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Following the EU’s ban on E171, the FDA told the Guardian that, based on current evidence, titanium dioxide as a food additive is safe.  “The available safety studies do not demonstrate safety concerns connected to the use of titanium dioxide as a color additive.”

TiO₂ comes in many different forms. However, only a few of these forms are considered food-grade (acceptable to be added to food). Many studies that raised concern about the safety of TiO₂, including the concern for genotoxicity, used forms of TiO₂ that are not considered acceptable for use in food and have different properties than food-grade TiO₂. Other studies did use food-grade TiO₂, but took steps to break the material down into smaller particles than what would normally be found in food.

Pigmentary TiO₂ particles are approximately 200-350nm in dimension and this form accounts for 98 percent of total production. It is used mainly for light scattering and surface opacity applications. It is used as a base for various colour paints or as a standalone ‘brilliant’ white.

Mexican researchers sought to evaluate the effects of E171 across a span of conditions in mice, including its influence on behavior, along with the effects on the colon and liver. The research, published in 2020 in the journal Food and Chemical Toxicology, showed that E171 promoted anxiety and induced adenomas, or noncancerous tumors, in the colon. They also found that E171 heightened goblet cells hypertrophy and hyperplasia, which is typically seen in asthma patients and triggered by smoking or external pollutants and toxins. They also noted mucins overexpression in the mice, which can be linked to cancer cell formation. 

Having thus described the origin and uses of the pigment, we now come to the question, what is lithopone? It is, in short, a chemical compound usually consisting of 30.5 per cent zinc sulphide, 1.5 per cent zinc oxide and 68 per cent barium sulphate, but these proportions vary slightly in the different makes. Lithopone of this composition is sold as the highest grade, either as red seal or green seal, as it best suits the idea of the manufacturer. Many manufacturers, especially in Europe, sell and also export other brands under other seals, containing 24, 20, 18 and as little as 12 per cent of zinc sulphide with very small percentages of zinc oxide, the balance being usually barium sulphate, but sometimes certain portions of China clay or gypsum (calcium sulphate) or whiting (calcium carbonate). Such brands are not a chemical compound, but mechanical mixtures of the chemically compounded lithopone and the admixtures referred to.