All participants in the Pure North program have the opportunity to be a part of something much larger than their own personal health improvement program.
After obtaining the consent of a participant, their health information is anonymized and integrated with the health information of other participants – this is referred to as secondary use of data (it is primarily collected to be used for your treatment).
Pure North’s doctors and researchers, as well as specialized, independent researchers, use these datasets to assess the benefits of the program on the health and well-being of participants overall. These findings are then published in peer-reviewed, well-recognized and widely accessible scientific journals. Our doctors and researchers also use this information to help develop and promote preventative healthcare within the Pure North program.
The following are publications looking at health outcomes in Pure North participants.
Title: The impacts of lower barrier access to preventative care on acute care utilization: evidence from a large scale not-for-profit intervention in Alberta
Researchers: Emery JCH, Zheng X. 2018.
Preventing physical and mental health disorders is one of the best investments we can make. Lower treatment costs, less suffering, and higher productivity are just some of the benefits. New evidence shows that preventative treatments are also cost-effective. In this study, researchers looked at the acute care utilization for 4,121 participants of the Pure North health and wellness program between 2007 and 2015, and compared them to 20,605 non-participants across the same time interval. After just one year, participants of the program visited the hospital 22% less, had 21% fewer visits to the emergency department, and 6% fewer visits to their general practitioner. If all Albertans over the age of 25 joined the Pure North program, there would be 475,000 fewer nights in hospital, 280,000 fewer visits to the emergency department, and 900,000 fewer visits to a general practitioner each year. This could immediately save tax-payers in the province over $173 million. Participants also gained more days spent in good health and participation in the program drastically lowered the costs of these days too.
Title: Effect of a vitamin and mineral supplementation on glycemic status: results from a community-based program
Researchers: Kimball SM, Emery JCH, Lewanczuk RZ. 2017.
Vitamin D supplements, a daily multivitamin, and omega-3 fatty acids reduce the risk of diabetes and reverse the progression of this disease. Diabetes affects nearly 3 million Canadians and another 7 million are at heightened risk of developing the disease, so-called “pre-diabetics”. For most, diabetes will follow a predictable course: diagnosis and treatment, followed by increasing health complications and disabilities. In this paper, researchers show that vitamin D with a broad-spectrum multivitamin and omega-3 fatty acids can stop this trend. The study examined 1,018 participants of the Pure North health and wellness program. Overall, blood sugar dropped as optimal vitamin D and nutrient levels were achieved. The number of participants progressing to dangerous blood sugar levels also plummeted. More incredibly, nearly 50% of pre-diabetics returned to healthy blood sugar levels after just one year of treatment.
Title: The association of serum 25-hydroxyvitamin D concentrations and elevated glycated hemoglobin values: a longitudinal study of non-diabetic participants of a preventive health program
Researchers: Munasinghe LL, Mastroeni MF, Mastroeni SSBS, Loehr SA, Ekwaru JP, Veugelers PJ. 2017.
The prevalence of type 2 diabetes is on the rise. Attempts to address its root causes – promotion of healthy lifestyles and weight management – have been largely unsuccessful. New clues for prevention are needed to curb this epidemic. Vitamin D has been suggested to have direct effects on insulin secretion, insulin resistance and sensitivity, as well as on insulin action. To examine whether improvements in vitamin D levels are paralleled by reductions in the risk of reaching unhealthy blood sugar levels, 6,565 non-diabetic participants of the Pure North health and wellness program were examined. Overall, blood sugar levels dropped as vitamin D levels increased. The number of participants with dangerous blood sugar levels also plummeted, from 30% to 17% while in the program. These findings suggest that public health initiatives that promote vitamin D levels may help reduce the public health burden associated with type 2 diabetes.
Title: The effect of serum 25-hydroxyvitamin D concentrations on elevated serum C-reactive protein concentrations in normal weight, overweight and obese participants of a preventive health program
Researchers: Mastroeni SSBS, Munasinghe LL, Pham T-M, Loehr SA, Ekwaru JP, Mastroeni MF, Veugelers PJ. 2017.
