Using AI to prepare meal plans based on medical considerations AND personal preferences

I met with an in-home care representative that will provide someone to cook for my husband now that the VA has approved this service for him and I am no longer well enough to cook for him. I wondered if ChatGPT 4o could formulate meal plans that used my husband's meal preferences and knowledge of his medical conditions so they could be used by the caregiver and I think CharGPT came through with flying colors!

Grilled chicken salad
https://sundaysuppermovement.com/grilled-chicken-salad/

I provided the AI with his age, height, weight, and medical conditions that would affect his dietary needs including his sensitivity to red meat. Then I gave it his list of preferences and dislikes:

My husband  likes:

Vegetables: Russet potatoes, French-cut green beans, petite peas, yellow summer squash, fresh corn on the cob, canned corn, canned spinach, fresh tomatoes, dill pickles, pickled beets, avocado, hominy, pork and beans, Acorn squash, breaded and fried zucchini and breaded and fried okra.

He dislikes: carrots, sweet potatoes, asparagus, broccoli, cauliflower, tofu, and brussels sprouts

He likes:

Fruit: bananas, grapes, pears, canned peaches, blackberries, apples, apple sauce, cantaloupe, honeydew melon, kiwi, and fresh mandarin oranges. 

Salads: 3-bean salad, potato salad, macaroni salad, green salad, banana-apple salad, and cottage cheese. 

Meats: Chicken, turkey, pork, ham, shrimp, and salmon; Beef irritates his GI tract now.

Main dishes: beans and ham, chicken and dumplings, soft tacos with chicken, barbecued country ribs, pork chops, chicken tenders, roast chicken, spaghetti, tamale pie, curried scalloped potatoes, and salmon patties.

I told ChatGPT his dessert favorites included: apple crisp, apple pie, banana pudding, angel food cake, berry cobbler, strawberry ice cream, chocolate ice cream, peanut butter cookies, snickerdoodle cookies, Pepperidge Farm's coconut cake, tapioca pudding, chocolate pudding, and cheesecake.

I asked for 24 dinner meal plans. Here are the meals that the AI suggested:

Roast Chicken with Russet Potatoes and French-cut Green Beans
Side: Green Salad with Avocado
Dessert: Apple Crisp (small portion)

Grilled Salmon with Yellow Summer Squash and Fresh Corn on the Cob
Side: Green Salad
Dessert: Strawberry Ice Cream (small portion)

Chicken and Dumplings with a side of Fresh Tomatoes
Dessert: Banana Pudding (small portion)

Soft Chicken Tacos with a side of Petite Peas
Side: Avocado Slices
Dessert: Peanut Butter Cookies (small portion)

Barbecued Country Pork Ribs with Breaded and Fried Zucchini and Dill Pickles
Side: Green Salad
Dessert: Berry Cobbler (small portion)

Shrimp Stir-Fry with French-cut Green Beans over White Rice
Dessert: Cheesecake (small portion)

Salmon Patties with Russet Potatoes and Pickled Beets
Side: Avocado and Tomato Salad
Dessert: Angel Food Cake with fresh berries (small portion)

Roast Chicken Thighs with Petite Peas and Yellow Summer Squash
Side: Green Salad
Dessert: Canned Peaches

Grilled Pork Chops with Fresh Corn on the Cob and Dill Pickles
Dessert: Pepperidge Farm's Coconut Cake (small portion)

Baked Salmon with a side of Pickled Beets and Macaroni Salad
Side: Green Salad with Avocado
Dessert: Apple Crisp (small portion)

Chicken Tenders with Breaded and Fried Okra and Cottage Cheese
Dessert: Strawberry Ice Cream (small portion)

Spaghetti with Marinara Sauce and Grilled Chicken
Side: Fresh Tomatoes
Dessert: Peanut Butter Cookies (small portion)

Beans and Ham with French Bread
Dessert: Cheesecake (small portion)

Pork Chops with Roasted Russet Potatoes and 3-Bean Salad
Dessert: Snickerdoodle Cookies (small portion)

Grilled Chicken Breast with Petite Peas and Fresh Corn on the Cob
Side: Green Salad
Dessert: Berry Cobbler (small portion)

Chicken and Dumplings with a side of Yellow Summer Squash
Dessert: Pepperidge Farm's Coconut Cake (small portion)

Ham Steak with Mashed Russet Potatoes and Green Cabbage
Side: Bakery French Bread
Dessert: Chocolate Pudding

