Category Archives: D Deficiency

Memorial to Those Who Have Died From Vitamin D Deficiency

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FF5r

There has been a huge amount of research that says we as a population of sun deprived people are dying of vitamin D deficiency. I am extremely sorry to the family members and survivors that have lived the grief of loss. My personal experience of loss is heart wrenching. As I researched for this article, I not only thought of the grief of the survivors, but also the pain and suffering from preventable disease that is caused by vitamin D deficiency. This is to say nothing of the economic loss of the sufferers and the economic gains of those caring for the suffering.

The Institute of Medicine (now the National Academy of Medicine, I think they changed their name because of shame) announced that the RDI for vitamin D was only 600 IU/d. Now, three different universities have confirmed a statistical error. The correct amount for the RDI should have been over 7,000 IU/d of vitamin D3. If we look at only the death, what has the result been?

If the epidemiologists are correct, then there are about 350,000 premature deaths from vitamin D deficiency in the US every year or about 1,000 deaths per day. This is like five plane crashes every day with 200 people on each plane. Since the National Academy of Medicine released its findings for vitamin D with the factor-of-over-10 error, there have been 1,697 days. This is from the release date of the information on November 30, 2010 until today, July 24, 2015. There have been 1,697,000 deaths during this period from vitamin D deficiency. Vitamin D deficiency represents about 14% of total deaths in the US.

US population leading causes of death:

  • Number of deaths: 2,596,993
  • Death rate: 821.5 deaths per 100,000 population
  • Life expectancy: 78.8 years
  • Infant Mortality rate: 5.96 deaths per 1,000 live births

Number of deaths for leading causes of death:

  • Heart disease: 611,105
  • Cancer: 584,881
  • Chronic lower respiratory diseases: 149,205
  • Accidents (unintentional injuries): 130,557
  • Stroke (cerebrovascular diseases): 128,978
  • Alzheimer’s disease: 84,767
  • Diabetes: 75,578
  • Influenza and Pneumonia: 56,979
  • Nephritis, nephrotic syndrome, and nephrosis: 47,112
  • Intentional self-harm (suicide): 41,149

Every day that government delays taking action means there are another one thousands deaths. The agony of the pain and suffering from the loss says that it is time for government to take action. Is the money sustaining our economy from the health sector more important than the lives of those who have died? Your government seems to think so. I am extremely sorry for your loss. – Pandemic Survivor.

Vitamin D — A Conflict of Science

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“Science in the modern world has many uses; its chief use, however, is to provide long words to cover the errors of the rich.” And more – “Truth, of course, must of necessity be stranger than fiction, for we have made fiction to suit ourselves.” – G.K. Chesterton

Chesterton was all about words and expressions of truth. This early 20th Century writer, philosopher, and humorist used words with great skill in debate and general discussions. I am sure he would be appalled at vitamin D science. Has science and allopathic medicine developed into some form of fiction to enhance the rich? Worse, has the largest sector of the US economy been sustained through production off the illness of the population?

Perhaps you should pause and take the time to read this article from Hank Campbell, published in the Wall Street Journal – The Corruption of Peer Review is Harming Scientific Credibility. There have been thousands of peer reviewed published papers on Vitamin D and its benefit to health. And, our greatest bastion of science, National Academy of Science and its Institute of Medicine, has allowed an error for the RDA for vitamin D to escape into the public domain. They were only off by over a factor of ten too low. Is this a mistake like the crash of the Martian Lander that went down because the conversion from miles to kilometers was in error? The only harm was the cost to the taxpayers. Because of a factor of ten for vitamin D intake, hundreds of thousands die prematurely in North America each year. Here is the recently published paper by Paul J. Veugelers, A Statistical Error in the Estimation for the Recommended Daily Allowance for Vitamin D. Grassroots Health has confirmed the error through testing of thousands of participants in their health initiative for vitamin D.