In response to acute trauma, inflammation, or infection, C-reactive protein (CRP) levels rise to trigger an immune system response. However, elevated CRP levels over time are an indicator of chronic inflammation, often associated with diabetes, hypertension, obesity, and cardiovascular disease. Reducing CRP concentrations in the bloodstream is an effective approach to decrease the risk of these chronic diseases. Vitamin D can help moderate CRP levels. In this study, the vitamin D and CRP levels of 6,755 participants of the Pure North health and wellness program were examined. From program entry to follow-up, CRP levels dropped as vitamin D levels increased. The most pronounced changes were seen in obese participants (≥30 kg/m2) who improved their vitamin D levels. The findings suggest that promotion of healthy vitamin D levels among obese individuals can alleviate the public health burden associated with chronic, inflammatory diseases.
Title: The association between serum 25(OH)D status and blood pressure in participants of a community-based program taking vitamin D supplements
Researchers: Mirhosseini N, Vatanparast H, Kimball SM. 2017.
Hypertension, also known as high blood pressure, is a medical condition in which the blood pressure in arteries is elevated. Hypertension causes your arteries to stretch which leads to scarring. These scars contribute to the buildup of cholesterol and other debris, and put extra stress on your pumping heart. About 1 of every 5 Canadians has hypertension. Vitamin D deficiency is a risk factor for hypertension. Researchers here examined blood pressure and vitamin D levels of 8,155 participants of the Pure North health and wellness program. There were significant improvements in both vitamin D levels and blood pressure after just one year of treatment. Of the 592 individuals with hypertension when entering the program, 421 were no longer hypertensive one year later. Also, there was no statistical difference between those taking blood pressure lowering medication and those only taking vitamin D supplements. The results suggest that vitamin D levels above 100 nmol/L reduce the risk of hypertension.
Title: Physiological serum 25-hydroxyvitamin D concentrations are associated with improved thyroid function – observations from a community-based program
Researchers: Mirhosseini N, Brunel L, Muscogiuri G, Kimball SM. 2017.
The thyroid secretes hormones that control metabolism and regulate vital body functions, including breathing and heart rate. In a new study, doctors looked at vitamin D levels and thyroid function in 11,017 participants of the Pure North health and wellness program. More than 72% of participants reached vitamin D levels above 100 nmol/L after one year of treatment. Hypothyroidism was detected in 2% of participants at program entry, while an additional 22% had mild hypothyroidism. Nearly 30% of participants were considered at risk of an autoimmune thyroid disorder (AITD). However, just 0.4% showed signs of hypothyroidism and only 6% had mild hypothyroidism after treatment. Less than 10% were still considered at risk of AITD. The results show that for normal thyroid function healthy vitamin D levels of at least 100 nmol/L are required.
Title: The effect of improved serum 25-hydroxyvitamin D on glycemic control in diabetic patients: a meta-analysis
Researchers: Mirhosseini N, Vatanparast H, Mazidi M, Kimball SM. 2017.
Every 3 minutes another Canadian is diagnosed with type 2 diabetes. Although many diagnosed with type 2 diabetes are vitamin D deficient, and vitamin D supplements improve glycemic control and insulin sensitivity, some continue to question the importance of vitamin D in treating and preventing this disease. In this new study, researchers from Pure North conducted a meta-analysis to determine the relationship between vitamin D and type 2 diabetes. Meta-analyses combine data from multiple studies to improve precision and accuracy, and get a better idea of how effective a treatment is. The researchers discovered that vitamin D supplementation and elevated blood levels of the vitamin dramatically stabilized the amount of sugar in the bloodstream and improved insulin resistance in type 2 diabetics. The researchers stated that a minimum dose of 4,000 IU/d is required to have a protective effect on glucose homeostasis in type 2 diabetic patients.
