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What is an exposure route? 

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CSPI’s Chemical Cuisine is the web’s definitive rating of the chemicals used to preserve foods and affect their taste, texture, or appearance. Besides titanium dioxide, the group recommends avoiding artificial sweeteners like aspartame, acesulfame potassium, and sucralose, as well as synthetic food dyes like Yellow 5 and Red 3. CSPI and others have recently asked the Food and Drug Administration to ban the latter dye in foods and ingested drugs because the FDA has already determined that it is a carcinogen unsafe for use in cosmetics.

The updated evaluation revises the outcome of EFSA’s previous assessment published in 2016, which highlighted the need for more research to fill data gaps.  

In a 2022 study published in the Journal of Hazardous Materials, scientists wanted to examine the effects of titanium dioxide as a food additive on atherosclerosis in mice. (Atherosclerosis refers to a hardening of the arteries.) Researchers fed mice 40 mg/kg of the food additive every day for 4 months, and found that it not only altered gut microbiota but also led to a significantly increased atherosclerotic lesion area, especially in animals that consumed a high-choline western diet (HCD).

Although the evidence for general toxic effects was not conclusive, on the basis of the new data and strengthened methods we could not rule out a concern for genotoxicity and consequently we could not establish a safe level for daily intake of the food additive, commented Matthew Wright, member of the EFSA's Food Additives and Flavourings Panel in a press statement.

EFSA's evaluation is related to the risks of TiO₂ used as a food additive, not to other uses.

But that depends on how titanium dioxide is being used and how you might come into contact with it. The International Agency for Research on Cancer (IARC) has classified titanium dioxide as possibly carcinogenic to humans based on studies that showed more lung tumors in rats associated with breathing in titanium dioxide.