The US and Canada, however, approve the use of titanium dioxide as a food additive. Canada's recent review of titanium dioxide reconfirmed its safety and pointed out that many of the toxicity studies the EU reviewed were not relevant to the safety of titanium dioxide as a food ingredient, and that the ban is based on an abundance of caution and uncertainty.

The European Commission banned titanium dioxide as a food additive in the EU in 2022 after the European Food Safety Authority (EFSA) conducted an updated safety assessment of E171 and concluded the panel could not eliminate concerns about its genotoxicity. 

Titanium IV oxide is also used in the pharmaceutical industry. It is often used as a coating for medications to improve their stability and appearance. Titanium dioxide helps to protect medications from degradation caused by light, moisture, and other environmental factors. It is commonly used in tablets, capsules, and other oral dosage forms to improve their shelf life and effectiveness.

In a study published in the journal Toxicology, researchers examined the effects of exposing human colon cancer cell line (HTC116) titanium dioxide food additives in vitro. “In the absence of cytotoxicity, E171 was accumulated in the cells after 24 hours of exposure, increasing granularity and reactive oxygen species, inducing alterations in the molecular pattern of nucleic acids and lipids, and causing nuclei enlargement, DNA damage and tubulin depolymerization,” the scientists wrote. Researchers removed the additive from the culture, then examined the results 48 hours later. They found, “The removal of E171 was unable to revert the alterations found after 24 h of exposure in colon cells. In conclusion, exposure to E171 causes alterations that cannot be reverted after 48 h if E171 is removed from colon cells.”

CSPI says it might reconsider its rating if specifications for food-grade titanium dioxide in the U.S. are updated to ensure nanoparticles are minimized, and new studies are conducted to assess its capacity to cause cancer or other health problems. 

Exposure routes are the pathways that allow ingredients to enter our bodies. Primary exposure routes include: 

Assessment of biocompatibility

Although barium sulfate is almost completely inert, zinc sulfide degrades upon exposure to UV light, leading to darkening of the pigment. The severity of this UV reaction is dependent on a combination of two factors; how much zinc sulfide makes up the pigments formulation, and its total accumulated UV exposure. Depending on these factors the pigment itself can vary in shade over time, ranging from pure white all the way to grey or even black. To suppress this effect, a dopant may be used, such as a small amount of cobalt salts, which would be added to the formulation. This process creates cobalt-doped zinc sulfide. The cobalt salts help to stabilize zinc sulfide so it will not have as severe a reaction to UV exposure.