Title: Evaluation of vitamin D3 intakes up to 15,000 internationals units/day and serum 25-hydroxyvitamin D concentrations up to 300 nmol/L on calcium metabolism in a community setting
Researchers: Kimball SM, Mirhosseini N, Holick MF. 2017.
A new study shows that vitamin D doses up to 15 000 IU/d and blood levels of vitamin D up to 300 nmol/L are safe. Using evidence from nearly 4,000 participants of the Pure North health and wellness program, 6,000 to 8,000 IU/d are needed to reach optimal vitamin D levels (100 nmol/L or higher), with some overweight participants needing up to 15,000 IU/d. The average blood serum level of the participants was 126 nmol/L after treatment and some safely reached concentrations up to 300 nmol/L. These findings show that daily doses and blood serum levels above the recommendations outline by Health Canada are safe.
Title: Estimated economic benefit of increasing 25-hydroxyvitamin D concentrations of Canadians to or above 100 nmol/L
Researchers: Grant WB, Whiting SJ, Schwalfenberg GK, Genuis SJ, Kimball SM. 2016..
If all Canadians had vitamin D concentrations above 100 nmol/L, nationwide spending on cancer, cardiovascular disease, dementia, diabetes, falls and fractures, multiple sclerosis, and respiratory infections would have been reduced by $12.5 billion in 2016. Over 23,000 lives would have been saved. To calculate these estimates, the researchers summarized information on the costs for each of these diseases, the number of deaths attributed to each, and the level of vitamin D shown to be effective in preventing each. Changes to national policies are needed to improve vitamin D levels in Canadians through promotion of safe sun exposure, vitamin D supplementation, and food fortification.
Title: The relationship between serum 25(OH)D and bone density and microarchitecture as measured by HR-pQCT
Researchers: Boyd SK, Burt LA, Sevick LK, Hanley DA. 2015.
It is clear that vitamin D has an important influence on bone health but, owing to studies that have used inappropriately low doses of the essential vitamin, the daily amount of vitamin D needed remains somewhat controversial. To help determine the optimal vitamin D dose for bone health, researchers from the McCaig Institute of Bone and Joint Health at the University of Calgary organized 105 participants of the Pure North health and wellness program into three groups based on their vitamin D levels: low (<75 nmol/L), medium (75–175 nmol/L), and high (>175 nmol/L). Using high resolution scans, the bone parameters of each participant was assessed. The results hint that higher vitamin D levels are associated with improved bone parameters. These data provided a basis to design and implement a three-year dose-dependent randomized controlled trial investigating the effects of vitamin D supplementation on bone health outcomes, to be completed in 2018.
Title: Optimal vitamin D supplementation doses that minimize the risk of both low and high serum 25-hydroxyvitamin D concentrations in the general population
Researchers: Veugelers PJ, Pham T-M, Ekwaru JP. 2015.
The Recommended Dietary Allowance (RDA) is the daily amount of vitamin D needed to help 97.5% of the population to reach what Health Canada deems to be a “sufficient” blood serum level, 50 nmol/L. So what is the correct RDA for vitamin D? These researchers approached this question in two ways. Firstly, based on information from 36 randomized control trials, these authors showed that to achieve 50 nmol/L or more in 97.5% of the population nearly 3,000 IU/d is needed. Secondly, based on the data collected from 11,693 participants of Pure North health and wellness program, to reach blood serum concentrations of 50 nmol/L or more in 97.5% of all the participants, almost 4,500 IU/d is needed. This number was nearly double in individuals who were overweight. All of these daily doses are above the current recommendations by Health Canada.
Vitamin D deficiency is a growing public health concern in Canada. The current recommendations of Health Canada are failing and need to be re-evaluated.
Title: Addendum to “Bending the Medicare cost curve in 12 months or less”: AHS analysis for sample of Pure North Seniors (55-plus)
Researchers: Dutton DJ, Emery JCH. 2015.