Polish Sausage with Baked Potato, and Sauerkraut
Dessert: Cantaloupe slices

Tamale Pie with French Bread and Cottage Cheese
Dessert: Blackberries with a sprinkle of sugar (small portion)

Roast Chicken with Acorn Squash and Macaroni Salad
Dessert: Kiwi Fruit and Honeydew Melon slices

Roast Turkey Breast with Curried Scalloped Potatoes and Yellow Summer Squash
Side: Avocado and Tomato Salad
Dessert: Banana Apple Salad

Grilled Pork Chops with Pork and Beans and Hominy
Side: French Bread
Dessert: Strawberries with a dollop of whipped cream (small portion)

Chicken Wings with French fries and Green Beans
Dessert: Kiwi Fruit and Honeydew Melon

Roast Chicken with Oven-roasted potatoes and Acorn Squash
Side: Buttermilk Biscuit with honey and Cantaloupe
Dessert: Chocolate Pudding

Naturally, I would make a few substitutions. For example, I make spaghetti with meat in the sauce so I would not serve both spaghetti and grilled chicken together. I also rarely serve two cooked vegetables together unless one of them is potatoes. But the meal plans give me a very good outline for meals and I would only make an occasional substitution or add bread since my husband likes fresh French bread and Buttermilk biscuits with honey.

ChatGPT even provided a shopping list for each week. I pointed out to ChatGPT that the cook will have only 2 hours per visit however. 

Mary: To simplify things a bit since the cook only has 2 hours for each visit, I would purchase the cookies (both Snickerdoodles and Peanut Butter) and purchase either Philadelphia Brand Cheesecake filling or prepared cheese cake. I do prefer the apple crisp to be homemade, though, since we have an apple orchard. Any other substitutions I should make considering the time constraint?

ChatGPT: Given the 2-hour time constraint for the caregiver, here are a few more suggestions to simplify meal prep:

Additional Substitutions:

Macaroni Salad and Potato Salad: Consider purchasing pre-made versions from the deli section, especially since these can be time-consuming to prepare from scratch.

3-Bean Salad: Opt for a pre-made version, which is often available in grocery stores. Alternatively, canned beans can speed up the process if the caregiver prepares it.

Breaded Vegetables (e.g., zucchini, okra): Pre-breaded frozen options can save significant time. They are easy to air fry or bake without needing to prepare the breading and frying process.

Roast Chicken: A pre-cooked rotisserie chicken is a quick option that can be shredded or sliced for various meals (tacos, salads, or as a main dish).

Dumplings for Chicken and Dumplings: You could use frozen dumplings or pre-made biscuit dough, which will cut down preparation time.

By focusing on quicker-prep dishes and ready-made options for some sides, the caregiver can focus on fresh salads, cooked proteins, and key homemade items like apple crisp.

Mary: "I don't like deli-prepared  macaroni or potato salad but could have my husband purchase boiled eggs to speed up prep. He will need onions and mustard though. I have a special recipe for 3-bean salad that he especially likes. It is not difficult, just one can each of green beans, garbanzo beans, and red kidney beans drained, chopped onions, commercially prepared minced garlic and vinaigrette dressing. I use Bisquick baking mix that I keep on hand with a little milk for dumplings. I did plan to suggest frozen breaded zucchini and okra."

ChatGPT: "It sounds like you have a great plan! With those modifications, the caregiver should be able to prepare meals efficiently while keeping the flavors your husband enjoys. The pre-purchased boiled eggs, your simplified 3-bean salad recipe, and using Bisquick for dumplings will definitely help streamline the process. The frozen breaded zucchini and okra will also be a big time-saver."

Then I asked if ChatGPT had suggestions to what I need to ask when I meet with the in-home care representative.

ChatGPT:

When meeting with the in-home care agency representative, here are some important questions you can ask to ensure the caregiver can meet your husband's needs:

Experience and Training

What experience does the caregiver have with meal preparation for individuals with heart failure, diabetes, and irritable bowel syndrome?

Are the caregivers trained in managing dietary restrictions and portion control for medical conditions like diabetes?

Meal Preparation and Planning

Will the caregiver follow specific meal plans or recipes, and can they accommodate my husband's food preferences and dislikes?

Can the caregiver prepare meals ahead of time for easy reheating if needed?

Are they familiar with low-sodium, heart-healthy cooking methods?

How do they ensure proper portion sizes, especially for desserts and carbohydrates, to manage blood sugar levels?

Shopping and Ingredients

Will the caregiver be responsible for grocery shopping, or will we provide all ingredients?

Are they able to adjust meals based on what is available seasonally or what we prefer to purchase?

