Other experts say there is simply no conclusive evidence at this point that titanium dioxide is damaging to humans after ingesting. Kaminski in particular said the research studies cite health hazards that were found by using high doses of the product, which you would not normally see in food.

At the present JECFA meeting, the committee considered additional toxicological studies relevant to the safety assessment of the chemical that investigated its toxicokinetics, acute toxicity, short-term toxicity, long-term toxicity and carcinogenicity, genotoxicity, and reproductive and developmental toxicity, as well as special studies addressing its short-term initiation/promotion potential for colon cancer. The experts acknowledged that a large number of toxicological studies have been conducted using test materials, including nanoparticles, having size distributions and physico-chemical properties not comparable to real-world uses of titanium dioxide as a food additive. The studies on non-representative materials were evaluated by JECFA, but the committee concluded that such studies are not relevant to the safety assessment of the additive.

Résumé–Cet article traite de la découverte de lithopone phosphorescent sur des dessins à l'aquarelle, datés entre 1890 et 1905, de l'artiste Américain John La Farge et de l'histoire du lithopone dans l'industrie des pigments à la fin du 19e et au début du 20e siècle. Malgré de nombreuses qualités souhaitables pour une utilisation en tant que blanc dans les aquarelles et les peintures à l'huile, le développement du lithopone comme pigment pour artistes a été compliqué de par sa tendance à noircir lorsqu'il est exposé au soleil. Sa disponibilité et son usage par les artistes demeurent incertains parce que les catalogues des marchands de couleurs n'étaient généralement pas explicites à indiquer si les pigments blancs contenaient du lithopone. De plus, lors d'un examen visuel, le lithopone peut être confondu avec le blanc de plomb et sa phosphorescence de courte durée peut facilement être ignorée par l'observateur non averti. À ce jour, le lithopone phosphorescent a seulement été documenté sur une autre œuvre: une aquarelle de Van Gogh. En plus de l'histoire de la fabrication du lithopone, cet article décrit le mécanisme de sa phosphorescence et son identification à l'aide de la spectroscopie Raman et de la spectrofluorimétrie.

Numerous studies have linked titanium dioxide to genotoxicity and cytotoxicity. Genotoxicity refers to a chemical’s potential to cause DNA damage, which can, in turn, lead to cancer. Cytotoxicity is a general term that refers to a characteristic of being harmful to cells.  

How can I tell if a product has titanium dioxide in it? How can I avoid the ingredient?

“Unlike some other chemicals used in food, titanium dioxide has no nutritive, preservative, or food safety function—its use is purely cosmetic,” said CSPI principal scientist for additives and supplements, Thomas Galligan. “The prospect of titanium dioxide nanoparticles damaging DNA is concerning enough for us to recommend consumers avoid foods that have it.” 

Lithopone B301, Lithopone B311 powder, brilliant white pigment used in paints, inks, leather, paper, linoleum, and face powder. It was developed in the 1870s as a substitute or supplement for lead carbonate (white lead), to overcome its drawbacks of toxicity, poor weathering, and darkening in atmospheres that contain sulfur compounds. Lithopone B301, Lithopone B311 powder is an insoluble mixture of barium sulfate and zinc sulfide that precipitates upon mixing solutions of barium sulfide and zinc sulfate. The precipitate is recovered by filtration, then calcined (roasted) at temperatures above 600° C (1,112° F). Although Lithopone B301, Lithopone B311 powder has been replaced in many applications by titanium dioxide, it is still widely used in a number of products, such as water paints.

Studies have been carried out with both emulsion paints and powder paints, both with clear results on how the use of Lithopone 30% reduces the appearance of algae in the paint once it has been applied (see photos). 

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).