This study highlights the benefits of Pure North health and wellness program for one of Alberta’s most vulnerable populations – senior citizens. This study examined 2,758 seniors enrolled the program and compared them with 2,758 seniors not enrolled. Those in the program visited the hospital 39% less, had 24% fewer visits to the emergency department, and avoided 22% of annual health care costs. If all Albertans over the age of 55 years joined the Pure North health program, there would be 376,000 fewer nights in hospital each year, a 14% reduction. Over 1,000 more beds would be available each year. A total of 120,000 emergency department visits would be avoided.
Title: Bending the Medicare cost curve in 12 months or less: how preventative health care can yield significant near-term savings for acute care in Alberta
Researchers: Dutton DJ, Emery JCH, Muille T, Zwicker JD. 2015.
The solution to the growing health care costs is in disease prevention, yet little has been done to make this shift. The Pure North health and wellness program provides participants with personalized preventative health care services through access to lifestyle and diet counselling, health assessment, nutritional supplementation, and dental services. Since 2007, over 45,000 Canadians have been treated. This study looked at the effect of the Pure North program on the use of Albertan hospitals, emergency departments, and general practitioners. 5,689 participants of the Pure North program were compared with 5,689 Albertans not enrolled. After just one year, Pure North participants had 45% fewer hospital visits and 28% fewer emergency department visits, in comparison to the Albertans not enrolled. The reduced use of Albertan hospitals, emergency departments, and general practitioners by Pure North participants, saved the province $2,075,000, a 22 to 39% reduction in the proportion of annual health spending by these participants. The costs for delivering the program can be under $500 per participant per year and average a savings of $1,750 in reduced Albertan hospitals, emergency departments, and general practitioners use.
Title: The Effect of Serum 25-Hydroxyvitamin D on Elevated Homocysteine Concentrations in Participants of a Preventive Health Program
Researchers: Pham T-M, Ekwaru JP, Mastroeni SS, Mastroeni MF, Loehr SA, Veugelers PJ. 2015.
Homocysteine is a naturally occurring amino acid that is produced during methylation, one of the ways the body turns genes on or off. However, when present in high concentrations, homocysteine has been linked to an increased risk of heart disease and strokes. Vitamin D can help reduce these dangerously high concentrations of homocysteine. In this study, 4,475 participants of the Pure North health and wellness program were examined over the course of twelve months to see if reaching and maintaining optimal serum vitamin D concentrations improved concentrations of homocysteine. The researchers found that higher vitamin D concentrations were significantly associated with lower concentrations of homocysteine. Additionally, participants who showed the largest increases in serum vitamin D concentrations were less likely to have elevated homocysteine. Vitamin D clearly contributes to the prevention of cardiovascular disease
Title: Longitudinal analysis of the association between removal of dental amalgam, urine mercury and 14 self-reported health symptoms
Researchers: Zwicker JD, Dutton DJ, Emery JCH. 2014.
This report shows that mercury amalgam fillings – so called “silver” fillings – substantially increases the amount of mercury in the body. Removing these amalgams results in improved health outcomes such as memory loss, stomach problems, confusion, and fatigue.
Mercury amalgams have been used by dentists for over a century because they are strong and cheap, but recent studies have shown that these amalgams are harmful to our health. Mercury amalgams slowly release mercury vapor which is absorbed into the bloodstream. Mercury is a powerful neurotoxin and can cause severe neurological, autoimmune, chronic illness, and mental health issues.
Nearly 1,000 participants from the Pure North health and wellness program were used to examine the associations of mercury amalgam fillings with adverse health risks. The study revealed that those with mercury fillings had more mercury in their urine than those without, even reaching levels as high as 50% more. When mercury fillings were removed, urine mercury levels went down to levels similar to those who never had fillings. Removing mercury fillings improved memory loss, stomach problems, fatigue, confusion, shakiness of hands, and loss of smell/taste.
