Mama V’s Almost Paleo Sweet and Sour Sausage Meatballs

These meatballs were one of my absolute favorite foods when I was growing up.  Frankly, they are still one of my favorite foods.  The only difference?  The old recipe has been remixed of course!  The original recipe had brown sugar and bread crumbs.  My Mom can be credited for the recipe remake.  After she started cooking more Paleo style dishes, she realized that the ketchup was plenty sweet, and there was no need to add the brown sugar.  She has also been substituting almond meal for bread crumbs in meatballs for the last few years.  Now, I know that ketchup is not considered strict Paleo, but I buy organic ketchup.  It is not only more delicious, but it doesn’t have corn syrup in it.  So, if you eat things like honey, maple syrup, agave nectar… a trace of sugar won’t totally derail your body.  But, I will try making it with organic tomato sauce one day, just to see if the flavor could be passable to the original.  The other matter in making this Paleo is substituting coconut milk for the milk.

The original recipe has milk.  You could absolutely use your favorite milk, although I would stay away from skim milk for this recipe.  I certainly haven’t totally given up dairy, but I do eat a lot less as I have adopted more aspects of the Paleo lifestyle into my diet.  Buying organic dairy is definitely preferred, but I still enjoy cottage cheese with probiotic, and eat 2% Fage yogurt.  My love of ice cream, specifically soft serve is another matter entirely, but I only indulge once every few months.  My brother is extremely lactose intolerant.  My Mom swears that his myriad ear infections and sets of tubes as a child were the result of a milk allergy that went unidentified.  Food allergies and insensitivities can cause all kinds of unpleasant side effects.  That’s why eating Paleo is appealing for so many, as cooking without gluten, lactose and high carbs can avoid these unnecessary symptoms.  My husband is not as sensitive, but as you may have noticed, I substitute coconut milk for most dairy products.  In this recipe I used unsweetened So Delicious Coconut Milk.  You may also use canned coconut milk, but the 1/3 cup is much easier to get from a carton than trying to save the remainder of a can.  When I use a can of coconut milk, it is normally the exact amount needed for a recipe.  However, no one says you can’t use the remaining cup or so to make a delicious smoothie or to make your scrambled eggs a little fluffier.  Also, with all the recent information I’ve seen about BPA in canned items, I’m trying to incorporate the coconut milk from cartons into my routine.  I will say though, that canned, full-fat coconut milk is best for certain recipes.  You just can’t get the same level of creaminess from the coconut milk in the carton.

Back to the recipe’s goodness: the delicious combination of sausage with the tangy sauce.  The beauty of the recipe is not only the simplicity, but the ability to tailor the flavors to your liking simply by using different combinations of meat!  Traditionally, the meatballs are all sausage.  I decided to try a spicy pork sausage, so I cut the heat by using a package of ground buffalo.  You could also use two mild pork sausages, or two hot pork sausages, but cutting it with buffalo also makes the meatball leaner.  Have fun experimenting with different meats.  Concerning the sauce: the soy sauce is not Paleo, but can be easily substituted with Coconut Aminos (can be found at any organic grocery store).  If you cannot find coconut aminos, again, this small amount of soy sauce will not completely derail your Paleo lifestyle.

My Mom always made note on her recipe that she doubles the sauce.  I also doubled the meatballs, but didn’t have enough ketchup, so I one-and-a-halved the recipe.  It ended up plenty saucy, but feel free to go nuts, doubling and tripling the sauce if you’re feeling it.  🙂  Growing up, my Mom often made this for Coast Guard events, New Years (they were a favorite of my Yia Yia for New Year’s eve), and company.  This is a fabulous and easy entertaining dish, but perfect for a last minute family meal.  There is so little prep and work, for such a big flavor pay off.  All you truly need is some sausage, and the rest of the ingredients are hopefully pantry staples by now.  Whether you eat these with toothpicks, forks, or spoons… you’ll probably wish you had a shovel.


  • 1 lb pork sausage (I used HOT Odom’s Tennessee Pride Real Country Sausage… no corn syrup!)
  • 1 lb ground buffalo or beef
  • 1 large egg, slightly beaten
  • 1/2 cup almond meal/flour
  • 1/3 cup coconut milk
  • 1/2 tsp sage
  • 3/4 cup organic ketchup
  • 1 1/2 cups water
  • 3 tbs red wine vinegar
  • 3 tbs soy sauce (or coconut aminos)


  • 1. Preheat oven to 400 degrees
  • 2. In a large bowl, mix meat, egg, almond meal, coconut milk, and sage with your hands… making sure it is evenly mixed
  • 3. Make small balls using about a tablespoon (or small ice cream scoop) of meat, and form with hands
  • 4. Evenly space meatballs on a parchment paper-covered baking pan (I needed two pans)
  • 5. Cook meatballs for 22-25 minutes
  • 6. Meanwhile, mix ketchup, water, red wine vinegar and soy sauce until smooth
  • 7. Pour into a large nonstick saucepan and gently heat on low, stirring frequently (careful not to let it stick on the bottom or boil)
  • 8. When meatballs are finished baking, place them gently in saucepan, stirring frequently, gently covering meatballs in sauce
  • 9. Simmer for 15 minutes, but longer will only help the meatballs soak up more flavor
  • 10. Enjoy!