European Consumer and Regulatory Trends in Medicinal Plant Food Supplements and Their Functional Properties: The Road from Farm to Fork

Abstract

The rising use of medicinal plant food supplements in Europe reflects a growing consumer shift toward natural health solutions and sustainability-driven lifestyles. The study aims to synthesize current literature and regulatory frameworks to better understand the drivers behind medicinal plant food supplements use and the challenges within the botanical products market. Findings reveal that usage patterns are strongly influenced by age, gender, income, education level, and cultural traditions, with women, older adults, and health-conscious individuals leading consumption. Consumers increasingly demand products that are organic, traceable, and ethically sourced, aligning with broader sustainability goals. However, discrepancies in national regulations, transparency in labeling, and environmental concerns such as over-harvesting persist across the European Union (EU). The distinction between Food Supplements (FSs) and Traditional Herbal Medicinal Products (THMPs) under current EU directives contributes to market fragmentation and consumer confusion. In conclusion, harmonizing regulatory standards, promoting responsible sourcing, and integrating traditional knowledge into sustainable production models are essential for ensuring safety, consumer trust, and long-term ecological viability in the medicinal plant food supplement sector.

1. Introduction

The overall European medicinal plant supplement market represents a critical intersection of traditional phytotherapy and modern wellness paradigms, experiencing robust growth driven by rising consumer health awareness, demographic aging, and a global concern toward preventive healthcare [1,2,3,4]. The European nutraceutical sector, for instance, is projected to expand from EUR 98.3 billion (2024) to EUR 192.2 billion by 2034, and medicinal herbs are anticipated to reach EUR 478.93 billion globally by 2032 [5,6]. Moreover, the COVID-19 pandemic has further catalyzed interest in herbal supplements, as individuals sought alternative ways to manage their health amidst uncertainty [7,8]. For instance, the compounded desire for immunity-boosting products has significantly shifted consumer behavior towards herbal-based dietary supplements, shaping preferences for those marketed as immune enhancers [8]. The Traditional Herbal Medicinal Products Directive (THMPD, 2004/24/EC) established a registration pathway for botanicals but inadvertently fostered a dual market [9,10] the pharmaceutical industry reviews some products, while others are marketed as food supplements, resulting in varying safety standards, variable quality, and poor labeling [11]. Consequently, 63% of European consumers rely on non-professional sources (e.g., social media and traditional media) for plant supplement decisions, amplifying the risks associated with misinformation [12].

At the same time, contemporary consumer behavior reveals a multidimensional demand landscape [13,14,15]. Personalized nutrition, propelled by diagnostics, genomics, and wearables, dominates innovation, with >50% of consumers seeking genetically tailored supplements [16]. Mental wellness has surged as a priority, driving demand for adaptogen-rich products (ashwagandha, rhodiola), while 70% of buyers prioritize sustainability, demanding ethically sourced ingredients, organic certifications, and eco-friendly packaging [17,18]. These trends align intrinsically with the European Farm to Fork strategy, which advocates shortening supply chains, promoting agroecological farming, and reducing synthetic inputs to enhance food system resilience [19]. Organic agriculture in the EU increased by more than 50% (2012–2020), demonstrating a connection between policy-driven sustainability and consumer preferences for “clean-label” botanicals with reduced carbon footprints [20].

Medicinal plant food supplements, encompassing botanicals and preparations derived from plants, algae, fungi, or lichens, represent a significant and historically entrenched component of health and wellness practices across Europe [21,22,23,24]. This continuing tradition is exemplified by the long-standing use of plants such as Valeriana officinalis, traditionally employed for insomnia and nervous disorders, Hypericum perforatum, recognized for its antidepressant properties, and Matricaria chamomilla, valued for its calming and digestive support [25,26,27]. In ancient times, Achillea millefolium and Salvia officinalis commenced their historical usage in monastery medicines across the continent [28,29]. Beyond individual plants, seaweeds and algae are also increasingly recognized for their potential as natural ingredients in European health products [30,31,32]. This rich heritage proves the deep cultural embedding and intellectual lineage of plant-based remedies within European health paradigms [31].

Despite market vitality, regulatory dissonance impedes harmonization [13,33,34]. Divergent national interpretations of THMPD create barriers for medicinal plant food supplements and compromise safety monitoring [15]. There are different EU-funded initiatives (PlantLIBRA and HERBPLANET) that address these gaps by standardizing risk/benefit assessments, validating analytical methods, and curating safety databases [15]. Nevertheless, digital misinformation and uneven safety communication persist, prompting the need for integrated pharmacovigilance and transparent labeling [23,35]. Additionally, fortification strategies employing medicinal plants have gained considerable scientific attention as a multifaceted approach to enhance the nutritional, functional, and therapeutic quality of food products [36]. Contrasting conventional fortification, which primarily involves the addition of isolated micronutrients, phytochemical fortification leverages the complex matrix of bioactive compounds inherent in medicinal plants (polyphenols, flavonoids, terpenoids, alkaloids, saponins, and glycosides) [37]. Recent advances in extraction technologies, nanoencapsulation, and delivery systems have enabled the stable incorporation of these compounds into diverse food matrices, ensuring enhanced bioavailability and targeted physiological functionality [37,38]. The inclusion of phytoconstituents augments the antioxidant and anti-inflammatory profiles of functional foods and exerts modulatory effects on gut microbiota, metabolic pathways, and immune responses, contributing to the prevention of non-communicable diseases (diabetes, obesity, cardiovascular disorders) [38,39]. Furthermore, the integration of medicinal plants into food systems reflects an emerging paradigm that aligns with the principles of personalized nutrition and sustainable health interventions [39,40].

2. Methodology

This review adopts a scoping review approach to comprehensively synthesize emerging consumer trends, regulatory frameworks, value, and supply chain trends within the European medicinal plant food supplement sector.

The literature studies were identified through a structured search of scientific databases (Scopus and Web of Science) and regulatory bases (EU regulatory documents, European Food Safety Authority-EFSA reports) using predefined keywords such as “medicinal plant food supplements”, “consumer trends”, “Farm to Fork strategy”, and “EU regulation”. Articles published between 2010 and 2025 were screened based on their relevance to the Farm to Fork strategy, sustainability, food safety, and accessibility, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [41]. The PRISMA-compliant flow diagram (Figure 1) was adapted to illustrate the number of records identified, excluded, and ultimately included in the review. After duplicate removal using EndNote, two independent authors screened titles and abstracts according to the eligibility criteria. Any disagreements were discussed collectively and resolved in consultation with all co-authors. Inclusion criteria focused on studies that provided empirical data, policy analysis, and systematic observations related to consumer use, product regulation, and supply chain practices. The selected materials were then thematically analyzed to identify knowledge gaps, regulatory challenges, and actionable opportunities for aligning the growth of the herbal supplement market with EU public health objectives.

3. Results and Discussions

3.1. Overview of Medicinal Plant Supplements

Medicinal plant food supplements are defined as plant-derived products formulated to support health and well-being, commonly presented in forms such as capsules, teas, tinctures, or powders [42,43]. According to Regulation (EC) No 1924/2006, a “food supplement” is defined as “foodstuff “the purpose of which is to supplement the regular diet and which is a concentrated source of vitamins, minerals, or other substances with a nutritional or physiological effect [10]. Although food supplements require notification procedures and compliance with food safety laws, herbal medicinal products fall under Directive 2004/24/EC, which demands stricter safety and quality evaluation [10].

The historical roots of medicinal plant use in Europe date back to ancient Greek and Roman civilizations, where Hippocrates (c. 460–370 BCE) and Dioscorides (c. 40–90 CE) laid the foundation for phytotherapy in Western medicine [10,22]. The seminal work De Materia Medica by Dioscorides, written in the first century CE, remained a principal reference in European herbal medicine for over 1500 years and influenced subsequent European pharmacopeias [10]. During the Middle Ages and the Renaissance, monastic gardens cultivated medicinal plants, and early pharmacological texts (Hildegard of Bingen and Paracelsus) further embedded herbal remedies into European healing traditions [10].