The use of mercury amalgams is prohibited for pregnant women in Canada but should be prohibited for all. Alternative restorative materials that are currently available should be utilized.
Title: The Effect of Changing Serum 25-Hydroxyvitamin D Concentrations on Metabolic Syndrome: A Longitudinal Analysis of Participants of a Preventive Health Program
Researchers: Pham T-M, Ekwaru JP, Setayeshgar S, Veugelers PJ. 2015.
Metabolic Syndrome is a combination of several health conditions — high blood pressure, high blood sugar level, obesity around the waist, abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes. Up until recently, diet, exercise and medications were thought to be the only ways to decrease the risk of Metabolic Syndrome. This study, conducted using the data collected by Pure North, shows that each 25 nmol/L increment increase in vitamin D levels reduced the risk of Metabolic Syndrome by 6%.
Title: The relationship of serum 25-hydroxyvitamin D and insulin resistance among nondiabetic Canadians: a longitudinal analysis of a preventive health program
Researchers: Pham T-M, Ekwaru JP, Loehr SA, Veuglers PJ. 2015.
Insulin is naturally produced by the body and serves as a gatekeeper, measuring the amount of glucose that enters the cells to be used as energy. Insulin resistance a condition that occurs when the body can’t respond to or use the insulin it produces. The result is too much glucose in the body and that can lead to diabetes, one of the leading causes of death in Canada. Overcoming insulin resistance is a way to avoid diabetes. This is where vitamin D supplements can help. This study, conducted using the data collected by Pure North, measured insulin resistance for 5,730 participants. The results showed that over half of those that were most at risk for insulin resistance were also vitamin D deficient. Simply put, increasing vitamin D levels decreases the risk for insulin resistance and the risk of developing diabetes.
Title: The effectiveness of a preventive health program and vitamin D status in improving health-related quality of life in older Canadians
Researchers: Ekwaru JP, Ohinmaa A, Veugelers PJ. 2015.
This study focused on Pure North health and wellness program participants and found that after a year in the program participants were less likely to have problems with mobility, usual activities, pain/discomfort and depression and anxiety. Increasing vitamin D levels were found to increase quality of life.
Title: A statistical error in the estimation of the Recommended Dietary Allowance for vitamin D
Researchers: Veugelers PJ, Ekwaru JP. 2014.
In 2011, Health Canada and the U.S. Institute of Medicine compiled information and entered all this into a mathematical model to determine that 600 IUs of vitamin D day is enough to achieve a blood serum level of 50 nmol/L, a level they deemed “sufficiently” healthy. However, researchers later found that the amount needed to reach 50 nmol/L was much greater than 600 IU/day. To figure out why these results were so much different, the researchers of this study read through the Health Canada and the U.S. Institute of Medicine’s report and redid the calculations. When all the mistakes were corrected, it was determined that Canadians and Americans should be taking 8,895 IU of vitamin D each day! More than 10 times the recommended daily dose presented by Health Canada and the U.S. Institute of Medicine. More public awareness of this error and its implications is greatly needed.
Title: The Importance of Body Weight for the Dose Response Relationship of Oral Vitamin D Supplementation and Serum 25-Hydroxyvitamin D in Healthy Volunteers
Researchers: Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. 2014.
The amount of vitamin D required for those who are overweight is 2 to 3 times the amount needed by a slimmer individual. This means that a person who is overweight needs 12,000-20,000 IU/d to reach optimal vitamin D levels (roughly 125 nmol/L), whereas a normal weight individual needs 5,000-9,000 IU/d of vitamin D. Doses up to 20,000 IU/d did not increase the risk of adverse effects. The current recommendations from Health Canada do not consider differences in body weight – only a single dose is provided for each age group. These recommendations are out-of-date and need to be re-evaluated. For health practitioners prescribing vitamin D, this means that to appreciably increase vitamin D levels, body mass index must be taken into account.