Many other errors have been made in vitamin D science over the years since its discovery:

  • Vitamin D2 is equal to vitamin D3
  • Selling vitamin D as a supplement in only 50 IU tablets that resulted in conspiracy charges of seventeen multinationals during WW II by the US (this sounds just like the error(?) made by the IOM)
  • Vitamin D is only useful for bone health
  • Dr. Cook’s description of birth defects from vitamin D in the 1960’s during the thalidomide scare
  • There is no warning label on sunscreen for the product preventing the body’s most significant steroid hormone from forming in your skin with exposure to the sun
  • Years of warnings by medical professionals about the dangers of the sun
  • Improper interpretation of findings in vitamin D research

It makes me wonder if it is just bad science, incompetence, idiopathic delusion, or orchestrated intention.

The only thing that I can tell you is from my own personal experience. Grassroots Health has it right. Have your serum 25(OH)D tested and then use the chart on Grassroots Health home page to achieve a level above 50 ng/ml. For more guidance on what level of vitamin D, take the advice of Dr. Mercola through his many years of practice.

And if you want to be proactive, sign the petition for Health Canada and the IOM to reevaluate its findings. – Pandemic Survivor

Okay, so maybe you are into a more poetic description: “Through epigenetic action of nuclear receptors as an orchestra, life is properly conducted by the vitamin D receptor. userprofiletileIn this auditorium, the microbiome listens and sustains life through applause.” Mark Pegram—inspired from discussions with Dr. P.R. Raghavan, developer of policosanol as a nano-emulsion, Metadichol®, a natural nuclear receptor agonist/inverse agonist when animals cannot get enough sunshine.

“Idolatry is committed, not merely by setting up false gods, but also by setting up false devils; by making men afraid of war or alcohol, or economic law, when they should be afraid of spiritual corruption and cowardice.” – G.K. Chesterton ILN, 9/11/1909

Pregnancy Not Included for Serum Vitamin D Testing

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The U.S. Preventative Services Task Force has an opportunity for Public Comment for vitamin D testing. In the draft proposal, pregnancy is not listed. Based on the work of Bruce Hollis of the Medical University of South Carolina and others, this is a very serious error. According to this work, higher vitamin D levels prevents very serious conditions during pregnancy and improved birth weight of the baby. Please take the time to read the drafts and make comments.

U.S. Preventive Services Task Force Opportunities for Public Comment

Draft Recommendation:

Under Importance, the Draft Recommendation states that ”low levels of vitamin D are associated with increased risk for fractures, functional limitations, cancer, diabetes, cardiovascular disease, depression, and mortality.”

The USPSTF is working in conjunction with the Health and Human Services AHRQ’s Effective Health Care Program. This group writes the medical guidelines for medical care.

Following is a paper that was written by the Endocrine Society Task Force in 2011:

Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline (pdf)

Authors: Michael F. Holick, Neil C. Binkley, Heike A. Bischoff-Ferrari, Catherine M. Gordon, David A. Hanley, Robert P. Heaney, M. Hassan Murad, and Connie M. Weaver

First published in Journal of Clinical Endocrinology & Metabolism, July 2011, 96(7): 1911–1930

Conclusions: Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test is patients at risk for deficiency. Treatment with either vitamin D2 or vitamin D3 was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend a screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.

Note in the Endocrine Society guidelines that it includes D2 as being equal to D3. This was considered good practice since the 1940’s at resolution of the US government law suit against seventeen multinational corporations for conspiracy to manipulate the vitamin D market. According to Bruce Hollis research, pregnant women should take at least 4000 IU of vitamin D3 per day to reach sufficiency. Most vitamins for pregnancy only contain 1000 IU of D3.

kids

It is my belief that the serum 25(OH)D level should be tested for any chronic disease, syndrome, or other conditions. There are some very serious diseases that were not included like tuberculosis. Vitamin D Wiki shows that vitamin D works on 47 health issues as of May, 2014 . Please take the time to comment. Women that I know that have taken serious consideration for vitamin D testing have had very successful outcomes. – Pandemic Survivor

Breast Cancer Survivor Takes on the Issues

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Carole Baggerly had her own experience with breast cancer. She then started to research the reason why. Her discovery; scientists have expressed the understanding that breast cancer is a deficiency disease. That is over her life time, her intake of vitamin D was not adequate. She was so upset and concerned about the issues that she started GrassrootsHealth. This is a consortium of more than forty scientists and doctors that are experts in vitamin D and nutrition. She discovered that it was not only breast cancer, but a host of chronic illness related to deficiencies. Take the time and watch her explain the issues in the first thirty minutes of this video presentation.  Carole Baggerly and Dr. Heaney, September, 2012  Presentation to Direct-MS Canada.