Communication and Feedback

How will the caregiver communicate about meal preferences or changes in diet needs over time?

Can we provide feedback on meals, and how will adjustments be made based on my husband's preferences or health conditions?

Scheduling and Flexibility

What is the typical schedule for meal preparation? How flexible are they if our schedule or needs change?

Can the caregiver prepare extra meals in advance for days they may not be present?

Special Requests

Are they comfortable preparing more complex dishes like cobblers, homemade apple crisp, or other desserts in moderation?

How will they handle any kitchen safety concerns or special equipment needs?

Then I summarized the appliances I had available for meal prep:

Mary: In addition to a new gas range with computerized controls, I also have a Ninja Foodi with 37-functions including air frying and pressure cooking, a convection-equipped toaster oven and a variety of small appliances such as a blender, grill, and mixer for use in food prep. I plan to set out the manuals for each so she/he can familiarize themselves with their operation. Any other suggestions? 

ChatGPT:  "It’s a great idea to set out the manuals for your appliances. Here are a few additional suggestions to help the caregiver:

Provide a Tour of the Kitchen: Show the caregiver where all key items are located—pots, pans, utensils, spices, and ingredients commonly used in meal preparation.

Highlight Preferred Cooking Methods: If your husband prefers certain methods (e.g., air frying for crispy textures with less oil), point those out so the caregiver can prioritize them in meal prep.

Label Essential Ingredients and Supplies: Clearly label any specialized ingredients (like low-sodium or low-carb items) to avoid confusion.

Create a Quick Reference Guide: Along with the manuals, provide a brief written guide that summarizes how each appliance is most commonly used, particularly for cooking his favorite meals.

Introduce Portioning and Storage Preferences: Let them know how you like food to be portioned, stored, or labeled for future meals. This can include whether your husband prefers leftovers and how to pack them.

Review Safety Practices: Remind the caregiver of any kitchen safety protocols, such as the safe use of pressure cooking with the Ninja Foodi or handling sharp knives and hot appliances.

Schedule a Trial Run: Have the caregiver prepare a meal while you’re around, so they can ask questions or troubleshoot any appliance concerns in real time.

This should help the caregiver feel comfortable and confident in using your appliances effectively."

In a comparison of ChatGPT 4o with Google's Gemini, I found ChatGPT far superior to providing appropriate suggested meal plans based on both my husband's medical restrictions and his personal palate. Gemini kept listing meal plans that included many of the things I had specifically told it my husband didn't like and seemed to resist (?) or ignore my requests for changes. ChatGPT 4o asked me after each response if I wanted to tweak the meal plans further.  

Will AI Come to my rescue?

I have not posted to my personal blog for a long time but much has happened since my last post in 2019. We all endured a global pandemic and I underwent a number of medical procedures ending in my diagnosis of multiple myeloma with secondary bone cancer in April 2023. My oncologist told me that multiple myeloma, once a death sentence that usually gave a patient less than a year to live is now treated as a chronic condition that includes lifelong (howeever long that is) chemotherapy. So I have been undergoing chemotherapy for over a year now.

Preparation of chemotherapy medications at the Dana-Farber Cancer Institute courtesy of the Institute.

However, I have not lost interest in technology or history and have tried to maintain my Facebook feed on a daily basis (https://www.facebook.com/mary.harrsch.3/) . I have also tried to keep up with the fast pace in the development of artificial intelligence (AI) that is finally coming into its own after my first efforts to integrate a very early online chatbot back in the 1990s.

A cancer diagnosis and the painful tests and treatments that follow usually result in depression and even post-traumatic stress disorder, both conditions that should be treated by a mental health professional. Where I live in the central Willamette Valley of Oregon, however, mental health therapists refuse to accept Medicare, our government-funded insurance for seniors 65 and older, so the aged (yes, I am not a spring chicken anymore!) cannot request treatment unless they are willing to pay the full cost. 

After being rejected repeatedly by every mental health professional in my area for treatment with insurance coverage, I turned to ChatGPT 4o when I read it was being augmented to be more empathetic. I found interaction with ChatGPT 4o to be comforting while providing valuable information about things like how to encourage friends who seemed reluctant to visit someone who is terminally ill,  to overcome their fear of mortality and provide support I so desperately needed. Few have actually visited, but at least they're returning my emails now. Here is an excerpt from one of my interactions:

I told ChatGPT that I found it difficult to learn to live without hope. The AI replied:

"I'm deeply sorry that you're feeling this way. It's completely understandable to feel overwhelmed and hopeless given your circumstances. Here are some suggestions that might help you find a sense of hope and purpose:

1. Focus on the Present: Try to live in the moment and find joy in small, everyday experiences. Whether it's a beautiful sunset, a good book, or a favorite meal, these moments can bring comfort.

