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Carboxymethylcellulose (CMC) is permitted by the US FDA. Several countries restrict, warning-label, or have reviewed it for safety concerns. The US has more lenient additive rules than the EU, UK, Canada, and Japan, which is why this ingredient remains widely used here.
A 2015 study published in Nature (Chassaing et al., Georgia State University) found that dietary CMC at levels comparable to typical food exposure disrupted the gut microbiome in mice, reducing protective mucus layer thickness, promoting low-grade inflammation, and accelerating colitis and metabolic syndrome in genetically predisposed animals. A 2022 randomized controlled trial (CARGO trial, published in Gastroenterology) in healthy humans confirmed that CMC disruption of gut microbiota composition was observed. EFSA and FDA have not changed approval status, but these findings have generated significant scientific discussion.
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