If you are concerned about the health of your children, yourself, your parents, the next hour is Dr. Heaney who has contributed significantly to the understanding of vitamin D. He talks about the longevity issues and decline with chronic disease because of nutritional deficiencies. There are many diseases that have now been linked to deficiencies that number into the hundreds. This is particularly pointed to vitamin D deficiency.

This discussion is fairly non-technical and is understandable by the average person. Dr. Heaney expresses the understanding that “things go better with vitamin D”. That is that vitamin D deficiency may not be the cause of a disease like TB, but not having enough vitamin D will prevent your body from properly healing. However, this understanding falls into the logic of the chicken versus the egg. In other words, if you had enough vitamin D would you have gotten TB in the first place? Dr. Heaney discusses everything from diabetes, heart disease, MS, pregnancy, and cancer to infectious diseases like TB. I give the video presentation six stars out of a five star rating system for understanding of chronic disease and the effect of vitamin D.  Presentation to Direct-MS Canada.

Your take away from this, is you, your friends, and your family should not suffer from vitamin D deficiency.   Standards within the medical industry have long been 20 ng/ml to 100 ng/ml.   There have not been any cases of toxicity below 200 ng/ml or 500 nmol/l.  There does not appear to be any downside at this level of vitamin D.  Some laboratories have decreased the upper number, 100 ng/ml, to whatever they are measuring the population. Best health for you can be reached with a vitamin D serum level, 25(OH)D between 40 ng/ml to 80 ng/ml; note this is still within the normal range as defined by medicine. It is not how much you take; it is where you maintain your serum level. Everyone responds differently to their intake from all sources of vitamin D. The only way to know is to test.  Dr. Heaney says to maintain a level above 40ng/ml will require an intake from all sources of 5000 IU or more of vitamin D3 per day.

Please note this presentation is in Canada. The measurements used are in nanamoles per liter or nmol/l. To convert ng/ml to nmol/l multiply ng/ml by 2.5. So the normal range of 20 to 100 ng/ml is 50 to 250 nmol/l. Get your serum level tested to give your body a chance to thrive. If you choose to do it through GrassrootsHealth, you become part of the study that will help to advance health in the population. – Pandemic Survivor

Test by GrassrootsHealth: banner_ad_long5company postingVideo of how to do the test:  bscvideothumbnailv3web

Vitamin D Awareness in Decline

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It is apparent from the number of newly reported cases of rickets that the UK has a severe problem with vitamin D deficiency.  The Guardian reports: “England’s chief medical officer, Dame Sally Davies, is concerned that young children and some adults are not getting enough vitamin D.”  It appears that since the free give away of supplements has stopped at clinics that the population is using less vitamin D.  I suspect this problem is more than just an awareness problem as it has been pushed by the medical profession for more than five decades that sun exposure is bad for you.  The problem in the UK now, as the Guardian reports, is “the hard bit – ideas on how to get more of us to get more vitamin D.”  The encouraging news is that he chief medical officer in the UK is aware and feels that new initiatives should take place.

The practice of giving away cod liver oil was stopped in the fifties because it was felt that it was not really needed.  How could such an incompetent decision be made?  The question now is will there be a new emphasis placed on the deficiency issue here in the US.  It seems that the Institute of Medicines decision that a serum level of 20 ng/ml has thrown a real monkey wrench into the works.  A level of twenty may prevent the worse cases of rickets, but how do you explain the continued issue of osteoporosis that is ongoing in the US if that is high enough level.  At least the committee said that there was no issue with using up to 4000 IU of vitamin D3 per day in children over nine.  The real issue is the statements made that a serum level of over 20 ng/ml could be detrimental to your health.  Again, this is the confusion over vitamin D2 versus vitamin D3.  Vitamin D2 is good for rats because they are nocturnal animals.  Vitamin D3 is good for humans because this is what our body makes when exposed to UVB from the sun.  Normal levels for sun exposed populations range for 54 ng/ml to 90 ng/ml.  This is the level required for health.  Vitamin D2 and vitamin D3 are not equivalent!

