ABSTRACT: The sustainability of the Paleolithic diet to support large populations groups is subject to debate. In terms of calorie production per unit of land, grain crops such as corn or wheat may have a higher output than Paleolithic food groups. However, production of grain requires the use of fossil fuels that will impact the long-term sustainability of this land use. In addition, impacts on health from chemical fertilizers and pesticides should also be considered in sustainability. This analysis compares the overall sustainability of traditional agriculture food production to an alternate production model of Paleolithic foods. All aspects of sustainability, including economic, environmental, and health impacts are included in a comprehensive model of long-term sustainability. Results highlight the high indirect costs of traditional farming and the health benefits of Paleolithic foods. A Sustainable Food Index is developed to assess the sustainability of various food production systems.