In a 2020 study published in the Journal of Trace Elements in Medicine and Biology, researchers conducted an in vitro experiment to analyze the effects of TiO2 nanoparticles on a human neuroblastoma (SH-SY5Y) cell line. The scientists evaluated “reactive oxygen species (ROS) generation, apoptosis, cellular antioxidant response, endoplasmic reticulum stress and autophagy.” The results showed that exposure to the nanoparticles “induced ROS generation in a dose dependent manner, with values reaching up to 10 fold those of controls. Nrf2 nuclear localization and autophagy also increased in a dose dependent manner. Apoptosis increased by 4- to 10-fold compared to the control group, depending on the dose employed.” 

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Research has shown that, when ingested as a food additive, titanium dioxide and its nanoparticles can impact, alter, and/or damage important protective bacteria in the gut, along with the metabolic pathways of gut bacteria.

Applications of Lithopone Powder:

Currently, titanium dioxide as a food additive is classified as GRAS, or “generally recognized as safe.” 

Less frequently, we ingest E171 through liquids such as salad dressing, dairy products, and some artificially colored drinks. However, since E171 is insoluble, manufacturers must use other stabilizers to keep E171 suspended in liquids as an emulsion; otherwise, it will settle to the bottom. 

It's hard to determine the total amount of food products that have titanium dioxide because federal regulations don't require all producers to list its use on ingredient labels, but the list of foods containing the substance certainly doesn't end with Skittles.

Example of partial substitution of titanium dioxide with lithopone supplier 30% in a liquid paint. 

Anyway, it doesn't matter if it reflects or absorbs, Titanium Dioxide is a pretty awesome sunscreen agent for two main reasons: it gives a nice broad spectrum coverage and it's highly stable. Its protection is very good between 290 - 350 nm (UVB and UVA II range), and less good at 350-400 nm (UVA I) range. Regular sized Titanium Dioxide also has a great safety profile, it's non-irritating and is pretty much free from any health concerns (like estrogenic effect worries with some chemical filters).

Food additive or carcinogen? The growing list of chemicals banned in EU but used in US, by Mikaela Conley, The Guardian, June 23, 2022

Following the filtration, the precipitate is washed thoroughly to remove any impurities and excess reagents. This is a crucial step, as thorough washing ensures that no contaminants interfere with the final mass measurement. Once washed, the precipitate is dried in an oven at a controlled temperature to remove moisture, ensuring that the mass recorded reflects only the titanium content.

In a study published in the journal Food and Chemical Toxicology in 2016, researchers investigated whether titanium dioxide exposure led to an increase in colorectal tumor creation in mice by using a colitis associated cancer model. By measuring tumor progression markers, the researchers found that mice given titanium dioxide experienced enhanced tumor formation in the distal colon.  There was also a decrease of cells that act as a protective barrier in the colon. The researchers wrote: “These results suggest that E171 could worsen pre-existent intestinal diseases.”