An introduction to the new medical wholism pattern: The P4 Initiative (Personalized - Predictive - Preventive - Participatory Medicine) for the Management of Chronic Diseases' Epidemic Dr. George Bellos, MD, PhD, MRCGP, MEPMA, MEURAC Managing Director at Health Centre Koropi, Attica

1. Dr.GEORGE BELLOS MD, PHD, MRCGP, MEPMA, MEURACT
COORDINATOR /MEDICAL DIRECTOR , KOROPI HEALTH CENTRE, 1st HEALTH AUTHORITY REGION
E-mail:geobellos1010@yahoo.gr
ΑΜΙΓΩΣ ΕΚΠΑΙΔΕΥΤΙΚΟΥ XAΡΑΚΤΗΡΑ ΕΙΣΗΓΗΣΗ

2. LONG-TERM DEVELOPMENT AND NUTRITION-MODERN CHARGE
OUT OF BALANCE
AD
BCE
10000BCE
200000BCE
Beginning
ofTime
100000 BCE
200000 BCE
Homo Sapiens
Pre-HomoSapiens
200,000BCE-10,000BCE
OriginofHumans
ModernBeverageEra
10,000BCE-present
0
Earliest possible date
Definite date
Water, Breast Milk
2000 BCE
Milk (9000 BCE)
Beer (4000 BCE)
Wine (5400 BCE)Wine, Beer, Juice
(8000 BCE)
(206 AD)
Tea (500 BCE)
Brandy Distilled (1000-1500)
Coffee (1300-1500)
Lemonade (1500-1600)
Liquor (1700-1800)
Carbonation (1760-70)
Pasteurization (1860-64)
Coca Cola (1886)
US Milk Intake 45 gal/capita
(1945)
Juice Concentrates (1945)
US Coffee Intake 46 gal/capita
(1946)
US Soda Intake 52/gal/capita
(2004)

3. 28/09/2015

6. Preliminary work presented by Cleveland Clinic at the 2017
Society of General Internal Medicine Annual Meeting
analyzed the contribution of modifiable behavioral risk
factors to causes-of-death in the U.S. population, using 2014
data.
Based on this preliminary work, the team found the greatest
number of preventable life-years lost were due to (in order
from greatest to least) obesity, diabetes, tobacco use, high
blood pressure and high cholesterol. However, researchers
also noted that some individuals may have needs that are
very different than those of the broader U.S. population. For
an obese and alcoholic patient, for example, alcohol use may
be more important to address than obesity, even though
obesity has a greater impact on the population.
Results highlight the clinical and public health achievement of
smoking cessation efforts because 15 years ago, tobacco
would have topped the list.

7.  Two new meta-analyses from Brigham Young University (BYU) in Provo,
UT, reveal that loneliness and social isolation may increase the risk of
premature death by up to 50 percent.
 The first meta-analysis included more than 300,000 adults across 148
studies, while the second comprised 70 studies involving more than 3.4
million adults.,
 Study co-author Julianne Holt-Lunstad, Ph.D., a professor of psychology
at BYU, and colleagues recently presented their findings at the 125th
Annual Convention of the American Psychological Association, held in
Washington, D.C.
 While loneliness and social isolation are often used interchangeably, there
are notable differences between the two. Social isolation is defined as a
lack of contact with other individuals, while loneliness is the feeling that
one is emotionally disconnected from others. In essence, a person can be
in the presence of others and still feel lonely.
 "There is robust evidence that social isolation and loneliness significantly
increase risk for premature mortality, and the magnitude of the risk
exceeds that of many leading health indicators."What is more, the team
found that the risk of early death associated with loneliness, social
isolation, and living alone was equal to or greater than the premature
death risk associated with obesity and other major health conditions.

8. Zn

9. IMMUNE-METABOLISM ISSUE

11.  High levels of air pollution can have a negative impact on sleep quality, according to a US study
presented at the American Thoracic Society's annual conference in Washington DC Previous studies have
shown that pollution adversely affects the heart and the lungs, cardiovascular mortality, and risk for
asthma, chronic obstructive pulmonary disease, lower respiratory tract infections and sleep apnea,
METABOLIC SYNDROME.

13. Bach (2002) N Engl J Med, Vol. 347, 911-920
2014
Public Health still insists on microbes,
But from the single species to whole ecological groups of microbes

16. «Το όλον είναι μεγαλύτερο από το
άθροισμα των μερών του»
(Μετά τα Φυσικά, τόμος 11)
Αριστοτέλης, 384-322 π.Χ.,

19. NEW ERA OF OMICS

20. ppm0123456789
Gene
Protein
Metabolite
Targets
and
Biomarkers
Targets
and
Biomarkers
Biostatistics
Bioinfomatics
Biostatistics
Bioinfomatics
geneindex
proteinindex
metabolite index
Sample Types:
• 10 ApoE3 mice
• 10 wildtype mice
• liver tissue
• plasma
• urine
Figure 1. A typical Systems Biology strategy for study of atherosclerosis [1] using
a transgenic ApoE3 Leiden mouse model.
Predisposition
Genotype
Prognostic
markers
Diagnostic
markers
Changes in pathway dynamics
to maintain homeostasis
Surrogate
Biomarkers
Late biomarkers
of disease
Early biomarkers
of diseaseOnset of
disease