The question now:  Secretary Kathleen Sebelius, will you come to the same level of awareness as Dame Sally Davis?  How many more cases of vitamin D deficient children with rickets will be taken from their parents because it is mistaken for child abuse?  This sad problem falls directly in the lap of dermatologist that have been used by the medical institutions seeking to garner profits from a sick population.  Of course the dermatologists plead complete unawareness because the cases of skin cancer have increased.  Skin cancer has increased from the use of sunscreen in a real catch 22 that has been played out on the people served by our health institutions.  Normally in a situation like this, the Surgeon General of the US issues a statement giving the population the latest health information.  This happened with tobacco use in the 1960’s, even though it was ignored by most of the population.  So Surgeon General, Vice Admiral Regina M. Benjamin,  what are you going to do?  I think that you should have a conversation with Dame Sally Davies and start a vitamin D initiative in conjunction with Canada.  The US, UK, and Canada taking such an action would bring the rest of the world along.

If not now, when?  – Pandemic Survivor

Two Eyes, Ten Fingers, and Ten Toes

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November 4, 2011 was an anniversary for me.  The date represents seven years since I started taking vitamin D3.  I remember well what my doctor said when I told him I was going to start taking 10,000 IU per day of vitamin D3.  “Your organs will turn to stone, or at least that is what they taught me in med school.”  His practice now is the leading practice in the area for helping resolve issues around vitamin D and disease.   Thank you Dr. Perini.  I have not grown any new fingers, eyes, or toes.  My organs have not turned to stones.  My body continues to heal confirming a report from the UK from the 1930’s that said: “If you take 5,000 to 10,000 IU of D3 per day, it will take four to eight years for your body to heal.”

My body continues to heal.  I have overcome a failed back surgery and avoided three additional back surgeries that would have been required.  I have maintained a low blood pressure even though it has spiked many times in the past.  I have not had any more trouble with heart arrhythmias.  My vision has improved.  My skin tone has improved.  I have no more “brain fog.” (which I am sure was from the sleep apnea and oxygen deprivation)  The most important thing is that I have not died from severe sleep apnea.  By the way, I also have not had a cold or the flu in the last seven years.  Typical for me was three to four colds per year and the flu every two years.

Even though I grew three inches taller in one year as the spacing in my vertebral disc increased from healing, this is not the most amazing healing that happened to me.  The most amazing thing is that I was able to rid myself of my CPAP for sleep apnea.  For those that do not know, a CPAP is an air flow device that holds your airways open while you sleep.  During my sleep test (nocturnal polysomnagraphy), I would breath for thirty seconds and then stop for thirty seconds.  Of course the tech stopped the test after an hour because my blood oxygen saturation had dropped below seventy percent.  I was close to death.  The neurologist described my condition as severe obstructive sleep apnea.  He was wrong; it was severe central sleep apnea from the nerves in my neck being compressed between C3-C4 from vitamin D deficiency.  I was even finding myself not breathing during the day when I was wide awake.  All of those issues have been resolved.  I did not die from oxygen deprivation.

I like to answer the question; ‘Have there been any side effects or toxicity from taking that much vitamin D for seven years?’  Yes – Health!  I also like to answer the question; ’Who was the physician that guided you through the healing process?’ – God!

I declare November 4 a vitamin D holiday.  November 4, 2004 will forever be remembered as a glad day.  – Pandemic Survivor

Vitamin D Ignorance, Incompetence, or Conflict of Interest

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As vitamin D science has advanced during the last one hundred years, it has stumped many why we do not routinely treat and prevent disease.  Some have said it is because we ignore the science of vitamin D for the many other opportunities to treat and prevent disease.  Others have thought that it was just incompetence by medical professionals in understanding how the biological processes work with nutrients and especially vitamin D.  However, what is really happening is this huge conflict of interest for everyone that makes any income from the medical industry.

I would like to believe ignoring the science and lack of understanding is not possible because of the mountain of published information available to anyone that would like to read the twenty five thousand or so peer reviewed papers on vitamin D that have been published since 1960.  I would also like to think that our medical professionals and scientists are very bright people.  They have competent understanding of how biological processes work.  What is missing is the will to use the understandings to treat disease.  The intent of the medical profession is to treat and heal disease as long as it makes economic sense.  That is, you perform a task for payment and it sustains or increases the market size.  This is the very heart of capitalism.