3.2. Traditional Roots and Modern Validation of Medicinal Plants

European traditional medicine historically emphasized treating the whole person, often integrating spiritual and cultural dimensions with the therapeutic use of plants [44,45]. Commonly employed herbs include chamomile (Matricaria chamomilla) for digestive and anti-inflammatory purposes, valerian (Valeriana officinalis) for relaxation, and St. John’s Wort (Hypericum perforatum) for mood disorders [46]. The principle of restoring bodily balance and stimulating natural defenses remains a core concept in many European phytotherapies [2]. The therapeutic potential of medicinal plants is primarily attributed to their diverse bioactive compounds, which exhibit pharmacological activities such as antimicrobial, anti-inflammatory, antioxidant, and anticancer effects [47,48,49,50]. Likewise, St. John’s Wort, traditionally used for gastrointestinal disturbances and mild anxiety, has been recently investigated [23,51]. For instance, Ng et al. (2017) analyzed 27 randomized trials involving over 3800 patients and concluded that plant extracts were significantly more effective than a placebo and comparable to standard antidepressants, with fewer adverse effects [51]. In parallel, interest in chamomile has recently revived, especially for stress-related and gastrointestinal conditions. A clinical study conducted by Schilcher et al. (2022) found that standardized chamomile extract reduced symptoms of irritable bowel syndrome by 41% over an 8-week intervention, due to the anti-spasmodic and anti-inflammatory properties of its flavonoid, apigenin [52]. Also, another clinical trial conducted in Germany evaluated the effects of 600 mg/day Valeriana officinalis root in 100 adults diagnosed with insomnia disorder for 6 weeks [53].

Moreover, in the field of anti-inflammatory therapeutics, Mirhashemi et al. (2022) demonstrated that patients with non-alcoholic fatty liver disease experienced significant reductions in ALT and AST liver enzymes after 12 weeks of silymarin supplementation, accompanied by improved liver ultrasound outcomes [54]. Pérez-Piñero et al. (2023) evaluated the effects of Boswellia serrata extract and omega-3 fatty acids in adults aged 40 and older with persistent knee pain. Results showed significant improvements in pain, function, and quality of life with synergistic effects in the Boswellia and omega-3 group [55].

At the phytochemical level, flavonoids, alkaloids, and terpenoids have attracted particular attention due to their multi-targeted mechanisms. Recent in vitro and in silico studies in Serbia demonstrated that quercetin, a flavonoid abundant in elderflower and yarrow, modulates key inflammatory pathways (NF-κB and COX-2) and exhibits synergistic antioxidant effects in polyherbal extracts [45]. In a randomized, placebo-controlled trial of 240 adults, standardized Echinacea purpurea extract reduced upper-respiratory-infection duration by 38% and symptom severity by 26% [56]. Also, garlic, known for its antimicrobial and cardiovascular benefits, showcases a long-standing presence in various culinary and medicinal contexts globally, validated by modern scientific research that confirms its active ingredients’ effectiveness [57].

Table 1 presents a concise overview of various medicinal plants, comparing traditional knowledge with modern scientific validation. The medicinal plants originate across multiple cultures, demonstrating a shared reliance on nature for health solutions [18,27,34,58].

At the official level, the Traditional Herbal Medicinal Products Directive (2004/24/EC) provides a registration pathway [10], with many herbal products in Europe sold as food supplements to avoid the stringent clinical testing mandated for pharmaceuticals [9,44,59]. As mentioned, this regulatory ambiguity results in product variability, inconsistent labeling, and potential safety concerns, particularly regarding herb-drug interactions [1,60]. Furthermore, despite significant research and momentum in this field, a 2018 PlantLIBRA consumer survey indicates that 63% of European herbal supplement users base their health decisions on non-expert sources, such as family, social media, or tradition [15].

Table 1. Traditional roots and modern clinical validation of medicinal plant supplements.

Medicinal Plant	Botanical Name	Traditional Uses	Clinical Validation	Active Compounds	Refs.
Ginger	Zingiber officinale	digestive issues anti-inflammatory pain relief	effectiveness against nausea and vomiting in pregnancy and chemotherapy	gingerol shogaol	[61]
Turmeric	Curcuma longa	anti-inflammatory antioxidant	anti-inflammatory and antioxidant agent against various diseases	curcumin	[62]
Echinacea	Echinacea purpurea	immune support respiratory health	efficacy in reducing the duration of colds and respiratory infections	polysaccharides alkamides	[63]
Ashwagandha	Withania somnifera	stress relief	adaptogenic properties and stress-reducing effects	withanolides	[64]
Hawthorn	Crataegus spp.	cardiovascular health	improving heart health and function through vasodilatory effects	procyanidins flavonoids	[65]
Nettle	Urtica dioica	arthritis allergies	anti-inflammatory and antihistamine properties	silica histamine	[66]
Valerian	Valeriana officinalis	natural sleep aid	improved sleep quality and managing anxiety	valerenic acid	[67]
Aloe Vera	Aloe barbadensis	skin care wound healing digestive aid	antimicrobial and healing properties due to its potential role in blood glucose regulation	aloin acemannan	[68]
Milk Thistle	Silybum marianum	liver detoxification gallbladder issues	hepatoprotective properties through active constituents	silymarin	[69]
Garlic	Allium sativum	cardiovascular health	lipid-lowering effects and antimicrobial properties through active components	allicin	[57]

Table 1. Traditional roots and modern clinical validation of medicinal plant supplements.

Medicinal Plant	Botanical Name	Traditional Uses	Clinical Validation	Active Compounds	Refs.
Ginger	Zingiber officinale	digestive issues anti-inflammatory pain relief	effectiveness against nausea and vomiting in pregnancy and chemotherapy	gingerol shogaol	[61]
Turmeric	Curcuma longa	anti-inflammatory antioxidant	anti-inflammatory and antioxidant agent against various diseases	curcumin	[62]
Echinacea	Echinacea purpurea	immune support respiratory health	efficacy in reducing the duration of colds and respiratory infections	polysaccharides alkamides	[63]
Ashwagandha	Withania somnifera	stress relief	adaptogenic properties and stress-reducing effects	withanolides	[64]
Hawthorn	Crataegus spp.	cardiovascular health	improving heart health and function through vasodilatory effects	procyanidins flavonoids	[65]
Nettle	Urtica dioica	arthritis allergies	anti-inflammatory and antihistamine properties	silica histamine	[66]
Valerian	Valeriana officinalis	natural sleep aid	improved sleep quality and managing anxiety	valerenic acid	[67]
Aloe Vera	Aloe barbadensis	skin care wound healing digestive aid	antimicrobial and healing properties due to its potential role in blood glucose regulation	aloin acemannan	[68]
Milk Thistle	Silybum marianum	liver detoxification gallbladder issues	hepatoprotective properties through active constituents	silymarin	[69]
Garlic	Allium sativum	cardiovascular health	lipid-lowering effects and antimicrobial properties through active components	allicin	[57]

3.3. Fortification of Food Supplements Using Medicinal Plants

Over the past decade at the European level, fortifying foods and supplements with medicinal plants has emerged as an effective strategy to enhance both nutritional quality and health functionality [38,39,40,70]. For example, enrichment of bread with stinging nettle (Urtica dioica) leaves significantly increased dietary fiber and mineral levels (calcium and copper), and carotenoids (lutein, β-carotene), polyphenols, and antioxidant capacity [71]. Similarly, breads fortified with Trigonella foenum-graecum (fenugreek) seed powder showed a reduction in glycemic index by 18% and a 25% increase in protein content [72]. In addition to nutritional enrichment, the essential oils of rosemary (Rosmarinus officinalis) and oregano have been added to cheeses as natural preservatives to inhibit spoilage microbes, effectively extending shelf life without harming beneficial lactic bacteria [73].

For athletes, functional beverages containing Sambucus nigra (elderberry) extract and Rosa canina (dog berry) resulted in a 35% increase in plasma antioxidant capacity post-exercise, and a reduction in muscle soreness scores by 22%, highlighting their application in recovery nutrition [74]. Likewise, the use of Rosa canina in fortified beverages has been linked to cardiovascular and anti-inflammatory benefits [75,76]. In a six-week clinical trial on physically active individuals, daily consumption of rosehip juice (40 g/day) led to a 39% reduction in plasma C-reactive protein, supporting its role in modulating oxidative stress and inflammatory responses [75]. Moreover, yogurt fortified with Sideritis scardica (ironwort), known for its neuroprotective and vasodilatory effects, demonstrated a tripling of total phenolic content (from 34.7 to 98.2 mg GAE/100 g) and a 150% increase in ferric reducing antioxidant power [77].

