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The California plaintiff is apparently not the only one concerned about titanium dioxide. The European Union recently banned its use citing concerns about serious health consequences.

Above 10%, 1 kg of TiO2 should be replaced by 1.3 kg of Lithopone 30%, reducing the amount of polymer accordingly. 

In 2021, the European Food Safety Authority concluded that titanium dioxide is no longer safe in foods due to the same concerns over nanoparticles. As a result, titanium dioxide is now banned as a food additive in the EU. Although studies have shown that the absorption of ingested titanium dioxide is low, evidence suggests that titanium dioxide nanoparticles can accumulate in the body over time. Health Canada deemed it safe in 2022 but noted concerns. Unlike their European counterparts, Canadian officials did not consider studies performed with titanium dioxide nanoparticles alone. 

Zhu et al. were the first to provide evidence that TiO₂ NPs (21 nm) can transfer from daphnia to zebrafish by dietary exposure. Hence, dietary intake could be a major route of exposure to NPs for high trophic level aquatic organisms. Ecological research should therefore focus, not only on the concentration of NPs in the environment, but also on its bioconcentration, bioaccumulation and biomagnification. In addition it has been shown that TiO₂ NPs can increase accumulation of other environmental toxicants: enhanced accumulation of cadmium (Cd) and arsenic (As) was found in carp in the presence of TiO₂ NPs. The strong adsorption capacity for Cd and As was explained by the large specific surface area and strong electrostatic attraction of TiO₂ NPs that contribute to facilitated transport into different organs.