However, humans are not exposed to E171 in drinking water at any significant quantity over a long duration, so this potential effect is irrelevant to the human experience. It’s important to understand that a potential hazard is not the same thing as an actual risk. 

Lithopone manufacturer: Application areas

There is some evidence that ingested titanium dioxide does not completely exit the body. A 2015 review of animal studies and a few human studies suggests titanium dioxide can get absorbed into the bloodstream and expose other organs to damage.

Sulphate process. The ilmenite is reacted with sulphuric acid giving titanium sulphate and ferric oxide. After separation of ferric oxide, addition of alkali allows precipitation of hydrous titanium dioxide. The washed precipitate is calcined in a rotary kiln to render titanium dioxide. The nucleation and calcination conditions determine the crystalline structure of titanium dioxide (e.g. rutile or anatase).

Lithopone: an alternative to titanium dioxide