The major restraint to the global Lithopone market is the availability of numerous white pigment substitutes. It can be replaced by other inorganic white pigments such as Titanium Dioxide (TiO2) and Sachtolith. Among these substitutes, the introduction of TiO2 has reduced the commercial importance of Lithopone white pigment. Compared to other white pigments, TiO2 has high brightness and refractive index, which results in lower pigment loading.
Health advocates urge US regulators to ban common food coloring additive, by Tom Perkins, The Guardian, June 2, 2023
Since then, there has been a few animal studies suggesting titanium dioxide is connected to cancer. A 2017 study in Scientific Reports, for instance, found that rats with titanium dioxide in their diet had impaired immune systems, which could contribute to autoimmune diseases and colorectal cancer.