Technological innovations have played a paramount role in enhancing the stability, bioavailability, and functional performance of bioactive compounds derived from medicinal plants when used in food supplement fortification [78]. Lepidium sativum (cress) essential oil was encapsulated in a whey protein matrix using spraydrying and subsequently incorporated into biscuit formulations. The results demonstrated that microencapsulation preserved up to 97.1% of the volatile compounds (alpha-linolenic acid) after thermal processing, compared to only 1.05% retention in non-encapsulated samples [79]. Furthermore, nanoemulsion technology has emerged as a powerful tool for enhancing the dispersibility and gastrointestinal bioaccessibility of lipophilic plant-derived polyphenols [80]. Székely-Szentmiklósi et al. (2024) applied complex coacervation using gum arabic and type-A gelatin to encapsulate lavender oil. GC-MS analysis revealed that linalyl acetate, a major volatile component, increased in relative proportion from approximately 38% in the free oil to 54–61% in the encapsulated form, indicating selective stabilization of key bioactives during encapsulation [81]. Ardestani et al. (2022) extracted Melissa officinalis (lemon balm) bioactives and nanoencapsulated them using chitosan to produce stable nanoparticulate formulations. The encapsulation efficiency for total phenolic compounds reached up to 68–75%, with mean particle diameters in the range of 120–180 nm, satisfying food-industry standards for nano-carrier systems [82]. In addition, coacervation, liposome entrapment, and solid lipid nanoparticles are increasingly being employed to encapsulate phenolic-rich extracts from Rosa canina, Sambucus nigra, and Vaccinium myrtillus (blueberry), improving their oxidative stability, masking bitter or astringent flavors, and providing controlled release in targeted sections of the gastrointestinal tract [83,84].

As such, fortification using native European medicinal plants has been shown to confer multifaceted benefits, from improved macronutrient and micronutrient profiles to enhanced functional properties by leveraging bioactive phytochemicals that contribute to better nutrition, prolonged shelf-life, and therapeutic outcomes (antioxidant protection, metabolic regulation, health promotion).

3.4. Medicinal Plant Supplements in the European Regulatory Context

The regulatory framework for medicinal plant supplements in Europe is nuanced and shaped by considerations of safety, efficacy, and public health awareness. The European Medicines Agency plays a key role in overseeing the regulation of these products, ensuring that herbal medicinal products (HMPs) meet rigorous standards before reaching consumers [35,63]. The EU’s framework, particularly following Directive 2004/24/EC, aligns with broader efforts to enhance consumer protection and standardize the criteria under which HMPs can be marketed [57,63].

Notably, Bilia et al. (2015) emphasized the regulatory ambiguity between botanicals marketed as supplements versus those claiming therapeutic effects, resulting in a fragmented European marketplace [1]. This overall regulatory framework remains fragmented across member states, largely due to variations in national legislation regarding HMPs. Even though certain countries may adopt stricter standards, others might have more lenient regulations, resulting in inconsistencies that complicate cross-border trade and consumer confidence [44,85,86].

The lack of uniformity can lead to significant discrepancies in product safety, quality, and efficacy, thereby necessitating ongoing discussions aimed at harmonizing regulations across the EU [63]. As herbal products often have diverse origins and formulations, establishing consistent quality controls becomes essential to safeguard public health against potential contaminants, including heavy metals, pesticides, and mycotoxins that have been detected in some commercial herbal products [87,88]. Moreover, the incorporation of novel scientific techniques (DNA barcoding and molecular methods) into regulatory practices presents opportunities for enhancing the authenticity and safety of herbal supplements [85,89].

The issue of pharmacovigilance constitutes another significant aspect of regulatory oversight, as monitoring adverse drug reactions (ADRs) associated with herbal food supplements is crucial for identifying safety risks linked to their use. A study in the Netherlands noted the complexities surrounding ADR reporting related to HMPs due to variations in product registration statuses [69]. Building effective pharmacovigilance frameworks in collaboration with healthcare professionals, product manufacturers, and regulatory bodies can enable timely identification and response to safety concerns, reducing the risks of patient harm associated with herbal products, as proven by global studies [90].

Table 2. Medicinal plant supplement authorization in the EU.

Botanical Name	AT	BE	BG	HR	CY	CZ	DK	EE	FI	FR	DE	GR	HU	IE	IT	LV	LT	MT	NL	PL	PT	RO	SK	SI	ES	SE
Arnica montana	✓	–	–	–	–	–	–	✓	–	–	✓	–	–	–	–	–	–	✓	–	–	–	–	–	–	–	–
Melissa officinalis	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓	✓✓	✓✓	✓✓	✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓
Salvia officinalis	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓
Hypericum perforatum	✓	✓✓	✓	✓	–	✓	✓	✓	✓	✓	✓✓	✓	✓	✓	✓✓	✓	✓	✓	–	✓✓	✓	✓	✓✓	✓	✓✓	✓✓
Echinacea purpurea	✓✓	✓✓	✓	✓✓	✓	✓✓	✓✓	✓	✓✓	✓✓	✓✓	✓	✓	✓✓	✓✓	✓	✓	✓✓	✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓
Thymus vulgaris	✓✓	✓✓	✓✓	✓	✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓	✓✓	✓✓	✓✓	✓	✓	✓✓	✓	✓✓	✓✓	✓	✓✓	✓	✓✓	✓✓
Urtica dioica	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	–	✓	–	✓	✓	–	✓	✓	✓	✓	✓	✓	✓
Matricaria chamomilla	✓✓	✓✓	✓	✓	✓	✓✓	✓✓	✓	✓✓	✓	✓✓	✓	✓	✓	✓✓	✓	✓	✓✓	✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓	✓✓
Gentiana lutea	✓	–	–	–	–	✓	–	–	–	✓	✓	–	–	–	✓	–	–	✓	–	✓	✓	–	✓	✓	✓	✓

✓—Food Supplement (Directive 2002/46/EC); ✓—Traditional Herbal Medicinal Product (Directive 2004/24/EC); –—not authorized; AT—Austria; BE—Belgium; BG—Bulgaria; HR—Croatia; CY—Cyprus; CZ—Czech Republic; DK—Denmark; EE—Estonia; FI—Finland; FR—France; DE—Germany; GR—Greece; HU—Hungary; IE—Ireland; IT—Italy; LV—Latvia; LT—Lithuania; MT—Malta; NL—Netherlands; PL—Poland; PT—Portugal; RO—Romania; SK—Slovakia; SI—Slovenia; ES—Spain; SE—Sweden; Source: European Medicines Agency [91,92]; European Commission [10,35,93]; Botanical Safety Handbook [94].

provides a comprehensive overview of the regulatory status of common medicinal plants across all EU Member States, distinguishing between their authorization as Food Supplements and Traditional Herbal Medicinal Products under EU Directives 2002/46/EC and 2004/24/EC. The table highlights harmonized authorizations and notable national differences, revealing the complexity and fragmentation of the European regulatory landscape for herbal supplements.

Despite increasing alignment under EU Directives 2002/46/EC and 2004/24/EC, heterogeneity across national regulatory systems remains a defining feature of the European medicinal plant supplement landscape. This heterogeneity is multidimensional as it encompasses differences in national interpretations of EU law, divergent enforcement of labeling and safety requirements, and unequal recognition of pharmacopoeial standards. As highlighted in Table 2, even commonly used botanicals such as Echinacea purpurea and Matricaria chamomilla exhibit marked variation in authorization status between the food supplement (FS) and traditional herbal medicinal product (THMP) categories. Such inconsistencies have tangible implications for market access, consumer expectations, and healthcare integration [10,95]. They also obscure comparative assessments of product quality, clinical performance, and public health outcomes across Member States [96].

At the national level, practical differences in how Directive 2004/24/EC has been implemented across Member States further illustrate the persistent heterogeneity. In Germany, one of the earliest adopters of the THMPD framework, the Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) maintains a comprehensive register of traditional herbal products, where monographs from the German Commission E are routinely applied in marketing authorization assessments [97]. This established regulatory infrastructure has facilitated a high number of THMP registrations and a relatively robust pharmacovigilance culture, with mandatory reporting through the national ADR database connected to EudraVigilance (the European Union’s central pharmacovigilance database and information system for collecting, managing, and analyzing reports of suspected adverse drug reactions). Conversely, Italy primarily regulates botanicals under the Ministerial Decree of 10 August 2018 as food supplements, relying on a notified product list (Registro degli Integratori Alimentari) managed by the Ministry of Health [1,98]. This pathway offers a faster route to market but limits the ability to make medicinal claims, reflecting the broader divide between FS and THMPs across the EU.

In the Netherlands, where herbal products can be registered either as THMPs through the College ter Beoordeling van Geneesmiddelen (CBG) or notified as FS under the Netherlands Food and Consumer Product Safety Authority (NVWA), recent pharmacovigilance analyses have revealed persistent under-reporting of herbal adverse drug reactions (ADRs) [69]. The national pharmacovigilance center Lareb documented that most reports originate from healthcare professionals and seldom from consumers, revealing the need for more proactive monitoring systems and public awareness initiatives [73]. Poland’s implementation demonstrates an evolving dual-pathway structure: while the Office for Registration of Medicinal Products (URPL) maintains a THMP list based on EMA monographs, a separate Chief Sanitary Inspectorate (GIS) register governs food supplements, with a rapidly expanding database of notified products exceeding 60,000 entries as of 2024 [99]. These structural differences directly affect both the consistency of product claims and the transparency of safety communication to consumers.

