In April, 2011, the National Center for Health Statistics (NCHS) published a brief that reviewed past years’ dietary supplement use in the United States.1 The data were taken from the National Health and Nutrition Examination Survey (NHANES), a multi-decade program designed by the Centers for Disease Control and Prevention to assess the health and nutrition status of Americans. The NHANES is considered a pinnacle of health evaluations; however, the most recent published data regarding dietary supplements are almost 6 years old. In the time since this data were gathered, several non-governmental organizations—e.g., trade associations and market research firms—have filled in the information gaps with surveys of their own design. Although many supplement statistics have remained stable over the years, an analysis of the most recent data reveals current and future consumer trends.
The NHANES Program
The NHANES program began more than half a century ago as an effort to gather information about specific health issues in different population groups. In the late 1990s, the focus of the study shifted toward collecting information to assess the overall health and nutrition status of Americans. Each of the study’s 5,000 participants undergoes thorough medical, dental, and physiological examinations. Additionally, participants are interviewed by trained professionals to gather demographic, socioeconomic, dietary, and other health information. 2
Instead of publishing results annually, NCHS compiles multiple years of data into separate groups to be analyzed. NHANES I, II, and III were conducted from 1971 to 1994. Since then, the annual study has been referred to as the Continuous NHANES, or simply, NHANES. In addition to providing information about dietary supplements, data from the NHANES are used to determine risk factors for disease; to create national standards for height, weight, and blood pressure measurements; and to determine health and nutrition concerns for particular groups of people, such as the elderly. In the past, NHANES data have been used to create pediatric growth charts, raise awareness about dangerous levels of lead in blood, and initiate health programs designed to end the obesity epidemic.2
Despite the strengths of the NHANES, the authors who analyzed the data noted that the lack of standardized definitions for certain supplements, such as multivitamin/multi-mineral supplements (MVMMs) and botanicals, makes it extremely difficult to compare results to other studies.3 Furthermore, the study relies heavily on participant recall, which is only as accurate as the participant’s memory. And with any study, biases are possible. Experimenter bias occurs when the researcher intentionally, or inadvertently, records data in a way that favors a particular outcome. Researcher bias occurs when the participant acts or responds in a way that portrays him or herself in a positive light. Each of these things has the potential to skew results.
The dietary supplement data analyzed in the April 2011 NCHS brief were collected between 2003 and 2006. According to the data, dietary supplement use is common in the United States. The NHANES III (1988-1994) found that 35% of males and 43% of females used dietary supplements. Continuous NHANES data from 2003 to 2006 found that 44% of males and 53% of females, or approximately half the population, used dietary supplements. MVMM supplements were the most frequently used (33%), followed by botanicals (14%) and amino acids (4%).3
One of the more significant findings from the 2003 to 2006 data was an increase in calcium use in women aged 60 or older, from 28% to 61%.3 Although the authors of the analysis did not discuss this result, mainstream media and commercial coverage of the benefits of calcium for bone health in the early 2000s may have been partially responsible.
Industry and Research Groups’ Recent Data
Using more recent data from several leading industry and market research organizations—including the Natural Marketing Institute (NMI), the Council for Responsible Nutrition (CRN), and the Nutrition Business Journal (NBJ)—patterns in the data become recognizable. CRN’s 2010 Consumer Survey on Dietary Supplements, for example, found that 66% of US adults consider themselves supplement users, a significantly higher percentage than what was found in the 2003-2006 NHANES. 4
NMI’s 2010 Health and Wellness Trends Database found a substantial increase in herbal supplement users over the past decade as well. (Editor’s note: The term “herbal supplement” was not defined in the survey, so it is possible that some non-herbal supplements may have been considered by survey participants, as such distinctions are not always clear to consumers.) Forty-seven percent of survey respondents said they had taken an herbal supplement in the past year, up from 37% in 2000. Similarly, condition-specific supplement usage also increased during this time, from 22% to 48%.5 According to CRN’s survey, 82% of supplement users said they were confident about the “safety, quality, and effectiveness” of dietary supplements—up slightly from 80% in 2007.4
Many of these numbers have remained stable over the past few years, despite global economic woes. “It’s encouraging that during these touch economic times, consumers are maintaining their supplement regimens,” said Judy Blatman, senior vice president of communications at CRN, in a 2010 press release. “It’s clear that year [after] year they still place value on these products.”4
More significantly, the percentage of supplement users taking vitamin D increased from 16% in 2008 to 27% in 2010. “The ever-growing body of research on the benefits of vitamin D has been widely circulated in scientific journals, among healthcare practitioners and within popular press, so it’s no surprise that we are seeing more consumers adding it to their existing supplement routines,” said Blatman. 4
CRN’s survey was conducted online by the market research company Ipsos Public Affairs and funded by CRN. According to Blatman, the annual survey, which began in 2000, is projectable to the general public, although Blatman advised that no survey is perfect. For example, answers will vary depending on how questions are asked and how supplements are defined. “As long as you’re willing to admit there are limitations in your survey, people are willing to take that into account,” she said (oral communication, August 29, 2011).
