Capacity for grain self-sufficiency on the Tibetan Plateau (TP) is an important basis for ensuring social stability and regional sustainability. Thus, based on county-level statistical data for population, grain production and consumption, we analyzed patterns and trends in grain supply and demand at regional, provincial, and county levels on the TP between 1985 and 2016. We applied two indices to evaluate capacity for grain self-sufficiency and found that the regional average self-sufficiency rate increased quickly by 1.97%/a since 1989, reaching 173.03% on the plateau over the period between 2010 and 2016. This indicates that grain supply in this region is able to fully meet demand. In addition, all provinces apart from Xinjiang exhibited similar increasing trends, attaining grain self-sufficiency during 2010-2016. Furthermore, 59% of counties attained grain self-sufficiency over this period, mainly distributed in southern Tibet, in the Sichuan-Tibet junction area, and in eastern Qinghai Province. A number of gaps in grain supply and demand occurred within the headwater regions of the Yangtze and Yellow rivers as well as on the Qiangtang Plateau. Grain self-sufficiency significantly increased over the study period in 36% of counties, mainly distributed in the agricultural areas of southeastern Tibet and in eastern Qinghai. Across the whole plateau, capacity for grain self-sufficiency substantially increased between 1985 and 2016, although serious spatial imbalances remain.