Thus, the coexistence of these diverse national systems contributes to uneven pharmacovigilance performance across the EU. Countries with well-integrated THMP systems, such as Germany and the Netherlands, demonstrate comparatively higher ADR reporting rates, while others reliant on FS notification systems often lack systematic post-market surveillance mechanisms [100]. These disparities not only hinder cross-country data comparability but also complicate the identification of pan-European safety signals for widely marketed botanicals such as Ginkgo biloba, Echinacea purpurea, or Hypericum perforatum. To address this imbalance, recent EU initiatives have encouraged Member States to harmonize data exchange between EudraVigilance and national FS registers, linking adverse event reporting with product notification databases. Strengthening this alignment could close existing data gaps, improve transparency, and enable policymakers to better assess the risk–benefit profiles of herbal supplements [101] marketed under both the FS and THMP frameworks.

Furthermore, the dynamic policy environment, particularly with ongoing reforms under the Farm to Fork strategy and EFSA’s evaluation of botanical claims, introduces temporal bias, as regulatory updates continue to reshape the evidence landscape [102]. The findings stress the need for more harmonized reporting standards across the EU for consumer information and safety [103].

To a practical end,

Table 3. Comparison of key regulatory requirements for Food Supplements (FSs) and Traditional Herbal Medicinal Products (THMPs) in the European Union.

Regulatory Aspect	FS	THMPs	Source
Regulatory Framework	Governed under Directive 2002/46/EC on food supplements and Regulation (EC) No 178/2002 (General Food Law).	Governed under Directive 2004/24/EC, amending Directive 2001/83/EC on medicinal products.	[10,104]
Proof of Use/Efficacy	No requirement for clinical or traditional-use evidence; must not claim to treat or prevent disease.	Requires at least 30 years of traditional use, including 15 years within the EU, demonstrating plausible efficacy based on long-standing use and experience.	[10,103,105]
Quality/CMC Requirements	Must comply with general food safety and hygiene legislation; limited testing for active compounds unless specified by EFSA or national law.	Must meet full CMC requirements consistent with the European Pharmacopoeia and EMA Guideline on Quality of Herbal Medicinal Products (Rev. 3, 2022).	[105,106]
Safety Assessment	Safety evaluation based on ingredient-level data (toxicology, contaminants, ADIs); no pre-market efficacy review.	Safety assessed through toxicological, pharmacological, and bibliographic data supporting traditional use; may require additional non-clinical data.	[106]
Claims Permitted	May only carry nutritional or functional claims approved under Regulation (EC) No 1924/2006; no therapeutic claims allowed.	Can make therapeutic indications consistent with traditional use (e.g., “for relief of mild stress”); claims must align with EMA Community Herbal Monographs.	[103]
Labeling Requirements	Must include dosage, list of ingredients, and warnings if relevant; claims must comply with EFSA approval.	Must display dosage, contraindications, side effects, and “Traditional herbal medicinal product for use in…” statement.	[103]
Pharmacovigilance	No formal EU-wide pharmacovigilance requirement; adverse event monitoring varies by Member State (voluntary or food-safety based).	Full pharmacovigilance obligations under Good Pharmacovigilance Practices (GVP), including ADR reporting to EudraVigilance.	[107,108]
Authorization/Notification	Simple notification procedure to national authorities (e.g., Italy’s Registro degli Integratori Alimentari, Poland’s GIS register).	Requires registration or marketing authorization with EMA or national competent authority following THMPD criteria.	[97,99]
Supervising Authority	National Food Safety Authorities or Ministries of Health.	National Medicines Agencies (e.g., BfArM, MHRA, AIFA) under EMA coordination.	[97,105,107,108]

Abbreviations: FS, Food Supplement; THMP, Traditional Herbal Medicinal Product; CMC, Chemistry–Manufacturing–Control; EFSA, European Food Safety Authority; EMA, European Medicines Agency; EC, European Commission; BfArM, Bundesinstitut für Arzneimittel und Medizinprodukte; GIS, Chief Sanitary Inspectorate (Poland).

summarizes the principal regulatory distinctions between FS and THMPs within the European Union, highlighting differences in authorization procedures, quality assurance, labeling, and pharmacovigilance obligations. As shown, while FS are primarily governed under food law with notification-based market entry and limited pre-market evaluation, THMPs require formal registration, documented evidence of at least 30 years of traditional use, and compliance with stringent quality and pharmacovigilance standards under EMA jurisdiction. These divergences reveal the fragmented regulatory landscape discussed above, where similar botanical ingredients may be marketed under entirely different legal categories, influencing both consumer perception and post-market safety monitoring.

From the aforementioned policy and industry perspectives, addressing this fragmentation is paramount for enhancing both consumer safety and market efficiency. The coexistence of FS and THMP pathways, while designed to accommodate innovation and traditional knowledge, often results in competitive imbalance and regulatory arbitrage [109]. Greater convergence of safety, labeling, and evidence requirements would help ensure that consumers receive consistent information about dosage, contraindications, and potential herb–drug interactions, regardless of a product’s regulatory classification [108]. Strengthening testing and labeling transparency—including clear identification of active constituents, standardized extracts, and risk statements—would improve public trust and reduce misinformation [110,111]. Such reforms could also benefit industry stakeholders by reducing compliance uncertainty, facilitating cross-border trade, and supporting the development of a single EU market for herbal products that aligns with the EU’s sustainability and health objectives [112].

Also noteworthy is the ethical dimension of regulating herbal medicine. There is increasing acknowledgment of moral responsibilities towards patients, warranting the need for transparent information about the benefits and risks of herbal supplements [113]. Furthermore, this landscape is continually evolving, with calls for more rigorous clinical guidelines and research that substantiate the health claims made about herbal food products [64,114]. Increased global scientific scrutiny fosters consumer protection and opens avenues for the legitimate inclusion of herbal supplements within modern healthcare, bridging the gap between traditional practices and contemporary medical protocols [3,115,116]. In Figure 2A–D, an integrated overview of the economic, botanical, and regulatory landscape of the European medicinal-plant supplement sector between 2014 and 2024 is synthesized. Figure 2A illustrates the sustained rise in EU trade value for medicinal plant products, evidencing the rapid expansion of phytochemical and nutraceutical markets under the Farm-to-Fork and circular bioeconomy frameworks. Figure 2B reveals that a relatively small group of botanicals dominates the European food-supplement scene, reflecting consumer preference for cognitive, immune, and stress-modulating functions and their broad regulatory recognition through EMA-HMPC and Ph. Eur. monographs.

The prevalence of these key medicinal plants is further sustained by regional specialization in cultivation and raw-material processing, concentrated in specific producer countries across the EU (Figure 2C). These regions benefit from suitable climatic conditions, established cultivation know-how, and proximity to processing industries. However, the stability of RASFF notifications on labeling deficiencies (Figure 2D) suggests that regulatory monitoring has not advanced at the same pace as market growth.

Ethically, the integration of herbal supplements into contemporary consumption raises questions about the transparency of herbal product marketing, informed consent for consumers, and their rights to access potentially beneficial products while being aware of the associated risks [113,120,121]. Regulations must encompass the scientific evidence of efficacy and address the ethical implications of marketing practices that may mislead consumers regarding the safety and effectiveness of herbal food supplements [44].

Moreover, the expansion of pharmacovigilance mechanisms to encompass herbal food supplements could represent a much-desired advancement in consumer safety. Current monitoring systems primarily focus on THMPs, leaving a substantial reporting gap for adverse events associated with FS products. Implementing unified EU-wide surveillance platforms and fostering collaboration among national authorities, healthcare providers, and manufacturers could enable the systematic collection of adverse reaction data and post-market performance indicators [73]. Progress has subsequently been made with the 2024 revision of the EMA Good Pharmacovigilance Practice (GVP) framework, reinforcing that pharmacovigilance requirements apply to all authorized medicinal products, including THMPs under Directive 2004/24/EC, and encourages the integration of traditional-use data in benefit–risk evaluations. Module XVI (Rev. 3) introduces new provisions on embryo research, fetal risk communication, and modernized risk minimization measures, strengthening collaboration between regulators and industry in managing herbal product safety. Additionally, enhanced literature monitoring and digital reporting tools, including EudraVigilance integration and automated signal detection, aim to improve transparency, traceability, and the early identification of safety concerns associated with widely used herbal products [100]. This evidence not only guides risk management decisions but also informs future revisions to the regulatory framework [122], bridging the current divide between food and medicinal product oversight.

