<p>This review aimed to explore the impact of extrusion on Andean grains, such as quinoa, kañiwa, and kiwicha, highlighting their macromolecular transformations, technological innovations, and contributions to food security. These grains, which are rich in starch, high-quality proteins, and antioxidant compounds, are versatile raw materials for extrusion, a continuous and efficient process that combines high temperatures and pressures to transform structural and chemical components. Extrusion improves the digestibility of proteins and starches, encourages the formation of amylose-lipid complexes, and increases the solubility of dietary fiber. However, it can degrade heat-sensitive nutrients, such as certain amino acids. The role of extrusion in food innovation is highlighted, especially in the creation of healthy and functional products such as snacks, gluten-free pastas, and meat analogs. Some innovations in the extrusion process and future trends, such as the use of artificial intelligence to optimize formulations and customize products, have been presented. The importance of Andean grains in the fight against food insecurity has been emphasized. These grains can be transformed into accessible, long-lasting, and nutritious foods, diversifying the diet and taking advantage of local resources. This review aims to serve as a valuable guide for researchers, food developers, and policymakers in their pursuit of creating more accessible, nutritious, and sustainable food options to meet escalating global demands for food security and enhanced nutrition.</p>