-resistant individuals less responsive to cholesterol-lowering diets. This evidence concerns the gene LDLR and metabolic syndrome.