Ultimately, the European medicinal plant food supplement sector stands at a critical juncture. While scientific and regulatory advances have strengthened product oversight, persistent heterogeneity and fragmented governance continue to hinder the full realization of policy goals related to safety, transparency, and innovation. Addressing these gaps through harmonized labeling, these new integrated pharmacovigilance systems, and balanced regulation between FS and THMP pathways will be essential to sustain consumer confidence and ensure that the sector evolves in alignment with the EU’s broader public health [123] and the sustainability agenda, within regional contexts that would empower European communities [124].

3.5. Regulatory Enforcement Challenges

Despite the comprehensive legislative base provided by Directive 2002/46/EC [104] on food supplements and Directive 2004/24/EC [10], enforcement across the EU remains heterogeneous and resource-dependent. At the supranational level, harmonization is constrained by the subsidiarity principle; Member States implement and monitor compliance individually. The Market Surveillance Regulation (EU) 2019/1020 [125] enhanced coordination and gave authorities stronger inspection and traceability powers, yet national disparities in laboratory capacity, inspection frequency, and sanctioning continue to create enforcement asymmetry. The Alert and Cooperation Network (ACN), which integrates the Rapid Alert System for Food and Feed (RASFF), the EU Agri-Food Fraud Network, and the Safety Gate for non-food products, now plays a central role in detecting non-compliant herbal food supplements and cross-border fraud [126]. Nevertheless, case follow-up and sanctions remain largely dependent on national enforcement resources and judicial mechanisms.

On the regulatory and consumer information side, the European Court of Auditors’ 2024 report [127] identified persistent label comprehension gaps and uneven enforcement of labeling and claims requirements. The report corroborates recurring confusion between FS and THMP claims for botanicals, especially in online marketing contexts. This is consistent with the European Commission’s 2024 consumer-law “sweep” operations [107], which found that a significant share of online supplement promotions failed to meet information and transparency standards, particularly in influencer marketing and cross-border e-commerce.

Post-market surveillance further highlights the regulatory asymmetry between FS and THMPs. While THMPs are governed by the Good Pharmacovigilance Practices (GVP) framework—updated through Module XVI, Revision 3 (effective August 2024) [100], no equivalent EU-level pharmacovigilance obligation exists for FS. Consequently, adverse reaction data for herbal supplements rely heavily on national reporting systems, such as the Netherlands Pharmacovigilance Center Lareb. As such, FS-related adverse event monitoring is being integrated into broader EU pharmacovigilance mechanisms.

Additionally, guidance from the European Medicines Agency’s Committee on Herbal Medicinal Products and the European Food Safety Authority’s (EFSA) Compendium of Botanicals [105] supports risk assessment and regulatory coherence, but both remain advisory rather than legally binding, limiting their enforcement leverage. As a result, compliance outcomes often hinge on local interpretation and prioritization. Mutual recognition (Reg. 2019/515) [100] still complicates day-to-day enforcement for botanicals when national interpretations differ (e.g., FS vs. THMP borderline): authorities must accept lawfully marketed goods unless a legitimate public-interest justification is evidenced, which can delay or dilute interventions on marginal claims/compositions.

DG SANTE’s 2024 Management Plan [128] emphasizes coordinated action on labeling, claims, and online enforcement; however, implementation depends on Member State capacity and political will. In practice, countries with robust pharmacovigilance systems (e.g., Germany, the Netherlands) and long-standing phytotherapy integration tend to demonstrate higher enforcement efficacy, while others remain constrained by limited human and technical resources.

3.6. European Consumer Preferences and Behavior

Consumer behavior regarding medicinal plant food supplements in Europe reflects a dynamic interplay of health awareness, cultural values, product perception, and trust in regulatory systems [14,129], including labeling. Across the continent, there is a noticeable shift toward natural and plant-based health solutions, often driven by the perception that herbal products are safer, more sustainable, and aligned with holistic wellness philosophies [130,131]. Collectively, these patterns reveal a distinctly EU-centric consumer profile, grounded in preventive health culture, regulatory trust, and a growing ethical awareness of product origin and sustainability. Numerous studies highlight that consumers are increasingly motivated by preventive health goals (boosting immunity, reducing stress, improving sleep quality), rather than solely treating existing conditions [13,23,46,57,132]. EU consumers report high label reliance and trust in pharmacist advice; pharmacies [13,14,133] remain the dominant purchase channel for supplements, with most buyers saying they read and follow on-pack instructions.

Complementing these findings, consumer surveys in the EU reveal that label-related trust signals play a critical role in shaping demand: more than half (56%) of EU consumers report prioritizing “organic,” “natural,” or “non-GMO” claims when purchasing supplements [134]. This preference for perceived naturalness [129] and products devoid of synthetic additives intersect with the regulatory complexity surrounding botanicals in the EU, where divergent national interpretations of the FS and THMP frameworks can influence consumer confidence and purchasing decisions [134].

The prevalence of Complementary and Alternative Medicine (CAM) use varies considerably across European countries, ranging from 10% in Hungary to nearly 40% in Germany [135,136]. Countries with high rates of self-care product uptake, including herbal remedies, include Germany, the UK, Belgium, Poland, and Finland [136]. Additionally, Lithuania demonstrated the highest odds ratio for the use of alternative medicinal systems (5.56), followed by Austria (2.53), France (2.45), Germany (1.78), and Slovenia (1.85) [136]. Conversely, Denmark (0.39), Finland (0.46), Norway (0.27), and Sweden (0.30) reported lower odds of alternative medicinal systems use compared to Hungary [4]. These patterns are strongest in countries with long phytotherapy traditions, and deep-seated cultural differences in recourse to non-conventional modalities (Germany, Italy, Poland), where pharmacy-based sales and the visibility of THMP registration identifiers (traditional-use statements) are associated with higher perceived safety/efficacy. Structurally, Germany exemplifies the influence of this regulatory clarity, maintaining more than 6600 licensed or registered herbal and traditional products under the BfArM system [97], reflecting deep phytotherapy integration and fostering consumer confidence in THMP-labeled items.

The stronger engagement in Mediterranean markets is also driven by pharmacy-centric retail, compared with lower, more medicalized patterns in Nordic countries. In Italy, pharmacies account for approximately 78% of supplement sales, supporting the pharmacist’s role as a primary advisor and consumers’ preference for pharmacy-dispensed products; the Italian market also represents one of Europe’s largest by value, exceeding EUR 4.5 billion in 2024 [11]. The same cultural familiarity and pharmacy-centric retail is reflected in the 72% supplement sales in pharmacies [137] observed among Spanish consumers. In contrast, countries with weaker herbal medicine integration (e.g., Nordic countries) show lower uptake of these products and a tendency to associate herbal remedies with non-medical wellness or dietary practices, reflecting stricter medicalization norms and less established awareness of traditional use. Interestingly, Nordic countries reveal lower herbal or MPFS use despite high overall supplement penetration, with Danish population studies showing that 39–60% [5] of adults use dietary supplements, dominated by vitamins and minerals rather than botanicals.

Furthermore, EU policy reviews conducted under the CAMbrella project emphasize the persistent fragmentation and inconsistency of national regulation and data on herbal medicine use, also revealing the methodological difficulties in comparing consumption patterns between Mediterranean, Nordic, and Eastern European Member States [5,107,112,127]. In markets with clearer regulatory guidance, such as Germany and Italy, consumers tend to exhibit greater trust and uptake of registered THMPs, whereas in countries with less transparent or fragmented systems, uncertainty regarding product safety and classification may suppress adoption.

Importantly, EU surveys [100,125,137] highlight the persistent confusion between FS and THMP claims and risk information for botanicals, reinforcing the need for clearer differentiation on labels and consistent risk communication across both pathways. Reports by SAFE (Safe Food Advocacy Europe) and the European Court of Auditors identify significant gaps in labeling transparency, with many botanical FS products lacking clear safety information or standardized guidance on herb–drug interactions [96,109,123]. These inconsistencies, alongside cross-border marketing and language variation, contribute to consumer uncertainty about product function, regulatory status, and safety oversight for consumers. Similarly, EU-wide surveys flag confusion about claims and risk information on botanical FS labels, which can depress uptake or shift choices toward general “natural” cues rather than evidence-based use. EFSA Eurobarometer data [102] also suggest that safety concerns (residues/additives) heighten demand for transparent, compliant labeling.

