In April of 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 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, 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), echinacea (Echinacea spp.), and aloe vera (Aloe vera), as well as “specialty herbs” (e.g., black
cohosh [Actaea racemosa],
green tea [Camellia sinensis], milk thistle [Silybum marianum]), “multi-herbs,” and other herbal supplements. The organization
attributes this increase to the large number of aging Baby Boomers, “consumer
awareness about general health and well being,” the strong safety record of
herbal supplements, and 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] and kava [Piper methysticum].”
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), açaí (Euterpe
oleracea), guarana (Paullinia
cupana), and green tea.7
In its 2010 Herb Market Report 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), saw
palmetto (Serenoa repens),
soy (Glycine max), and
garlic (Allium sativum),
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[s]. 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) extract and the increasingly popular agave (Agave americana) 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.
“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.”
—Tyler Smith
References
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.
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