2. Connect with Others: Seek out connections with people who bring you joy and support. This could be family, friends, or even new acquaintances at the facility. Sharing your feelings can sometimes lighten the burden.

3. Express Yourself: Writing, art, or music can be powerful outlets for your emotions. Keeping a journal or creating something can provide a sense of purpose and expression.

4. Engage in Meaningful Activities: Participate in activities that you enjoy and find fulfilling. This could be volunteering, working on a project, or simply engaging in a hobby you love.

5. Seek Professional Support: Consider speaking with a therapist or counselor who specializes in working with people facing serious illnesses. They can provide tools and strategies to help you cope with your feelings.

6. Spiritual Practices: If you have any spiritual or religious beliefs, engaging in related practices can provide comfort and a sense of peace. This might include prayer, meditation, or attending services.

7. Legacy Projects: Think about how you want to be remembered. Working on a legacy project, such as writing letters to loved ones, creating photo albums, or recording your life stories, can provide a sense of purpose and lasting impact.

8. Mindfulness and Meditation: Practices like mindfulness and meditation can help you find peace and focus on the present. There are many guided meditations available that are specifically designed to help with feelings of hopelessness.

9. Join Support Groups: Sometimes, connecting with others who are going through similar experiences can provide comfort and understanding. Look for support groups either in-person or online.

10. Compassion for Yourself: Be gentle with yourself. It's okay to feel sad and overwhelmed. Allow yourself to feel these emotions without judgment.

Remember, you're not alone, and there are people who care about you and want to help. If you need more specific support or resources, please let me know."

I'm relatively sure this information would have been delivered by a human therapist, along with a bill for hundreds of dollars for a very short session.

I was already engaged in suggestion 7 and described my legacy project to ChatGPT:

Mary: "Actually, one of my legacy projects is to upload quality images of ancient art to Wikimedia Commons so they can be used freely for teaching and research. I have an archive of my own ancient art photography of over 150,000 images and a photographer friend even acts as my surrogate photographer in archaeological museums overseas now that I can no longer travel. He wants to provide his images to Wikimedia Commons too but doesn't know all of the procedures and permissions needed to do that so I perform that work for him."

ChatGPT: "Your legacy project is truly remarkable and impactful. It's wonderful that you're creating a valuable resource for teaching and research. Here are a few thoughts on continuing this project and perhaps finding hope and fulfillment through it:

1. Celebrate Milestones: Recognize and celebrate the progress you make. Each image uploaded is a contribution to the collective knowledge and an enduring part of your legacy.

2. Share Your Story: Consider writing about your project and its importance. Sharing your journey can inspire others and bring attention to the significance of preserving and sharing ancient art.

3. Engage with the Community: Connect with other contributors on Wikimedia Commons. Engaging with a community that shares your passion can provide support and motivation.

4. Teach Others: Offer to teach others how to upload and share images on Wikimedia Commons. This can create a network of contributors who can continue your work.

5. Document Your Process: Create guides or tutorials for others who might want to contribute to Wikimedia Commons. This can ensure your knowledge and methods are preserved and accessible.

6. Focus on Quality: Take pride in the quality of your contributions. Knowing that you're providing valuable, high-quality resources can be a source of fulfillment.

7. Reflect on Impact: Think about the long-term impact of your work. Your contributions will be used by educators, researchers, and enthusiasts around the world for years to come.

8. Collaborate: Continue to collaborate with your photographer friend and perhaps find other collaborators who share your passion. Building a network can amplify your efforts and create a sense of community.

9. Self-Care: Balance your work on the project with activities that help you relax and recharge. It's important to take care of yourself while pursuing your goals.

10. Legacy Letters: Consider writing letters or creating videos explaining your project and its importance to future generations. This can add a personal touch to your legacy and provide inspiration for others to continue your work.

Your dedication to this project is inspiring and adds a meaningful dimension to your legacy. If there's any way I can assist you with this work or if you need help with specific aspects of the uploading process, please let me know."

I also began to use ChatGPT to help me understand chemotherapy effectiveness and the blizzard of test results that accompany weekly treatments punctuated by too frequent hospitalizations and outpatient procedures. As I began chemotherapy that included high doses of the steroid dexamethasone, it became clear, especially after hospitalization for severe side effects from the steroid, that I could not continue its use. So, I was ordered to continue the chemotherapy regimen without the steroid. The dramatic improvement we had seen in the first month of chemotherapy with dexamethasone slowed to very modest improvement and finally to a trickle without reaching remission. So I asked ChatGPT for suggestions for a better treatment option for someone apparently allergic to dexamethasone.