So what principles drive the everyday operations of medical institutions, whether it is your local doctor, hospital, medical insurance company, pharmaceutical company, government agencies for health, and medical marketing (think insurance ads and pharmaceutical commercials)?  This could best be summed up by the principles that were stated by former Secretary of Health and Human Services, Michael O. Leavitt.  Of course HHS is the administrative department of government that all medical institutions and individual medical professionals either report directly to or responsible to for medical guidelines, rules, and laws for all the various functions of the medical industry.  These principles are:

1.      National standards, neighborhood solutions
2.      Collaborations, not polarization
3.      Solutions transcend political boundaries
4.      Markets before mandates
5.      Protect privacy
6.      Science for facts, processes for priorities
7.      Reward result, not programs
8.      Change a heart, change a nation
9.      Value life

These principles seem in reverse order for someone that is dying of a chronic disease or everyone.  To ‘value life’ when you are dying would seem to be a number one goal.  However, if you want to maintain a healthy medical economy, then a large sick market is needed.  To maintain this market then the first four principles are absolutely necessary.  The first three keep everyone in ‘locked step’ for moving toward the goal of a healthy economy.  However, number four, ‘markets before mandates’ brings confusions to persons wondering why a miracle medical solution is not implemented.

If you had to give up your job or source of income to save a life, would you do it? This seems almost too simple of a question that ultimately drives the medical industry.  It is a huge conundrum for persons in administrative positions including the president of the US.  It is a huge conundrum for the individual whether you work for the medical profession or have a number of friends and family whose income is derived from the medical industry.  Another way to ask this question: would you be worse off to have a chronic disease that takes 50 years to kill you or no income to sustain a nice life style.  As a society we have decided on the former.

So a miracle cure comes along for all chronic disease.  One that impacts more than ten percent of the genome and in particular the part of the genome that is responsible for disease – vitamin D.  You are the secretary of HHS and you meet with the president of the US to decide whether to implement the solution or try to cover it up to prevent a reduction of eight percent (represents fifty percent reduction of the medical economy or a true miracle cure) of an already failing economy- a reduction that could collapse the economy.  What would you do?

Yes everyone has a conflict of interest when it comes to reducing the medical economy by half.  If the science had been allowed to come forward as it was discovered and we grew the economy into it, then the decision to ‘value life’ would be number one on our priority.  Why didn’t this happen?

‘Markets before mandates’ is sad if you are dying.  If you derive your income from medical practice then million dollar houses on South Beach and million dollar yachts on the Chesapeake is the order of the day.   Ah character and a moral conscience are truly prized qualities to look for as you are trying to find a doctor to treat your illness with vitamin D.  The government, disguised as the IoM Food and Nutrition Board, implemented the principle of ‘markets before mandates’, and has put the responsibility for your health squarely on the character and competence of your doctor.  If the doctor cannot tell you his own level of serum vitamin D and how much he gets everyday to get there, and his level is not that of a sunny country or a serum 25(OH)D above 50 ng/ml find another doctor.    If your doctor starts to talk about the IoM rules on vitamin D and has a large house and a boat then run – run hard and fast.  – Pandemic Survivor

Food and Nutrition Board Delay

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During a recent visit to the Food and Nutrition Board website for vitamin D and calcium I was alarmed to find that the report had been delayed from May of this year until the end of the summer.

Most likely this will continue until the boards deadline of 24 months has ended.  That would put the report to sometime in the fall of 2010.  I would not be so concerned except for the 100,000 or so deaths each month that we delay because of vitamin D deficiency to say nothing of the suffering.

A. Catherine Ross, a vitamin A researcher, as chair most certainly is having a very difficult time in resolving the issues of a board that ultimately could have a huge effect on health as well as more of an impact on the medical economy than the recently passed health care bill.  Don’t you find it strange that a board for the Institute of Medicine that was seated to set standards and guidelines for vitamin D is chaired by a person who’s life’s research has been vitamin A?

