Titanium dioxide as used in sunscreens is commonly modified with other ingredients to ensure efficacy and stability. Examples of what are known as surface modifier ingredients used for titanium dioxide include stearic acid, isostearic acid, polyhydroxystearic acid, and dimethicone/methicone copolymer.

In a small study published in the European Journal of Nutrition in 2020, researchers examined the effects of several food additives, including titanium dioxide, along with artificial sweeteners and cleaning products by testing the fecal samples of 13 people. Titanium dioxide was among the samples that “induced significant shifts in microbiome community structure.”  The growth of the bacterium species belonging to C. leptum, which has been shown to decrease in patients with inflammatory bowel disease, “significantly decreased in the presence of … titanium dioxide” among other additives and sweeteners tested.