Gluten-Related Disorders and Brain-Heart Interactions: Pathophysiological Links, Clinical Manifestations, and Translational Implications

Gluten-related disorders (GRDs) comprise a heterogeneous group of immune-mediated and immune-associated conditions triggered by gluten or wheat exposure, including celiac disease, non-celiac gluten sensitivity, and wheat allergy. Although traditionally regarded as gastrointestinal disorders, GRDs are increasingly recognized as systemic conditions with clinically relevant involvement of the central nervous system and the cardiovascular system. Neurological, psychiatric, autonomic, and cardiovascular manifestations are now understood to represent integral components of the disease phenotype rather than incidental comorbidities. This narrative review examines current evidence on the mechanisms linking gluten-related immune activation to brain and heart dysfunction, highlighting convergent inflammatory, autoimmune, neuroimmune, and endothelial pathways. Emphasis is placed on the gut-brain-heart axis, alterations of epithelial and blood-brain barrier integrity, autonomic dysregulation, and vascular dysfunction. The potential reversibility of selected neurocardiac manifestations through dietary and immunologically targeted interventions is also discussed. A systems-level understanding of brain-heart interactions in GRDs may improve diagnostic accuracy, inform cardiovascular and neurological risk stratification, and support more integrated, holistic management strategies for affected patients.