Nutritional Interventions for Perimenopausal Anxiety and Depression Targeting Tryptophan and GABA Pathways: A Narrative Review.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing mechanistic and preclinical evidence without systematic study selection or meta-analysis.
PubMed 42451185 · doi:10.3390/nu18132185
What was done
This narrative review evaluated the mechanistic links between gut-brain axis dysfunction, estrogen fluctuations, and mood disorders during perimenopause. It specifically examined the metabolic pathways of tryptophan (the precursor to serotonin) and gamma-aminobutyric acid (GABA), synthesizing preclinical findings and preliminary human observations to outline potential nutritional intervention strategies (including tryptophan supplementation, kynurenine pathway modulation, and probiotics/prebiotics).
What was found
The abstract reports no quantitative results, sample sizes, or clinical trial outcome metrics. It describes mechanistic relationships wherein perimenopausal estrogen shifts alter gut microbiota composition, increase intestinal permeability, promote neuroinflammation, and disrupt hypothalamic-pituitary-adrenal (HPA) axis regulation. The authors note that while in vitro and animal models support modulating tryptophan and GABA pathways via diet or microbiome interventions, therapeutic efficacy in perimenopausal women remains unestablished.
Why it matters
It provides a mechanistic framework linking gut microbiota changes to neurotransmitter synthesis during perimenopause, highlighting non-hormonal nutritional targets that warrant formal clinical trial testing.
Limits
This is an unsystematic narrative review with no defined search protocol or risk of bias assessment. The proposed nutritional strategies rely largely on in vitro and animal models, and clinical evidence demonstrating efficacy in perimenopausal human populations is currently lacking.