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.
Each cell has the same DNA. As this is the case there must be ways for cells to differentiate from other cells while all cells have the same DNA. In different cell types different genes are translated which is achieved by genes in different cell types having different epigenetic marks. Epigenetic marks on genes can increase or decrease transcription of genes. DNA methylation and histone methylation are two ways genes can be epigenetically marked and thereby transcription of genes affected. There are various other ways that genes can be epigenetically marked. Environment can affect what epigenetic marks are on genes.
With genetic diseases there is systematic evidence of the genetic anomaly. Take any cell from the body and genes in that cell will show the genetic anomaly. For example, blood tests can be used to detect genetic anomalies With epigenetic diseases, however, there is no genetic evidence of the disease.
Vitamin D is now suspected to play a part in lots of illnesses and I think this is correct but with epigenetic anomalies there need not be any genetic anomalies though there is still disease. The last step in the formation of calcitriol, which is active vitamin D, by CYP27B1 requires an iron-sulfur protein called adrenodoxin. Due to difficulties in forming iron-sulfur clusters there will be low levels of adrenodoxin whereby there are low levels of calcitriol. Giving calcitriol alone, however, is not sufficient to treat many illnesses where there is evidence of calcitriol deficiencies. With iron-sulfur proteins dysregulated a lot of processes besides the formation of calcitriol will also be adversely affected.
There not being diseases associated with aberrant epigenetic marks is basically impossible given the large part that epigenetics plays in regulations of cells. I think schizophrenia is an illness associated with epigenetic aberrations, an illness in which there are deficiencies of calcitriol but which is basically non-responsive to calcitriol.