3.7. Demographic Profiles and Determinants of Food Supplement Use

Demographic characteristics have been shown to have a significant influence on the utilization of medicinal plant supplements in Europe [138]. Researchers have indicated that factors such as age, gender, socioeconomic status, and educational level were correlated with the consumption of medicinal plant supplements [15,135,138]. In Germany, 17,450 children and adolescents aged 0–17 years reported utilizing at least one herbal therapeutic substance weekly, representing 5.8% of the population. Interestingly, the study found that the usage rate was highest among those aged 6 years or less, with a substantial reduction observed with increasing age [112]. In Madrid, Sánchez et al. (2020) found that 89.6% of respondents had used medicinal plants in the past year, primarily Matricaria recutita, Valeriana officinalis, and Tilia spp., with users predominantly being young (18–44 years) [24].

Furthermore, studies suggest that women are more inclined than men to use plant medicinal supplements, frequently seeking remedies for conditions such as stress, menopause symptoms, and digestive issues [139]. Gasparini et al. (2016) indicate that the prevalence was higher for women (16.93%) compared to men (14.46%) for medicinal plant supplements [140]. In terms of proven efficacy, a clinical study involving 30 postmenopausal women (aged 46–58 years) investigated the effect of 100 mg of Salvia officinalis extract on menopausal symptoms over four weeks, with results demonstrating a significant reduction in the severity of hot flashes, night sweats, panic, fatigue, and concentration problems after consuming the plant extract [141].

Education and income levels also play vital roles in the demographic profiles of plant medicine users [21,142]. Higher education levels have been positively correlated with the use of medicinal plants [142]. Additionally, individuals with higher incomes often have better access to quality herbal supplements and are more likely to invest in organic or sustainably sourced products [27,143]. Further research also confirms that higher income, education, and the female gender were consistently associated with increased supplement use, and that many consumers initiate use based on personal choice rather than physician recommendation [109,110]. Taken together, gender, education, and income not only predict overall medicinal plant consumption but also tilt the portfolio toward supplement forms (capsules/tablets) among higher-educated, higher-income women, with health-prevention framing especially salient- an alignment that has direct marketing and public-health implications for the supplement category, with studies [144] focusing on the Romanian population, noting EU regulatory and classification nuances (the same plant may be marketed as a medicine or as a supplement), and that responsibility for supplement safety/efficacy lies primarily with producers, underscoring the added importance of trust signals (quality documentation, compliant claims) when targeting the heavy-user segment in supplements. Consumption of these products was positively correlated with healthcare orientation and environmental protection, indicating that preventive-health motives and sustainability values reinforce purchase behavior [145]. Consumers also exhibited a growing interest in environmentally certified MAP products, treating eco-labels and related cues (recyclable packaging, traceability) as meaningful quality signals [144,145]. In a European analysis of novel fortified foods, consumers with higher trust in scientific institutions and regulators were significantly more likely to purchase products labeled for functional and botanical benefits [126].

The geographical origins of these medicinal plant supplements also shape consumption patterns significantly [26]. In regions such as the Mediterranean, where there is a robust tradition of herbal medicine, familiarity and acceptance of herbal remedies are generally higher [26,146]. Studies on the ethnobotanical practices among specific communities, such as the Lukomir Highlanders in Bosnia and Herzegovina, highlight a rich repository of local knowledge concerning the use of endemic medicinal plants, integrated into daily wellness practices [26]. Also, in Bulgaria and Croatia, medicinal plants remain integral to cultural identities and are essential components of folk medicine and everyday health practices [147,148].

In terms of accessibility, urbanization, and healthcare system expansion have significantly influenced the availability of medicinal plant food supplements [25]. The growth of organic markets and health food stores in urban centers has facilitated greater access to herbal products as consumers increasingly seek alternative health solutions [25,149]. Conversely, rural areas with limited healthcare options may still rely heavily on traditional knowledge, using local flora as significant health resources due to their inaccessibility to commercial healthcare [149]. A comparative regional survey in Sweden indicates that the complementary and alternative medicine usage was more prevalent in less populated rural areas, where residents reported poorer access to conventional medicine and stronger community-based knowledge sharing, compared to those in metropolitan Stockholm [150]. Moreover, in Slovenia and other Eastern European contexts, limited public awareness and integration of herbal remedies into formal health systems leave many rural users dependent on familial and community-based botanical practices, even as urban populations benefit from commercial availability and formal regulation [143].

In recent years, there has been a marked increase in the consumption of food supplements, particularly those fortified with medicinal plants [13,45,151,152]. According to a nationwide survey of Czech adults (n = 1049), 48.6% of them reported using food supplements, with herbal products ranking among the most popular supplement categories, second only to vitamins and minerals [151]. The Pan-European PlantLIBRA Consumer Survey (n = 2359) in Finland, Germany, Italy, Romania, Spain, and the UK found that 18.8% of respondents utilized at least one plant food supplement weekly. Consumers were predominantly elderly, well-educated, non-smokers, and reported good or very good health conditions [153]. The main reasons given were immune system support, stress relief, and digestive support [151,153], addressing the common ailments of modern society in the pandemic and post-pandemic context.

Simultaneously, health consciousness has emerged as a central driver of supplement usage [154,155]. Willis et al. (2016) found a strong positive correlation between individual health consciousness and favorable attitudes toward dietary supplements; highly health-conscious individuals perceived more benefits and fewer risks associated with supplements compared to prescription medications [154]. Additional psychological modeling confirms that health consciousness influences purchase intentions both directly and indirectly, notably via perceived behavioral control (confidence in selecting healthy products) and health-related self-identity, reinforcing the role of preventive wellness orientation in supplement adoption [155]. Correspondingly, post-COVID consumer tracking by Food Supplements Europe (2024) [156] found that 64% of EU adults reported using at least one botanical or plant-fortified supplement monthly, an increase of almost 10 percentage points compared with 2019, while immunity (45%) and stress/sleep (37%) remain dominant purchase motivations. The pandemic also reinforced digital trust asymmetries: according to SAFE (2023) [8,156] and EFSA Eurobarometer [102] 48% of consumers reported difficulty distinguishing between FS and THMP claims online, and three-quarters supported EU-wide harmonization of herbal product labeling and herb–drug interaction warnings.

Moreover, perceived efficacy, particularly of botanical ingredients, significantly shapes consumer preference. The expectation that specific dose forms and plant-based extracts deliver traditional health benefits contributes to stronger brand loyalty. After medicinal plants were incorporated (standardized extracts of Sambucus nigra and Rosa canina), consumers often perceived fortified supplements as both credible and efficacious, even when regulatory endorsement was absent [157,158]. The strength of this perception was further amplified among consumers with higher health consciousness and trust in scientific and regulatory institutions [155]. Overall, consumers often perceive plant-based supplements as “more natural” compared to pharmaceuticals, and this perception of naturalness strongly correlates with purchase decisions, especially for preventive health purposes (general wellness and immune support) [13,44,49,124,159]. Furthermore, in consumer evaluations of plant-based foods, these emotional and conceptual associations, such as “naturalness,” environmental stewardship, and healthfulness, drive willingness to consume more than price and taste alone.

3.8. Psychographic Factors and Cultural Influences

Many European countries have rich traditions of using plants for medicinal purposes, which adds a layer of complexity to how these products are perceived in public health discourse [152,160]. On the psychographic axis, “holistic wellness”, oriented individuals, identified via latent class analysis of 4000 European respondents, demonstrate a markedly higher propensity to integrate multicomponent plant food supplements into routines characterized by yoga, mindfulness, and organic diets, while “conventional health” adherents remain more reliant on singular, pharmaceutically styled formulations [161].

Psychographic variables encompass a wide range of attributes that influence consumer behavior toward medicinal plant supplements, including lifestyle choices, health beliefs, and attitudes towards wellness [24,56,139]. Health-conscious consumers are more inclined to investigate herbal therapies compared to individuals who rigorously follow conventional medical methods [162]. Consumers frequently report a strong alignment between their values and their health choices, often influenced by environmental sustainability, organic practices, and a historical preference for natural remedies [135,161,163]. Galman et al. (2024) have documented a significant correlation between the rising prevalence of lifestyle-related diseases, such as type 2 diabetes and cardiovascular conditions, and increased consumption of nutraceutical formulations containing turmeric (Curcuma longa) and green tea. In their longitudinal cohort study of 5600 middle-aged and elderly adults, each additional daily dose of these supplements was associated with a 12% reduction in inflammatory biomarkers and a 9% lower incidence of metabolic syndrome over four years [163].

