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The safety of the food additive E 171 was re-evaluated by the EFSA ANS Panel in 2016 in the frame of Regulation (EU) No 257/2010, as part of the re-evaluation programme for food additives authorised in the EU before 20 January 2009.  

Relative to a lot of other things that people should be concerned about, titanium dioxide in my mind, is really low on the list. I would be more worried about some substitutes that people are using for titanium dioxide that don't have decades of research associated with it, said Westerhoff.

For a mini-review published in the journal Particle and Fibre Technology in 2021, scientists wanted to evaluate whether Ti02 particles contributed to the development and/or exacerbation of irritable bowel disease, and whether they altered the four elements of intestinal barrier function: the intestinal microbiota, the immune system, the mucus layer, and the epithelium. The breakdown of these four elements can contribute to autoimmune, neurological, inflammatory, infectious, and metabolic diseases. Following their review, the researchers concluded: “Data indicate that TiO2 is able to alter the four compartments of IBF and to induce a low-grade intestinal inflammation associated or not with pre-neoplastic lesions.”