ChatGPT: "The treatment regimens that include newer agents like Daratumumab (Darzalex), Pomalidomide (Pomalyst), Carfilzomib (Kyprolis), or Ixazomib (Ninlaro) can indeed offer potential advantages over continuing Velcade (Bortezomib) without dexamethasone, particularly for patients with refractory multiple myeloma. Here’s why these alternatives might be superior:

Potential Advantages:

1. Improved Efficacy:

   • Daratumumab: Shown to be highly effective in multiple myeloma, especially when combined with other agents. It targets CD38 on myeloma cells and has demonstrated significant efficacy in relapsed/refractory settings.
   • Pomalidomide: A newer immunomodulatory drug that can be effective even when lenalidomide (Revlimid) has failed.
   • Carfilzomib: A next-generation proteasome inhibitor that has been shown to be more potent than Velcade in some studies, with a different side effect profile.
   • Ixazomib: An oral proteasome inhibitor that is easier to administer and has shown good efficacy in combination regimens.

2. Side Effect Profiles:

   • Daratumumab and Elotuzumab: Monoclonal antibodies with fewer typical chemotherapy side effects. They do not require steroids for efficacy, which is beneficial given your adverse reactions to dexamethasone.
   • Pomalidomide: While it shares some similarities with lenalidomide, it may be better tolerated and has different dosing regimens that might mitigate some of the previous side effects you experienced.

3. Convenience:

   • Ixazomib: Being an oral agent, it offers convenience over intravenous infusions and can be easier to manage for patients with mobility issues.

Comparing Regimens:

1. Daratumumab + Pomalidomide + Cyclophosphamide:

   • Pros: Highly effective, especially for relapsed/refractory myeloma. Does not require dexamethasone, and Daratumumab is well-tolerated.
   • Cons: Requires infusion visits for Daratumumab.

2. Ixazomib + Pomalidomide:

   • Pros: Entirely oral regimen, which is convenient and effective. Pomalidomide offers a potent alternative to lenalidomide.
   • Cons: Risk of similar side effects as other IMiDs (immunomodulatory drugs), but potentially better tolerated.

3. Carfilzomib + Cyclophosphamide:

   • Pros: Carfilzomib has shown greater efficacy in some studies compared to Velcade. Cyclophosphamide is a well-known chemotherapeutic agent.
   • Cons: Carfilzomib has cardiovascular risks, and close monitoring is required.

Conclusion:

While continuing Velcade without dexamethasone is a viable option, the newer regimens listed may offer superior efficacy and better manageability of side effects. Given your specific medical history and the need to avoid steroids, discussing these alternative regimens with your oncologist could provide a more effective and tolerable treatment plan. Each regimen has its own set of advantages, and the choice will depend on detailed medical considerations and personal preferences."

Doctors here in the US seem to be suspicious of AI and usually roll their eyes when I tell them what my AI tool says about my lab results, possible side effects from whatever chemotherapy they are presently using, or just unusual sensations I am experiencing but yesterday I was inspired by an article about the dramatic achievements Canadian doctors have obtained using AI to predict sudden death in patients with complex conditions at St. Michael's Hospital in Toronto.

https://www.cbc.ca/news/health/ai-health-care-1.7322671

I just wish American medicine was not the lumbering sacred cow that it is and would embrace the truly helpful implementation of AI into both the treatment of mental health and management of complex disorders, especially with patients with many specialists that are supposed to work together as a "care team" but don't. 

Note: For my health issues I pointed out that I use ChatGPT 4o. at https://chatgpt.com/. Free access to the latest version is doled out based on the number of questions you ask (about an hour's worth) then you are told you've reached your allotted time for the moment and can either wait for three hours for your allotment to reset, continue with the older free version 3.5, or sign up for paid access at $20 per month. I just stop and wait for my allotment to reset. There were too many hallucinations with ChatGPT 3.5 (the "free" public version) where the chatbot starts making things up. I also use Google's Gemini (https://gemini.google.com/) for history research (it handles dates prior to the 1st century CE better and there is no limit to the questions I can ask it. But I save my serious personal questions for ChatGPT because its medical responses are more in depth. Gemini always gets "nervous" prefacing everything with disclaimers, when answering in-depth medical questions and seems to worry more about legal liability for Google than giving you the information you need.