In their September 2010 newsletter, NBJ voiced a similar opinion. “Although the findings generated by each research group can vary rather significantly at the micro level, one macro trend is clear: An involvement in promoting health and wellness is no longer seen only among a niche group of consumers; rather, nearly every demographic embraces this goal—at least to some extent.”6
Current and Future Trends
The global herbal supplements and remedies market is projected to reach $93.15 billion by 2015, according to Global Industry Analysts, Inc., a market research organization. This broad market category includes several popular herbs such as ginkgo biloba (Ginkgo biloba, Ginkgoaceae), echinacea (Echinacea spp., Asteraceae), and aloe vera (Aloe vera, Asphodelaceae), as well as “specialty herbs” (e.g., black cohosh [Actaea racemosa, Ranunculaceae], green tea [Camellia sinensis, Theaceae], milk thistle [Silybum marianum, Asteraceae]), “multi-herbs,” and other herbal supplements. The organization attributes this increase to the large number of aging baby boomers, “to consumer awareness about general health and well being,” to the strong safety record of herbal supplements, and to a general trend toward using natural, preventative care to stay healthy.7
Negative press about herbal supplements during the past 2 decades is fading in the minds of consumers, Global Industry Analysts, Inc. reported earlier this year. The herbal and botanical supplement market, it says, is “slowly crawling out of the vicious circle of negative publicity framed across certain controversial ingredients such as ephedra [Ephedra sinica, Ephedraceae] and kava [Piper methysticum, Piperaceae].”
Further, the steady consumption of herbal and botanical supplements has been helped by certain herbs that have crossed over to the mainstream market. Now, common botanicals include Asian ginseng (Panax ginseng, Araliaceae), açaí (Euterpe oleracea, Arecaceae), guarana (Paullinia cupana, Sapindaceae), and green tea.7
In its 2010 Herb Market Report published in HerbalGram, the American Botanical Council (ABC) reported the top-selling herbal dietary supplements in all channels of trade. The one channel in which the most precise data are available is the Food, Drug, and Mass Market Channel (FDM; including drugstores, large retailers, etc.), where the top-selling herbal supplements include cranberry (Vaccinium macrocarpon, Ericaceae), saw palmetto (Serenoa repens, Arecaceae), soy (Glycine max, Fabaceae), and garlic (Allium sativum, Amaryllidaceae), among others. “The popularity of food-based herbs is indicative of the fact that many popular herbal supplements are not exotic or arcane medicinal ingredients but have been used for centuries (and millennia) as foods and spices,” the report concluded.8
Notably, the economic recession appears to have had very little effect on the dietary supplement industry with respect to overall sales. According to 2010 data from NBJ, 74% of supplement users haven’t changed their supplement routines, 6% have opted for lower-cost varieties, and 11% of users have actually increased their supplement usage. “When you no longer have a job or health insurance, a multivitamin is a pretty cheap insurance policy,” explained Scott Van Winkle, managing director for the consumer research agency, Canaccord Genuity, in a September 2010 NBJ article.6
Concerns about the economy have not had as much of an effect on what supplements people are buying as on where they are buying them. ABC’s 2010 Herb Market Report found that herbal supplement sales increased in the mainstream food, drug, and mass markets. The data showed an increase of 4% to $914 million in 2010 from $878 million in 2009. Combined growth in all channels, however, was less substantial—only 0.2% in 2010.8 “Consumers have changed where they are shopping these days,” said Maryellen Molyneaux, NMI’s president and managing partner, in NBJ. “They are shopping more at club stores and mass merchandisers and they are looking more at private label. There is definitely more competition from mainstream outlets and the Internet.”8