22. 22

26. THE TOTAL P4
SPECTRUM

31.  3,101,804,739 base pairs
 22 chromosomes plus X and Y
 21,224 protein-coding genes
 15,952 ncRNA genes, miRNA..: 2nd code
Dr.John
Stamatoyannopoulos
Less than 2% of the human genome encodes proteins.
50% of the human genome consists of jumping genes or
mobile genetic elements.
The 8% of human DNA from retroviruses has been vital to
human evolution, such as determining the human placenta,
epigenetic changes in the brain and digestive enzymes.
An epigenetic immune system in the nucleus battles the
jumping genes for control of the cell and control of
evolution.
Now, Polintons are a new link between viruses, jumping
genes,, 1-3% is from horizontal-ecological relationships,
role in metabolism.
This total amount of functional DNA and
RNA+microbiota DNA is called the hologenome.

34. Government Office for Science, Dept. of Innovation, Universities and Skills
OBESUTY MAPPING

35. Societal influences
Individual
psychology
Biology
Activity
environment
Individual
activityFood
Consumption
Food Production
OBESITY DETERMINANTS

36.  “Analyzes 6 of your
genes that may play
an important role in
determining how your
body manages overall
insulin resistance”
 “..assesses five key
 Diet and lifestyle
action areas”
INFLAMMATION
AND COMMON SNP’s:
Induces up to 913 genes
ΕΜΜΕΣΑ
ΜΕΤΡΗΣΗ
1,25D3 KAI
25D3

41. GENETIC
BIOMARKERS
MICROBIOME
BIOMARKERS
NEW
METABOLOME
BIOMARKERS

47. HUMAN MICROBIOME IS REFERRED TO THE GROUP OF MICROBIAL BUGS LOCATED IN THE BODY,
INCLUDING BACTERIES, MUCOMES, ANCIENTS AND PROCARYOTICS.
THE HUMAN BODY CONTAINS MORE THAN 1.4 X MICROBIAL CELLS FROM HUMAN CELLS!
40% UNKNOWN TO TODAY !!!

60.  Volume 47, Issue 3, 19 September 2017, Pages 406–420
 Foundations of Immunometabolism and Implications for Metabolic
Health and Disease
 Gökhan S. Hotamisligil1, ,

 Highly ordered interactions between immune and metabolic responses
are evolutionarily conserved and paramount for tissue and organismal
health. Disruption of these interactions underlies the emergence of many
pathologies, particularly chronic non-communicable diseases such as
obesity and diabetes. Here, we examine decades of research identifying
the complex immunometabolic signaling networks and the cellular and
molecular events that occur in the setting of altered nutrient and energy
exposures and offer a historical perspective. Furthermore, we describe
recent advances such as the discovery that a broad complement of
immune cells play a role in immunometabolism and the emerging
evidence that nutrients and metabolites modulate inflammatory
pathways. Lastly, we discuss how this work may eventually lead to
tangible therapeutic advancements to promote health.

65. “Leaky gut”: the source of
degenerative and immune illnesses?
Increased permeability is a characteristic of the “civilized” gut,
with loose connections between gut cells.
Caused by:
proteotoxic effects of gluten and casein,
dysbiotic gut flora, grilling-frying, stress,
low fiber in food, too much physical exercise.
Aggravated by:
NSAID, aspirin, steroids, antacids (PPIs), antibiotics
Leading to:
chronic low-grade inflammation

66. 1. leaky gut → chronic low-grade inflammation:
A leaky gut lets some gut contents (endotoxins, LPSs) to enter
circulation and shifts the anti-inflammatory ↔ pro-
inflammatory cytokine balance to pro-inflammatory.
2. chronic low-grade inflammation → universal membrane deficiency
→ illnesses of civilization:
The long-lasting pro-inflammatory condition can change the
permeability of other membranes in the body (e.g., blood-brain
barrier, synovial stratum, endothel, bronchial mucosa and
alveolar wall). This way the permeability problem of the gut
extends to other barriers, and a universal membrane deficiency
may be the common ground of many illnesses of civilization.
The gut and the GUT
(Grand Unification Theory) in medicine

67. Alzheimer’s dementia
Attention deficit
Parkinson’s disease
Childhood hyperactivity
Autism spectrum disorders
Depression

76. george mias
RSV 18 days
Platelet Plug Formation
Glucose Regulation of
Insulin Secretion

80.  Good genes are nice, but companion joy is better!!
 Harvard study, almost 80 years old, has proved that embracing
community helps us live longer, and be happier-“Loneliness
kills. It’s as powerful as smoking or alcoholism.”
 — Robert Waldinger, Main researcher
April 11, 2017 | Editor's Pick Popular
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