Italian Sausage & Cauliflower Rice: A Paleo Delight

Natalie Perry | Perry's Plate Updated

Take Italian sausage. Place it over cauliflower rice. And you have this easy, quick, delicious Paleo recipe!

Italian Sausage & Cauliflower Rice Picture

You've had cauliflower rice before, haven't you? If not, you must try it. It's a great alternative to regular rice if you happen to be avoiding grains or looking to reduce your carb intake.

Or if you're in the paleo crowd... which we try to be most of the time. "Try" being the key word. I try to keep one foot in the circle while the other is off searching for ice cream or tacos with actual tortillas. That one foot in the paleo circle keeps me from straying too far, though, much to the delight of my jeans.

So, cauliflower rice is basically cauliflower chopped up into itty bitty pieces and cooked. This particular version is packed with basil pesto and topped with Italian sausage and some sweet Italian relish. Another version of Cauli-rice is the Mexican Chicken and "Rice" recipe I posted a while back, and I even tried it out on my parents while I was visiting.

Italian Sausage with Cauliflower Rice

Being the sneaky child that I was (and still am) I told my meat-and-potatoes dad it was a "special kind of rice" so he would eat it. He knows I eat "weird" things, like Indian food. And green vegetables. He just figured it was another one of my strange food choices.

But he ate it -- two big helpings of it, in fact. It's clear that although he's skeptical of my food choices, he trusts me. That means a lot.

If you like this quick paleo meal, you might also like the cilantro-filled Paleo Meatballs Recipe!

Paleo Sausage and Cauliflower Rice Recipe

    5 Servings


  • 1 large head cauliflower, trimmed and cut into florets
  • 2 tablespoons coconut oil
  • 1/2 cup onion
  • 3-4 tablespoons basil pesto
  • 2 cups baby spinach
  • 12 ounces italian style chicken sausage, precooked
  • sweet italian relish, for garnish


  1. Place cauliflower pieces into the work bowl of a food processor (you may have to do this in batches). Pulse until cauliflower pieces are about the size of grains of rice.
  2. In a large skillet, heat the coconut oil over medium-high heat. Add the onions and sauté for 3-4 minutes or until translucent. Add the cauliflower to the skillet. Stir to combine, then reduce the heat to medium-low, cover, and let it steam/cook for 5-8 minutes or until the cauliflower is tender.
  3. Meanwhile, slice the sausage into 1/2-inch rounds and heat in a separate skillet. When they are heated through and have a bit of color on them, remove from heat and keep warm.
  4. Stir 3 Tablespoons of pesto and the baby spinach into the cauliflower. Cook until heated through and the spinach is wilted. Taste, adding salt and additional pesto if needed.
  5. Serve the sausage over the cauliflower and top with sweet Italian relish or giardiniera, if desired.


Prepared basil pesto contains Parmesan cheese. For strict paleo eaters, make your own cheese-free pesto by combining 1 bunch of basil, 2 cloves garlic, 3 Tablespoons pine nuts, and a generous pinch or two of salt in to a food processor. Blend until mostly smooth, then add about 1/3 cup of extra-virgin olive oil into the processor while it's running. Add a little more if necessary to achieve smooth texture. If you aren't using it all right away, freeze into an ice cube tray and transfer to a freezer-safe container once frozen.

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Natalie Perry

About Natalie

Natalie embraced the Paleo way of eating slowly, over time, and you can read about it on Perry's Plate. These days she's downright in love with it. Check out her Paleo fanatic recipes, and you'll see why.


This recipe BLEW MY EVERLOVING MIND. I have never loved cauliflower. It's boring and weird all at once. HOWEVER. This recipe was my first foray into preparing it like a rice or a couscous, and I am not exaggeration when I say I think it will change my life. I went off gluten this summer and was missing couscous and pilaf type things. Rice is ok for me to eat but I've also gone a little lower carb so I don't want to go crazy with it. So, having a vegetable that I can sub in for rice or a pasta side? Amazing. It even stores better than the traditional sides... stays fluffy and moist. AND I'm shoving a super healthy veggie into my face while I enjoy myself. My coworkers were eyeing my lunches with envy when I made this. THANK YOU! :)

@ M

Sorry - exaggeratING, not exaggeratION. Sheesh. :)


Hey Natalie,
Thanks for providing the above recipe. As a mom both of the above recipe are truly important for for me. Because my kids always request me to make cauliflower rice for him. But I can't able to make this for my kids. Because I can't properly make this. But now I will try this to follow your above recipe. I hope I will succeeded to do this.


I made this tonight with a few changes. I made the cauliflower using thawed frozen florets, running through my food processor's coarse shredder disc. I browned the onion, then added the sausage pieces. I removed them to a bowl, then sautéed the cauliflower "rice" for a few minutes til tender, then placed it in a bowl, put the sausage & onions back in the skillet, added the pesto & spinach. I served the "rice" separately. My husband doesn't like casserole-type dishes. We liked it a lot! Thanks so much for sharing your recipes! We're trying to learn to eat Paleo style, and you have helped us out!

Stephie swope

Ok, I really must try this. I've heard about cauliflower "rice" or "couscous", but have yet to give it a go, mostly because I think I was skeptical about the flavor. Yours looks so packed full of awesome flavor, though!


I love the idea of the cauliflower "rice". I've had it made into "mashed potato" before, but I like the idea of rice texture MUCH more!

Kate donahue

This sounds wonderful! I've been intrigued by the Paleo diet for some time now and always worry that I won't be able to do it. I am kind of a carb-o-holic, ice cream addict and well, I write a baking blog!! But this recipe sounds flavorful and delicious for any diet!! It also makes me think I could survive being Paleo because this recipe is packed with tons of ingredients I love!