It’s true that titanium dioxide does not rank as high for UVA protection as zinc oxide, it ends up being a small difference (think about it like being 10 years old versus 10 years and 3 months old). This is not easily understood in terms of other factors affecting how sunscreen actives perform (such as the base formula), so many, including some dermatologists, assume that zinc oxide is superior to titanium dioxide for UVA protection. When carefully formulated, titanium dioxide provides excellent UVA protection. Its UVA protection peak is lower than that of zinc oxide, but both continue to provide protection throughout the UVA range for the same amount of time.

In a review published in 2022 in the journal Archives of Toxicology, researchers found that the ingestion of E171 is a “a definite health risk for consumers and their progeny.” After reviewing dozens of in vivo, ex vivo and in vitro studies on the toxicity of E171, the researchers wrote that two facts must be noted: “First, reprotoxicity studies show that animals of both sexes are impacted by the toxicity of these nanoparticles, underlining the importance of conducting in vivo studies using both male and female animals. Second, human exposure begins in utero via maternal-fetal transfer and continues after birth by breastfeeding. Children are then chronically re-exposed due to their food preferences. To be relevant to the human in vivo situation, experimental studies should therefore consider nanoparticle exposure with respect to the age or life period of the studied population.”

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Aside from its use in paints, coatings, plastics, and paper, TiO2 is also utilized in a variety of other industrial applications. It is commonly found in cosmetics, sunscreens, and food products, where it serves as a safe and effective whitening agent. TiO2 is also used in the production of ceramics, glass, and textiles, where it enhances their appearance, durability, and resistance to fading.

On the other hand, Westerhoff said, there are hundreds of studies showing no adverse effects from the substance.

The most significant uncertainty identified by the EU experts was the concern that TiO₂ particles may have genotoxic effects. Genotoxicity refers to the ability of a chemical to directly damage genetic material within a cell (DNA), which may lead to cancer in certain situations. Although the experts did not conclude that TiO₂ particles in E171 are genotoxic, they could not rule out the concern that they might be.

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Duan et al. administered 125 mg/kg BW or 250 mg/kg BW of anatase TiO₂ (5 nm) intragastrically to mice continuously for 30 days. The exposed mice lost body weight, whereas the relative liver, kidney, spleen and thymus weights increased. Particles seriously affected the haemostasis of the blood and the immune system. The decrease in the immune response could be the result of damage to the spleen, which is the largest immune organ in animals and plays an important role in the immune response. Powel et al. demonstrated that TiO₂ NPs may trigger immune reactions of the intestine after oral intake. They showed that TiO₂ NPs conjugated with bacterial lipopolysaccharide, but not TiO₂ NPs or lipopolysaccharide alone, trigger the immune response in human peripheral blood mononuclear cells and in isolated intestinal tissue. This indicates that TiO₂ NPs may be important mediators in overcoming normal gut-cell hyporesponsiveness to endogenous luminal molecules, which may be particularly relevant to patients with inflammatory bowel disease, which is characterized by an abnormal intestinal permeability.