Furthermore, studies have shown that the behavior of the wellness-driven cohort was further modulated by peer-to-peer and digital influences. Among 1500 Spanish millennials, exposure to user-generated content on adaptogens (ashwagandha and maca root) increased trial likelihood by 42% over three months [24], illustrating how anecdotal efficacy narratives propagate through social networks. Conversely, ethnobotanical fieldwork in Anatolian villages cataloged over 120 endemic species in both traditional infusions and encapsulated formats, with 87% of practitioners attributing their supplement choices to familial knowledge transmission [164]. Similarly, Northern European preferences for Echinacea during cold seasons are deeply rooted in communal memory and reinforced by historical use [165]. Nam et al. (2025) suggest that institutionalizing herbal medicine leads to a 31% increase in acceptance among insured populations, underscoring that endorsement amplifies cultural credibility and consumer trust [34].

However, these psychographic and cultural factors function under varied regulatory and socioeconomic environments [166,167,168]. Supply chain audits of 150 companies reveal transparency gaps, with 58% failing to specify the geographical origin of botanical raw components [166]. Concerns about environmental sustainability exacerbate trust difficulties, as the overharvesting of high-value species (Gentiana lutea and Panax ginseng) has resulted in habitat reductions of more than 40%, leading to demands for Good Agricultural and Collection Practices (GACP) [167]. In addition, a combination of DNA-metabarcoding and HPLC-MS revealed that commercial preparations of Veronica officinalis (common speedwell) were adulterated in 62% of products with Veronica chamaedrys (germander speedwell), indicating oversights in cultivation and post-harvest handling that circumvent monograph allowances for foreign matter [168]. On safety and quality assurance, stakeholders in the field of HMPs call for compliance with GACP and EU rules and acknowledge strict controls for honest operators, yet warn that limited market monitoring, scarce accredited labs/consultancy, and high testing costs allow non-compliant or adulterated products to slip through—placing heavy responsibility on producers [144,145].

Religious and spiritual orientations also constitute a critical psychographic dimension that shapes European consumers’ engagement with plant-based medicinal food supplements [169,170,171]. In a German outpatient cohort (n = 428) with endocrine and metabolic disorders, higher self-rated religiosity/spirituality was significantly associated with increased use of dietary supplements and complementary therapies, despite no correlation with perceived efficacy of conventional treatments [169]. Similarly, in Christian cults, Salvia officinalis and Rosmarinus officinalis were often incorporated into herbal tonics for purification and cognitive support [170,171]. In Muslim communities, Nigella sativa (“black seed”) was widely used for respiratory, inflammatory, and immune-supportive purposes, based on a prophetic hadith [172]. Ethnopharmacological surveys indicate that black seed preparations, which contain the bioactive compound thymoquinone, are taken daily as a form of faith, as well as for their antimicrobial and anti-inflammatory properties [172,173,174].

Collectively, these findings highlight that consumer psychographics and enduring cultural narratives, mediated by regulatory rigor and socioeconomic context, coalesce to determine the patterns, perceptions, and safety of medicinal plant supplement use across Europe.

3.9. Market Trends and Challenges for Fortified Dietary Supplements with Medicinal Plants

The interplay of market trends and challenges in the EU food supplement landscape reflects a nuanced consumer environment influenced by both opportunities for growth and barriers to access [175]. The rising demand for traceable, sustainable, and locally sourced products indicates a significant shift in consumer preferences towards health-oriented choices. Marketing strategies that highlight the quality, effectiveness, and natural origins of herbal products further shape consumer perceptions [176]. Campaigns successfully linking product efficacy with personal narratives resonate particularly well with consumers seeking alternatives, illustrating how cultural expectations and marketing can influence trends in awareness of herbal remedies’ performance [175].

Moreover, over the past decade, a confluence of consumer distrust in pharmaceutical corporations, precipitated by high-profile cases of drug recalls and adverse event reporting, and an increasingly prevention-oriented public health discourse has driven a pronounced uptick in the European market for plant-based medicinal supplements [33].

This is proven by research in a European context, such as a mixed-methods study of 1200 adults conducted across five EU member states by Molin et al. (2019) who demonstrated that nearly 47% of respondents who had ceased and reduced prescription medication use did so in favor of standardized herbal extracts, citing a 73% reduction in perceived side-effects and a 58% increase in overall health satisfaction over a six-month follow-up [33]. Additionally, Mahmoodi-Eshkaftaki et al. (2025) conducted an economic analysis of national sales data for herbal products in Germany and Italy, finding that traditional preparations (St. John’s Wort) and evening primrose oil (Oenothera biennis) accounted for 38% and 34% of total botanical supplement revenues, respectively, attesting to deeply ingrained cultural acceptance driven by centuries-long pharmacopeial traditions [176].

However, despite this positive market trajectory, several challenges hinder consumer understanding and contribute to misinformation within the dietary supplement sector. Public knowledge about the efficacy, safety, and proper use of these supplements is often inadequate, leading to misconceptions about their benefits [177]. Additionally, consumer behavior theories emphasize the importance of perceived risks and benefits on consumption patterns, suggesting that a lack of clarity around supplement efficacy can deter potential users [178]. This knowledge gap underscores the essentiality of education and outreach to inform consumers about trustworthy dietary supplements and their rightful place within a health-conscious lifestyle [12,175,179]. Consumer preference for European medicinal plant-fortified dietary supplements is shaped by regulatory rigor, product integrity, professional knowledge, safety labeling, and cultural trust, each influencing perceived value and choice [150,151]. Figure 3 provides an integrative framework of the European medicinal plant food supplement sector, delineating the interplay between macro-determinants, systemic constraints (regulatory fragmentation, limited consumer literacy regarding herb-drug interactions, and unsustainable raw material procurement), and future perspectives.

Regulatory hurdles present significant challenges for smaller producers and innovators within the medicinal plant food supplement market [5,11,12]. Many smaller companies struggle to navigate the complex regulatory landscape that governs product formulation, marketing, and safety testing within the EU [1,97,175]. The high costs associated with compliance and the need for extensive scientific substantiation can deter innovation, resulting in fewer options for consumers who seek novel or alternative herbal remedies. Additionally, regulatory barriers favor larger corporations that possess the resources to meet stringent requirements [1,44,97].

This is even more relevant, as proven by a landmark study of Ginkgo biloba supplements sold across European markets found widespread quality failures. Many samples failed to meet the European Pharmacopoeia standards of 22–27% flavonoids and 5.4–6.6% terpene lactones, and some contained undeclared material and lacked any detectable Ginkgo extract, highlighting adulteration, label misrepresentation, and unreliable dosage claims [180].

Moreover, the prevalence of incomplete and missing safety information on product packaging undermines trust [181]. For example, analyses of widely used European herbal supplements (St Mary’s thistle, echinacea) found that most lacked essential consumer guidance such as contraindications, dosage ranges, or warnings about herb–drug interactions, especially outside regulated herbal medicinal product classifications [182].

The knowledge base of healthcare providers further moderates consumer behavior [183]. A survey of European pharmacists revealed that only one-third scored above median in objectively assessed knowledge of herbal supplements; more experienced pharmacists demonstrated better competence, but overall training gaps inhibited safe patient counseling [184]. A systematic review of European and global studies also underscored persistent barriers, limited formal education, inconsistent continuing training, and the absence of clear regulatory guidance, impeding pharmacists’ ability to advise on herbal/dietary supplements effectively [181].

3.10. The Farm to Fork Concept and Strategy and Its Implications for the Herbal Medicinal Plant Food Supplement Value Chain

The EU’s Farm to Fork (F2F) strategy [185] presents a comprehensive approach aimed at reshaping food systems, encouraging sustainability, and alleviating environmental impacts associated with food production and consumption. The core goals of the strategy include fostering healthier food systems and reducing reliance on environmentally detrimental agricultural practices, according to Goulas & Papachatzis (2024) [186]. In particular, the initiative promotes sustainable agriculture, which is vital in addressing inefficiencies present in traditional farming. By encouraging sustainable practices, it ensures, overall, that the food chain (from food production, transport, distribution, marketing, to consumption) has a neutral or positive environmental impact. This growing inclination suggests considerable market potential for supplements that adhere to the principles outlined in the Farm to Fork strategy, where consumers actively seek products that reflect their values regarding health, ethics, and sustainability [187]. Sustainable dietary patterns are those that promote health and well-being at all life stages for present and future generations, while at the same time have low environmental impact, thus recognizing the link between healthy people, healthy societies, and a healthy environment.