The largest generation of Americans is beginning to retire and many older individuals have made staying active a priority. Taking supplements has become part of this goal for many Americans. “People are making a transformation toward [wanting] a higher quality of life,” said Shelly Balanko, vice president of ethnographic research for The Hartman Group—a market research firm that tracks sales in the natural food channel—in the September 2010 issue of NBJ. “In years past, wellness was more about longevity. Then, in 2007, we saw a shift to quality of life, and we [saw] it more … in 2010.”6
In addition to an increase in popularity of age-related supplements, certain products have started to become popular among all age groups. “We believe what is coming in future years is that mainstream consumers will see digestion as a foundation of health and [a] place where illness can take root,” predicted Balanko. “[Leading-edge consumers] will begin using digestive enzymes and continue their use of probiotics with the belief that, if digestion is taken care of, other aspects of their health will be taken care of as well.”6
With the ongoing obesity epidemic, weight loss continues to be a primary concern for many Americans, and more attention has been placed on natural alternatives to common table sugar (sucrose). No-calorie stevia (Stevia rebaudiana, Asteraceae) extract and the increasingly popular agave (Agave americana, Asparagaceae) syrups have already become commonplace in most specialty food retailers. “The issue of sweetness and forms of sugar used, such as artificial sweeteners, are all issues that are not going away,” said Molyneaux. “Consumers are learning that less sugar and less sweetness is good.”6
Supplements Will Survive
Having survived, even prospered, in the worst recession since the Great Depression, dietary supplement sales are projected to increase over the next several years. Widespread acceptance of certain botanicals such as agave and açaí, an aging population focused on staying active, and a more holistic view of health have all contributed to the continued success of the industry.
The economic downturn, in fact, may have contributed to the industry’s growth. “We have a new era of opportunity that is driven by consumers,” said Molyneaux. “They have a renewed sense of self-reliance and responsibility.”6
For some, turning to dietary and herbal supplements is common sense. “With this kind of economy, people are taking a more proactive approach to their health because they can’t afford to be sick,” said CRN’s Blatman. “Supplements play an important role in staying well to begin with. As our country moves away from sick care to well care, there’ll continue to be a growing role for dietary supplements.”
1. Gahche J, Bailey R, Burt V, et al. Dietary Supplement Use Has Increased Since NHANES III (1988-1994). Hyattsville, MD: National Center for Health Statistics, US Department of Health and Human Services; 2011.
2. National Health and Nutrition Examination Survey, 2007-2008: Overview. Hyattsville, MD: National Center for Health Statistics, US Department of Health and Human Services; 2007.
3. Bailey RL, Gahche JJ, Lentino CV, et al. Dietary Supplement Use in the United States, 2003-2006. The Journal of Nutrition. 2011;141:261-266.
4. Supplement Usage, Consumer Confidence Remains Steady [press release]. Washington, DC: Council for Responsible Nutrition; September 30, 2010.
5. Trended Supplement Use: Use of “Self Care” Types of Supplements is on the Increase. 2010 Health and Wellness Trends Database. Harleysville, MD: Natural Marketing Institute; 2010.
6. Recession Makes Wellness a More Urgent Priority for Most Consumer Groups. Nutrition Business Journal. September 2010;15(9):1-23.
7. Global Herbal Supplements and Remedies Market to Reach US$93.15 Billion by 2015 [press release]. San Jose, CA: Global Industry Analysts, Inc.; January 12, 2011.
8. Blumenthal M, Lindstrom A, Lynch MA, Rea P. Herb Sales Growth Continues – Up 3.3% in 2010. HerbalGram. 2011;90:64-67. Available at: http://cms.herbalgram.org/herbalgram /issue90/MarketReport.html. Accessed November 18, 2011.