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Manufacturers get titanium dioxide from minerals called brookite, rutile, and anatase. It's processed into a powder and refined to meet strict safety guidelines.
Australian researchers examined how titanium dioxide as a food additive affected gut microbiota in mice by orally administering it in drinking water. The study, published in the journal Frontiers in Nutrition in 2019, found the treatment could “alter the release of bacterial metabolites in vivo and affect the spatial distribution of commensal bacteria in vitro by promoting biofilm formation. We also found reduced expression of the colonic mucin 2 gene, a key component of the intestinal mucus layer, and increased expression of the beta defensin gene, indicating that titanium dioxide significantly impacts gut homeostasis.” The changes were then linked to colonic inflammation, along with a higher expression of inflammatory cytokines, which are signal proteins that help with regulation. The researchers concluded that titanium dioxide “impairs gut homeostasis which may in turn prime the host for disease development.”
Some food products will include titanium dioxide on their nutrition label. But again, it can be hard to tell for those who don't list the ingredient.

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Yes. According to the FDA and other regulatory agencies globally, “titanium dioxide may be safely used for coloring foods”. Titanium dioxide is safe to use, and the FDA provides strict guidance on how much can be used in food. The amount of food-grade titanium dioxide that is used is extremely small; the FDA has set a limit of 1 percent titanium dioxide for food. There is currently no indication of a health risk at this level of exposure through the diet.
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