Even before this key strategy of the EU, Farm-to-Fork sourcing, which involves direct procurement of food products from local farms to the restaurant table and the consumers, has been considered a way to support sustainable agriculture and decrease the carbon footprint of the food supply chain [188]. Practices in the harvesting and overall procurement of HMPs emphasize conservation agriculture, biodiversity protection, reduced agrochemical dependency, and process efficiency. Circular economy strategies are also central, demonstrating the potential to valorize agro-industrial residues into energy, fertilizers, food preservatives, and bioactive compounds. Authors [189] in the field, propose key sustainability parameters (irrigation water, fertilizer use, harvest quotas, drying temperatures, CO₂ emissions from extraction) as the basis for future assessment tools of these practices, aligning with EU F2F objectives by promoting environmentally sound resource management, supply chain transparency, and consumer-driven demand for sustainable, health-oriented products (

Table 4. HMP sourcing practices and alignment with Farm to Fork.

Sourcing Practice	Description	Alignment with Farm to Fork Pillars
Ethical sourcing	Fair wages, equal opportunities, reinvestment in local communities; cooperatives over large-scale farming	Fair trade and social justice—supports fair income for farmers and rural resilience. Sustainability—encourages long-term viability of farming communities.
Local sourcing	Site selection by ecological/geographic factors; traditional methods; supports biodiversity and local economy	Sustainability—reduced carbon footprint of the supply chains Health and authenticity—ensures quality and traceability of supply chains Rural development—supports local economies and cultural heritage.
Organic production	Minimized chemicals; use of compost, green manure, crop rotation; organic certification on labels	Climate neutrality—reduces emissions and pollution. Sustainability—maintains soil health and biodiversity. Health—reduces harmful residues for consumers
Sustainable harvesting	Quotas, seasonal restrictions, continuous monitoring to avoid over-exploitation	Sustainability—preserves ecosystems and biodiversity. Health—ensures safe, high-quality herbal raw materials. Transparency—supports traceable, regulated sourcing.
Circular economy valorization	Residues (e.g., rosemary, sage, basil, lavender) turned into compost, biopesticides, dietary fibers, bioactive compounds	Climate neutrality—reduces waste and emissions. Sustainability—closes resource loops. Innovation—creates value-added local products.

Source: Marcelino et al., 2025 [189]; EC 2020 [185].

). A study on Romanian HMP stakeholders [144,145] traces the value chain from raw material to finished product, urging integrated controls across cultivation, harvest, processing, and storage; beginning with soil analysis to prevent heavy-metal/pesticide carryover, noting seed-sourcing gaps, and flagging weak collaboration along the chain that breaks the link “from cultivator to consumer”.

The WHO (2003) [190] guidelines have been reference points in both cultivation and labeling, with further reinforcement from local policies. A study by Grigore et al. (2016) found that integrating sustainable agricultural practices in the medicinal plant sector could reduce the environmental impact of plant-derived supplements by up to 33%, while enhancing biodiversity protection in the Mediterranean basin [191]. Likewise, Petrescu-Mag et al. (2021) reported that Romanian consumers showed a significantly higher willingness to pay for medicinal plant supplements derived from organic farms certified under EU sustainability schemes [192]. With the advent of F2F, medicinal plant food supplements are now at the intersection of regulatory examination and shifting consumer expectations. Prior to its introduction, studies by Schunko et al. (2019) [134] and Lenssen et al. (2019) [193] confirmed that European consumers were more willing to purchase herbal supplements that are organically certified, traceable to local origin [194], and labeled with transparent information about harvesting practices. This was confirmed by the 2024 European Commission Farm-to-Fork Progress Report, underlining that consumer demand for “clean-label,” plant-based, and locally sourced supplements has grown by over 30% since 2020, driven by sustainability and traceability objectives that align with F2F policy targets on transparency and product origin [19,187,188].

The strategy’s support for Good Agricultural and Collection Practices has also shaped the regulatory and consumer landscape. Environmental stressors (over-harvesting and biodiversity loss) documented in species like Gentiana lutea have triggered regulatory responses promoting conservation, which are now echoed in consumer behavior patterns [195]. The F2F regulatory and consumer landscape ensures that medicinal plants like Echinacea purpurea, Salvia officinalis, and Melissa officinalis are safe and sustainably produced [190,196].

Across the EU HMPs food supplement sector, concrete sourcing cases show how ethical, local, and organic frameworks are being embedded in practice: Pukka Herbs integrates FairWild-certified wild botanicals (rosehip from Bulgaria/Poland/Spain/Hungary) into EU products, demonstrating audited wild-collection and social safeguards [197]. FairWild has also documented Serbian rosehip brought to EU markets via the local company Plantamell, exemplifying traceability and fair benefit-sharing in European wild harvests [198]. For standardized extracts, Indena’s Mirtoselect^® relies on a structured, traceable wild bilberry (Vaccinium myrtillus) supply from Northern/Eastern Europe and frames sustainability around biodiversity and community benefits [199].

Euromed operates vertically in Spain, launching the Earth Harmony Organic Extracts™ line under EU organic rules and highlighting seed-to-extract control for supplement ingredients such as milk thistle [200]. On the buyer side, the Martin Bauer Group’s mabagrown^® program-assessed by UEBT/Rainforest Alliance, illustrates EU-relevant supply chain governance across dozens of botanical ingredients used in teas and supplements [201,202]. Finally, EU market guidance underscores compliance and documentation expectations for natural ingredients such as rosehip oil, aligning sourcing with organic certification and buyer due diligence norms [203,204].

As consumers become increasingly informed and value-driven, purchasing decisions reflect health motivations and ethical considerations, including the carbon footprint of imported botanical materials [58]. This convergence of ecological responsibility and personalized wellness indicates a future in which medicinal plant supplements will be evaluated for efficacy, for provenance, and environmental cost [19,20,134]. Hence, the Farm to Fork strategy acts as both a regulatory compass and a cultural signal, transforming the medicinal plant supplement sector from a niche health domain into a focal point of sustainable consumerism [19].

4. Conclusions, Limitations, and Future Perspectives

The study acknowledges several research, consumer, and governance limitations stemming from this significant heterogeneity. The information is fragmented, often characterized by varying study designs, inconsistent reporting of product formulations, and limited availability of standardized toxicological and efficacy data. The overlap between FS and THMP categories further complicates data synthesis, but more importantly, consumer use and potential safety, as similar botanical preparations may be marketed under different regulatory designations depending on national frameworks or manufacturer strategies.

The consumer market for medicinal plant supplements in Europe is undergoing a profound transformation, shaped by shifting health priorities, environmental awareness, and evolving regulatory frameworks. Despite promising growth, the market still faces significant challenges, most notably, regulatory fragmentation, insufficient public education on herb-drug interactions, and environmental concerns tied to over-harvesting and unsustainable sourcing. A unified EU regulatory framework that harmonizes Food Supplement and Traditional Herbal Medicinal Product pathways is urgently needed to reduce disparities and enhance consumer trust.

Risk assessment inputs are improving (e.g., from the EFSA, European Court of Auditors, or national authorities), but non-binding status means uptake in day-to-day enforcement depends on national practice. Also, DG SANTE’s annual plans keep market surveillance, fraud, and digital enforcement (including influencer marketing) on the agenda, yet laboratory capacity, case prioritization, and sanctioning power remain national bottlenecks. HMPC monographs and THMP identifiers increase predictability for THMP enforcement (quality/CMC, indications), whereas FS enforcement still wrestles with claims boundaries and online distribution, making coordinated sweeps, ACN data-sharing, and Safety Gate/RASFF integration crucial to real-world compliance.

Overall, looking ahead, greater integration of ethnobotanical knowledge, digital consumer tools, and sustainable farming systems aligned with Farm to Fork principles will be key to supporting a resilient and credible medicinal plant supplement industry. However, in order to operationalize regulatory harmonization and enhance stakeholder guidance, several concrete mechanisms could be considered. Establishing an EU Medicinal Plant and Food Supplement (MPFS) Certification Body could centralize quality assurance through unified labeling and verification standards. Mandatory Good Agricultural and Collection Practice (GACP) compliance and traceability audits could be linked to market authorization or notification, ensuring supply chain integrity from cultivation to sale. A shared EU register of approved botanicals—integrating EFSA opinions, HMPC monographs, and national lists—would support mutual recognition and reduce duplication of assessments. Furthermore, implementing EU-wide digital product passports for herbal supplements, connected to the Safety Gate and RASFF systems, would facilitate rapid risk communication and consumer transparency. Finally, targeted funding under Horizon Europe or the Farm to Fork strategy could support pilot programs testing these mechanisms, providing an evidence base for future legislative integration. Future research should also prioritize real-world efficacy studies, population-based safety assessments, and circular economy models that close the loop between cultivation, consumption, and conservation.