Dr. Holick has underestimated the problems with vitamin D/calcium. Where Dr. Holick made a misstep though is that the form of the calcium supplement matters a whole lot. Only calcium hydroxapatite works. Calcium hydroxapatite has to be taken with taurine and vitamin D.
Over the last few decades there have been huge controversies about whether there are widespread vitamin D deficiencies and whether vitamin D supplementation could prevent many chronic illnesses. Dr. Michael Holick claims there is a vitamin D deficiency pandemic. Dr. Holick points to association of vitamin D deficiency with a myriad of acute and chronic illnesses including preeclampsia, childhood dental caries, periodontitis, autoimmune disorders, infectious diseases, cardiovascular disease, deadly cancers, type 2 diabetes and neurological disorders.
However, a umbrella study that addressed meta-analyses that addressed studies where vitamin D supplements were given did not show much effectiveness in terms of outcomes when vitamin D was supplemented.
Dr. Holick is a lot more right than wrong. Taurine is required for calcium homeostasis. See also this paper. See also this paper. With taurine deficiencies calcium homeostasis is upset. With taurine deficiencies individuals can develop severe cases of osteomalacia even where vitamin D levels are normal.
Very unfortunately supplementation with vitamin D alone is not enough to treat these dysregulations of calcium homeostasis. The umbrella study as to the efficacy of vitamin D supplementation alone is also correct. To treat dysregularities in calcium homeostasis due to deficiencies in taurine, L-taurine must be supplemented, calcium hydproxapatite must be supplemented and vitamin D must be supplemented.
Opioids are very frequently prescribed for back pain. Opioid addictions are a horrendous problem in the US and around the World. If a lot of back pain is due to a hidden osteomalicia then there could be a switch away from opioids to treat back pain to taurine, calcium hydroxapatite and vitamin D. Thousands and thousands of lives could be saved by switching to taurine, calcium hydroxapatite and vitamin D3. Mexico could be brought back from the abyss that drug cartels have brought Mexico to.
A point about a hidden osteomalacia is that in a hidden osteomalacia calcium homeostasis is dysregulated. Along with osteomalacia there would be a plethora of very negative psychological effects due to dysregulations in calcium homeostasis. People with back pain due to a hidden osteomalacia would not only be in physical pain but would also be in very serious psychological pain. Indeed back pain would be an indication that opioids should not be prescribed as individuals with back pain would be very prone to addiction to opioids due to the psychological pain that goes hand in hand with back pain.
The psychological pain associated with a hidden osteomalacia could be the driving force for addictions to opioids where there is back pain as opioids are not all that effective for the physical pain attendant on back aches.
If taurine, calcium hydroxapatite and vitamin D3 would be infinitely preferable for the treatment of back pain compared to opioids.
As it turns out lots of backaches are due to a hidden osteomalacia. With low levels of taurine fine control of calcium transport is lost. Calcium blood levels can be normal or just slightly low and one can still have a severe case of osteomalicia. Osteomalacia refers to a marked softening of the bones, most often caused by severe vitamin D deficiency. Severe vitamin D deficiencies can result in poor absorption of calcium which can lead to softening of the bones.
Taurine is required for calcium homeostasis. See also this paper. See also this paper. With taurine deficiencies fine control of calcium is lost which can lead to a hidden osteomalicia as calcium levels are normal or very near normal.
The treatment would be to take taurine, however, there is an added complication. Apparently the calcium-sensing receptor has become dysregulated. The calcium-sensing receptor is over-sensitive. With taurine deficiencies there can apparently be a kind of hypocalcemic hypercalciuria which can result in a hidden osteomalicia. The calcium-sensing receptor is antagonized by phosphate. Phosphate binds to the calcium-sensing receptor blocking the calcium-sensing receptor. Calcium must be taken with taurine to treat this hidden osteomalicia but the calcium in the calcium supplement must be bound to phosphate. That basically leaves calcium hydroxyapatite as the only acceptable calcium supplement. Calcium supplements not bound to phosphate are worse than useless for this hidden osteomalicia. Supplemental vitamin D would also be helpful.
An added complication is that taurine must be taken with filtered flax seed oil otherwise there is a spaced out feeling from the taurine. Taurine is needed for fat absorption. With taurine deficiencies there can be shortages of essential fatty acids which filtered flax seed oil taken with taurine can supply. Taurine and filtered flax seed oil should be taken at the same time for better absorption of fatty acids from filtered flax seed oil.
The bad news is that this is a very, very different view of backaches. New transformative ideas appear to be clearly wrong to the the vast majority of individuals, including MDs. The good news is that lots of backaches heretofore untreatable turn out to be very treatable. Osteomalacia can be cured.
In Alzheimer’s disease there are high levels of homocysteine which points to the transsulfuration pathway (homocysteine to L-cysteine) being dysregulated in Alzheimer’s disease. Taurine is synthesized from L-cysteine. Taurine lowers LDL cholesterol levels. High LDL cholesterol levels, which increase the risk of Alzheimer’s disease, could be connected to the dysregulation of transsulfuration pathway as with dysregulation of the transsulfuration pathway there will be low levels of taurine which will increase cholesterol levels.
High homocysteine levels indicate the transsulfuration pathway (homocysteine to L-cysteine) is dysregulated. Taurine is synthesized from L-cysteine. Taurine is needed to form various bile acids. Bile acids are needed for fat absorption.