Title: Vitamin D and Health-Related Quality of Life in a Community Sample of Older Canadians
Researchers: Chao YS, Ekwaru JP, Ohinmaa A, Griener G, Veugelers PJ. 2014.
Reaching optimal vitamin D levels provides more than just strong bones, higher levels of vitamin D increases quality of life. In this new study, Chao and co-authors investigated the quality of life in 1,500 elderly participants entering the Pure North health and wellness program. These health of these participants was assessed before any treatment was given. Participants that entered the program with high vitamin D levels were 37% less likely to report any quality of life related problems. Mobility, usual activities, and pain and discomfort were significantly less likely to be issues with high levels of vitamin D. Those with vitamin D levels above 125 nmol/L had the highest quality of life scores. This is important to Canadians who, due to our northern position and poor national guidelines, have an average vitamin D level well below 65 nmol/L. To increase your quality of life, optimal vitamin D levels are needed.
Title: The fiscal, social and economic dividends of feeling better and living longer
Researchers: Emery HJC, Fyie K, Brunel L, Dutton DJ. 2013
Just a small investment in prevention and wellness, rather than providing treatment after people become sick, would save lives and money. Treating chronic disease is expensive. Preventing a person from getting sick would not only help the individual but also eliminate expenses on the health care system. This study looked at 6,570 participants of the Pure North health and wellness program, and compared them with 6,570 non-participants. The findings show that the preventative health care services offered by Pure North leads to genuine and significant near-term cost. For instance, the total cost of the Pure North program is roughly $2,300 per person annually but each programs saves $4,500 in direct health care spending. If just the 242,000 Albertans currently in “poor health” registered in the program, a savings of $500 million could be realized.
Title: Vitamin D status of Canadians employed in northern latitudes
Researchers: Chao Y-S, Brunel L, Faris P, Veugelers PJ. 2013.
This novel study looked at the prevalence of vitamin D deficiency and insufficiency among individuals working in northern latitudes. Over 6,000 workers of all ages were examined. Half of these workers were male and half were female. The mean latitude of their residence was 53°N or, more plainly, the latitudinal line just south of Edmonton, Alberta. The study found that living in northern latitude considerably increased the likelihood of vitamin D deficiency and insufficiency. Males were also significantly more likely to be vitamin D deficient or insufficient than females. There was a strong correlation between being physical activity and adequate vitamin D levels. Dietary sources of vitamin D, such as milk or oily fish, did little to elevate vitamin D levels. Vitamin D supplementation, however, was an effective means to reduce the burden of vitamin D deficiency and insufficiency in these workers.
Title: The importance of dose, frequency and duration of vitamin D supplementation for plasma 25-hydroxyvitamin D levels
Researchers: Chao Y-S, Brunel L, Faris P, Veugelers PJ. 2013.
This study examined the importance of dose amount, frequency, and duration in achieving and maintain healthy vitamin D levels. This study examined 4224 records of 2714 participants of the Pure North health and wellness program. It found that participants taking a minimum regimen (less than 2000 IU of vitamin D once or twice per week for one month) had vitamin D levels that were not statistically higher than those of participants not taking supplements. These authors suggest that doses of at least 5,000 IU taken each day for 5 months or more were needed to raise vitamin D concentrations to healthy levels.
Title: A novel approach localizes the association of vitamin D status with insulin resistance to one region of the 25-hydroxyvitamin D continuum
Researchers: Heaney RP, French CB, Nguyen S, Ferreira M, Baggerly LL, Brunel L, Veugelers P. 2013.
Vitamin D status has a protective role in insulin resistance, type 2 diabetes, and hypertension. This study defines a range of vitamin D status in a group of non-diabetic adult Canadians. Higher vitamin D levels are associated with improved insulin response and lower blood pressure. Further, the range of vitamin D status that is found to help insulin response is above the range established for bone health.