I hope this is science and not politics at work.  It is for your health that I am concerned.  The scientist are saying that an upper limit of 10,000 IU per day needs to be set and I say that this may not be enough for an obese person.  However, anything less than this and we know that is more concerned with the medical economy than your health.  It would seem that the best DRI or daily required intake should be set for IU’s/per body weight.  It is the only thing that makes sense.

Doctor’s should also be instructed that long term levels of less than 200 ng/ml is safe for 25(OH)D.  This information already exist in the NIH Fact Sheet on Vitamin D in Table 1. It is also stated that no toxicity has been found in levels of less than 400 ng/ml.  Even though these numbers sound large they are still very small numbers.

Typically an intake from all sources of about 35 IU’s per pound of body weight should get your 25(OH)D above 50 ng/ml.  However, there is no way of knowing for sure without testing and because of the serious health consequences of vitamin D deficiency, testing should become a standard and doctors required to take enough CME’s to understand the complexities.

The longer we delay in not having a national intervention for vitamin D deficiency the suffering will continue.  Number one in this issue is that doctors need to be educated.

Millions Needlessly Die of Vitamin D3 Deficiency

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Well, in my satire on the presidential declaration of a national emergency it seems that I got my numbers wrong about the amount of death from vitamin D deficiency.   I had used 400,000 deaths that is an extrapolation used in William Grants paper on what would happen if everyone in the US were to take 2000 IU of D3 per day.  “Reducing the Burden of Disease Through Adequate Intake of Vitamin D3.” http://www.sunarc.org/GrantGrassrootsHealth.pdf Since Dr. Grant wrote this paper that used data from 2001 new research has come to light.

I received an email today from the John Cannell, Vitamin D Council, that said that William Faloon, Co-Founded of Life Extension Foundation, had written a new article with a retraction of his data from the letter of 2007.  http://www.lef.org/magazine/mag2007/oct2007_awsi_01.htm His new numbers that appeared in the January, 2009 issue of Life Extension Magazine shows that there could be well over a million deaths in the US every year from vitamin D deficiency.  http://www.lef.org/magazine/mag2009/jan2009_Millions-of-Needless-Deaths_01.htm

So what are we to believe?  I always like to check my data from an independent source.  If we consider that vitamin D has the possibility of reducing all chronic disease by 40 percent what would that mean for America?  If you will recall my post on Health Care Reform Heal the People we found that the death rate in Mexico is 4.8 per 1000 per year and in the US the death rate is 8.4 per 1000 per year,  or 43% less deaths per year in Mexico.  CIA Fact Sheets:  https://www.cia.gov/library/publications/the-world-factbook/rankorder/2066rank.html So you ask what the disparity of data is.  Do they have a better health care system?  The answer of course is that they are a sun-splashed country in the lower latitudes which means they most likely have higher vitamin D levels than the US.  And not only that,  but much of the population lives above 5000 ft which is above much of the atmospheric moisture and pollutions and this allows a higher incidence of UVB radiation to make vitamin D.  Also their winters are not as cold so more of the human body is exposed because they simply wear fewer clothes.

The death rate in the US of 8.4 minus the death rate of 4.8 is 3.6 per 1000 population per year.  If we take that most of this is from the difference in vitamin D levels then the US could reduce death by 3.6 times 307,000 thousand (307 million US population) per year.  This works out to 1,150,000 people per year.  If we say that there are more deaths because we have more cars and higher incidence of toxins because we are (were) a more industrialized nation, we would still have well over a million less deaths from vitamin D3 deficiency every year.  This would decimate the medical and medical insurance industries to say nothing of big pharma and over-the-counter goods sold at retail as remedies for whatever.  If the deaths are reduced by this much imagine how much less suffering and pain there would be from disease.

This is one heck of a survivor story as Mexico has significantly less death and suffering than the US because of vitamin D3.  I know the above may not be very scientific but it makes a lot of just plain common sense.  Imagine the millions of needless deaths in other countries because of this dread deficiency in a world with a population 6.7 billion people with a large portion living at the higher latitudes.

William Faloon sent this article to all Congressmen and Senators:  http://www.lef.org/magazine/mag2009/jan2009_Millions-of-Needless-Deaths_01.htm

While you are basking in the sun write your Congressman, The President, and the Secretary of Health and tell your friends.    – Pandemic Survivor