How have dietary supplement use patterns changed over a recent 25-year period?

Dietary supplement use among adults continues to grow worldwide. Globally, the dietary supplements market was valued at nearly US$200 billion in 2024 and is projected to double by 2033. Only about 25% of these products are used under the guidance of a healthcare professional. Understanding how dietary supplement use patterns evolve over time is essential for informing both clinical guidance and public-health communication.Evidence supporting the impact of supplements on health outcomes remains mixed, with some findings suggesting benefits and others showing no benefit or possible harm. In addition, evidence on adverse interactions between supplements and medications remains limited for many products despite the large and growing supplement marketplace.Even with rising public interest, no comprehensive review has evaluated emerging trends in dietary supplement use, particularly for botanicals and other nonvitamin–nonmineral supplements. To explore this issue, American researchers examined 25 years of data from the U.S. National Health and Nutrition Examination Survey (NHANES)—a continuous, nationally representative review of the U.S. civilian, non-institutionalized population—to characterize national trends in supplement use. Particular attention was given to evolving product categories, temporal pattern changes over time, sociodemographic subgroups and periods surrounding the COVID-19 pandemic. The analysis included participants aged 20 years or older from 11 NHANES cycles that collected data on supplement use between 1999 and August 2023. Key findings: A total of 63,542 adults aged 20 years or older (mean age, 47.3 years; 52% women) completed the interview; of these, 100 were excluded due to missing information on supplement use;Supplement use increased over time: 51% of adults reported any use in 1999–2000 compared with 60% in 2021–2023;The largest absolute increases in supplement use were seen among adults ≥ 65 years of age, increasing from 62% to 78% over the 25-year study period;Multivitamin/multi-mneral use declined overall from 35% in 1999–2000 to 31% in 2021–2023; although use declined in younger and middle-aged adults, it increased slightly among older adults;Vitamin use increased from 47% to 54% over the same period, but no significant long-term differences overall were observed for mineral use. Vitamin and mineral use increased markedly among older adults; For individual supplements, some of the largest increases were observed for vitamin D (increasing from 5.1% to 29%) and zinc (from 4.6% to 11.0%); Other vitamins or minerals with notable increases included vitamin K, biotin, vitamin B12, potassium, copper, iron and magnesium; Large decreases were observed for nickel, tin, silicon, vanadium, chromium and boron; Notable increases were observed for turmeric and curcumin, lycopene and omega-3. Other notable emerging supplements included ashwagandha, acai, hyaluronic acid, elderberry, collagen, prebiotics and probiotics; Substantial decreases were observed for ginseng, ginkgo, gotu kola and carnitine, as well as ephedra, hesperidin, para-aminobenzoic acid, lecithin and garlic; Comparing supplement use during the COVID-19 pre-pandemic and early pandemic years (2017–2020) and later-pandemic and post-pandemic years (2021–2023), several individual products showed increases (> 1.5-fold), including rose hip, ashwagandha, lecithin, vitamin K, zinc, prebiotics, collagen, elderberry and potassium. Several of these products were marketed for immune support.The authors commented that older adults had the highest supplement use and the largest increase in supplement use. They warn that as the baby boom cohort ages, the growing older adult population, many with multiple chronic conditions and polypharmacy, may face increasing risks of drug–supplement interactions and rely on supplements for disease management and health promotion, often without healthcare professional oversight. The findings highlighted the need to document and understand patterns of supplement use in the older adult population, as well as the need to evaluate the efficacy and safety of supplements.The authors also note the increasing popularity of supplements marketed for immune, adaptogenic or anti-inflammatory support, such as zinc, elderberry, ashwagandha and turmeric and curcumin, which is consistent with prior reports documenting increased immune-related supplement use during COVID-19. Other notable trends include growing use of probiotics, prebiotics, collagen and hyaluronic acid, reflecting increasing consumer interest in digestive, skin and joint health. Reductions in the use of goldenseal, ginkgo and ginseng may reflect concerns over drug interactions and inconsistent evidence for purported benefits.Overall, the authors stressed that their findings highlight increasing supplement use, especially in older adults. They underscore the need for continued comprehensive monitoring and research on supplement efficacy, safety and health implications across different populations.Reference: Lam CS, O’Connell K, Monroy-Iglesias MJ, et al. Emerging patterns in dietary supplement use among US adults, 1999-2023. JAMA Network Open 2026. 2026;9(6):e2619291. (accessed June 16, 2026).

How have dietary supplement use patterns changed over a recent 25-year period?

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