Overall, the Food Directorate's comprehensive review of the available science of TiO₂ as a food additive showed:

What's the Verdict?

Titanium dioxide (E171) is an additive that is used in food as a colour. The function of food colours is to make food more visually appealing, to give colour to food that would otherwise be colourless, or to restore the original appearance of food. Titanium dioxide is used to provide whiteness and opacity to foods.

In a study published in the journal Environmental Toxicology and Pharmacology in 2020, researchers examined the effects of food additives titanium dioxide and silica on the intestinal tract by grouping and feeding mice three different food-grade particles — micro-TiO2, nano-TiO2, and nano-SiO2.  With all three groups, researchers observed changes in the gut microbiota, particularly mucus-associated bacteria. Furthermore, all three groups experienced inflammatory damage to the intestine, but the nano-TiO2 displayed the most pronounced changes. The researchers wrote: “Our results suggest that the toxic effects on the intestine were due to reduced intestinal mucus barrier function and an increase in metabolite lipopolysaccharides which activated the expression of inflammatory factors downstream. In mice exposed to nano-TiO2, the intestinal PKC/TLR4/NF-κB signaling pathway was activated. These findings will raise awareness of toxicities associated with the use of food-grade TiO2 and SiO2.”

There are many uses of titanium dioxide that we don't know about because they were made exempt from being on the package in 1977, said Faber, who added that nothing much has changed since – other than the FDA approving some other uses of the color additive, such as expanding the use of mica-based pearlescent pigments (prepared from titanium dioxide) as color additives in distilled spirits over recent years.

In industrial settings, people can be exposed to titanium dioxide through inhalation. Inhalation exposure to titanium dioxide is exceedingly rare for most people. 

When choosing lithopone, you must choose a good brand and pay attention to its production date. Some people just don’t pay attention to this aspect and often pursue cheap prices. As a result, they buy products that are close to their expiration date and have not been stored for long. It is no longer usable. This is very important.

Wegman’s puts titanium dioxide in its Original Macaroni and Cheese. Campbell’s Healthy Request Chunky Chicken Corn Chowder has it, as does Food Club’s Chunky New England Clam Chowder. Marzetti uses the color agent to brighten its Cream Cheese Fruit Dip. Dairy products usually don’t need titanium dioxide to look white, but Kroger has decided to add titanium dioxide to its Fat Free Half-and-Half. And titanium dioxide isn’t only in especially white or brightly colored foods: Little Debbie adds it to Fudge Rounds and many other products. According to the Food Scores database maintained by Environmental Working Group, more than 1,800 brand-name food products have titanium dioxide on their ingredients list. That said, it can still lurk as an unspecified “artificial color,” or labels might simply say “color added.”