Titanium dioxide is the most widely used whitening pigment in the world and has been linked to adverse health effects, particularly genotoxicity and intestinal inflammation. It is applied as food coloring and a whitening agent to a wide variety of foods, including chewing gum, cakes, candies, breads and ice cream. 

CSPI says it might reconsider its rating if specifications for food-grade titanium dioxide in the U.S. are updated to ensure nanoparticles are minimized, and new studies are conducted to assess its capacity to cause cancer or other health problems.