Nepalese immigrants to refuse to change their eating habits even after diagnosis of a chronic health condition (28). Health insurance is also an issue for Nepalese Americans. Many don’t have jobs that provide medical benefits, nor do many qualify for Medicaid (28).


Nepal has three major geographical regions: Terai Region, Mountain Region, and Hill Region (30). The geography is important to the cuisine because it determines the types of resources available. Likewise, the climate varies greatly with altitude, as do the crops and livestock that are available for food in each region.


The Terai region is set in the lowlands of Nepal. The climate is optimal to grow cereal crops such as


rice, wheat, maize, and barley (30). Cereal crops are a large part of the Terai diet—especially rice because it is plentiful and affordable. Rice with a tiny side dish of dal (lentils) is a common dish in the Terai region (31). Dal bhat is a dish with boiled rice and a thin lentil sauce that is commonly eaten twice a day: in the morning and after sunset (32). Another rice dish, Bhakka, is made by soaking and draining white rice, and then grinding it into flour. The flour is then mixed with water, molded into cups, wrapped in muslin, and steamed for three to five minutes. Bhakka is served hot with a pickle and is eaten at breakfast by the Tharu community (10). Although cereal crops are the most common, the Terai region also produces numerous vegetable crops, including cauliflower, tomato, cabbage, pumpkin, and radish. These make their way into the typical cuisine, where they are used in sauces or fried and served with rice (33).


The Hill region is the most suitable region to grow fruits and vegetables. Hence, many Hill dishes


contain fruits and vegetables (30). Vegetables grown in the Hills include radishes, cauliflower, cabbage, mustard, and rayo (mustard leaves). Kathmandu Valley, part of the Hill region, also offers a plentitude of vegetables—carrots, cauliflower, beans, eggplant, and cabbage—during the winter season. In the springtime, tomatoes, peppers, peas, squash, and cucumbers flourish (32). Other Hill crops include chayote (a type of gourd), asparagus, tree tomato, wild garlic, hot chilies, wild onion, and wild spinach (34). Gundruk is made throughout Nepal using leaves of mustard, cabbage, cauliflower, rayo, and radish plants. The leaves are first cleaned and dried in the sun for one to two days. They are then crushed and shredded to release juices, which ferments the leaves. The mixture is then put into glass bottles, pots, or plastic containers and sealed. The containers are kept warm for 10 to 15 days. Ideally, gundruk has a pleasant sour smell. Gundruk preparation varies among communities, but the overall process is the same (10).


In the high-altitude regions, rice is less available and more expensive. Therefore sattu or tsampa


(roasted flour made from local grains such as maize, wheat, barley, millet, and buckwheat) is used as a replacement in their diet (32). Dhiro is another staple food of the Hill diet. Dhiro is a mush made from millet or corn flour and may be eaten alone, with fried vegetables, or as a thin soup (32). Kinema is eaten in the Eastern Himalayan regions of Nepal. It is prepared by cooking soybeans, cooling them to room temperature, mixing them with vegetables, and then wrapping them in banana or sal leaves to ferment. After two to three days of fermentation, the beans are mashed by hand or a mortar. The texture is slimy and it has a short shelf life. These fermented soybeans may be fried and used in curry (35).


The Mountain region has a high altitude of 2,000 to 2,500 meters. The climate is cool with moderate


to heavy snowfall during the winter. When the snow melts, the mountains are covered in grass that the sheep, yak, and other mountain animals graze on. Staple crops in the mountain region include potato, naked barley, buckwheat, and maize (36). While vegetable variety is low, there are many uses for potatoes. In some highland regions, potatoes are eaten peeled, boiled, and salted with a chili and garlic relish. Sherpa


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