Polyphenols can increase beta-oxidation which can lead to serious difficulties if there are difficulties in the metabolism of fatty acids which are likely if there are high homocysteine levels.
Many illnesses for which polyphenols have been postulated to be treatments are associated with high levels of homocysteine, however, where there are high homocysteine levels there could be difficulties in fatty acid metabolism. Increasing levels of polyphenols, which increase beta-oxidation, would be contradicted where there are difficulties in fatty acid metabolism.
Polyphenol supplements are frequently suggested as treatments for Alzheimer’s disease and Parkinson’s disease, however, both Alzheimer’s disease and Parkinson’s disease are associated with high homocyteine levels whereby there could be difficulties in fatty acid metabolism. Polyphenol supplements could worsen Alzheimer’s disease and Parkinson’s disease. In the treatment of Alzheimer’s disease polyphenols have been full of promise but have failed to deliver effective treatments.
Caffeine pills have nowhere near the same effect as coffee. There must be more to the effects of coffee than caffeine and that something more is the polyphenol contents of coffee and the effect of those polyphenols on beta-oxidation.
Docosahexaenoic acid (DHA) levels are low in Alzheimer’s disease. DHA is synthesized from alpha-linoelic acid which is an essential fatty acid which must be obtained from the diet. For DHA to be synthesized from alpha-linoelic acid, alpha linoleic acid must first be absorbed.
A meta-analysis indicates that homocysteine levels are significantly high in Alzheimer’s disease. High homocysteine levels in Alzheimer’s disease indicate the transsulfuration pathway is dysregulated in Alzheimer’s disease as homocysteine is not being metabolized to L-cysteine which is what the transsulfuration pathway does.
With low levels of L-cysteine there will be low levels of taurine. Taurine is synthesized from L-cysteine. Taurine is needed for the formation of bile acids which are needed for fat absorption. With alpha-linoelic acid not absorbed in Alzheimer’s disease due to low levels of taurine synthesis of DHA will be impaired in Alzheimer’s disease which is what is seen is Alzheimer’s disease. Effectiveness of supplementation with DHA in Alzheimer’s disease could be limited due to a failure to absorb DHA due to low levels of taurine in Alzheimer’s disease.
Taurine only poorly crosses the blood-brain barrier. However, to assist with essential fatty acid absorption taurine does not have to cross the blood-barrier. Taurine by enhancing fat absorption can enhance brain function.
Homotaurine has has been shown to be a promising therapy for Alzheimer’s disease. In Alzheimer’s disease taurine could be taken with with linoelic acid and/or alpha linoelic acid.
There is lots of controversy as to what fatty acid abnormalities are present in Alzheimer’s disease. An important point about essential fatty acid supplements is that without supplemental taurine supplementing with essential fatty acids results in brain fog.
Levels of arachidonic acid (AA), which is synthesized from linoleic acid and docosahexaenoic acid (DHA) which is synthesized from alpha linoelic acid are significantly lower (P < 0.001) in drug-naive patients with schizophrenia compared to controls. See also Reddy et al. Linoleic acid and alpha linoelic are the two essential fatty acids. Essential fatty acids must be obtained from the diet. Essential fatty acids must also be absorbed to be effective.
With difficulties in fat absorption due to low levels of taurine, which is required for synthesis of various taurine conjugated bile acids, absorption of essential fatty acids would be impaired which would lead to low levels of arachidonic acid and low levels of docosahexaenoic acid which is what is seen in schizophrenia.
Taurine is synthesized from L-cysteine. L-cysteine is synthesized by the transsulfuration pathway. With dysregulation of the transsulfuration pathway in schizophrenia there will be low levels of L-cysteine and low levels of taurine which will lead to low levels of various omega-6 and omega-3 fatty acids in schizophrenia.
With a dysregulation of the transsulfuration pathway (homocysteine to L-cysteine) sufficient L-cysteine for iron-sulfur cluster formation is not synthesized. Sulfur for iron-sulfur cluster biogenesis is derived from L-cysteine. Supplemental iron increases levels of iron-sulfur proteins. Supplemental iron can partly compensate for dysregulation of the transsulfuration pathway in schizophrenia. Selenomethionine, the food form of selenium is metabolized by enzymes in the transsulfuration pathway. Metabolism off Se-methylselenocysteine by-passes the transsulfuration pathway whereby Se-methylselenocysteine can provide bioavailable selenium for individuals with schizophrenia. Taurine is synthesized from L-cysteine. With L-cysteine not synthesized appropriately taurine will not be synthesized at appropriate levels. Taurine is needed to form various bile acids, With low levels of taurine there will not be sufficient taurine conjugated bile acids. Fat absorption requires bile acids. With low levels of taurine due to low levels of L-cysteine fat absorption will be impaired. Supplemental taurine and supplemental essential fatty acids will compensate for low levels of taurine due to low levels of L-cysteine which are in turn due to dysregulation of the transsulfuration pathway. Taurine by sparing L-cysteine will also increase levels of L-cysteine.
An Important Warning: No supplements that contain L-cysteine or L-methionine should be supplemented. And no supplements that reduce cystine to L-cysteine, such as lipoic acid, should be supplemented. See the Treatment page for supplements that can be of assistance in the treatment of schizophrenia.