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5 from 1 vote

Paleo Spaghetti and Meatballs

This comforting recipe comes from Caroline Potter's first cookbook, All American Paleo Table. Find more delicious, grain-free and refined-sugar-free recipes in her beautiful collection.
Prep Time15 mins
Cook Time45 mins
Total Time1 hr
Course: Main Course
Cuisine: Italian
Keyword: healthy spaghetti and meatballs, low carb, paleo spaghetti and meatballs, zucchini noodles
Servings: 16 meatballs
Calories: 714kcal
Author: Root + Revel Collective




  • 2 tbsp olive oil or bacon grease , for frying
  • 1 organic, pastured egg
  • 1 tbsp balsamic vinegar
  • 1 ½ tsp salt
  • 1 tsp organic oregano
  • ½ tsp fresh cracked black pepper
  • 1 lb organic ground beef
  • 1 lb organic pork Italian sausage , casings removed
  • ¾ cup organic almond flour
  • ½ cup finely shredded parmesan (optional), omit for dairy free


  • To make the sauce, warm a large stockpot to medium heat and all the olive oil. Sautee the onion, garlic, rosemary, oregano and salt for about 5 minutes or until the onions are translucent. Stir in the crushed tomatoes, tomato sauce, wine and basil. Reduce the heat to low, cover and simmer for 25 minutes.
  • Meanwhile, start making the meatballs. Warm a large skillet to medium heat and add the olive oil. Place the egg, balsamic vinegar, salt, oregano and pepper in the bottom of a large mixing bowl. Whisk together. Add the ground beef, sausage, almond flour and parmesan to the bowl. Use your hands to crumble and mix together the meat until incorporated.
  • Next, shape the meatballs into medium-size round balls. Brown the meatballs in the skillet for 8 minutes, rotating so that all sides are browned. You may need to work in batches depending on the size of your skillet.
  • Once your tomato sauce has simmered, use an immersion blender to carefully puree the sauce. Drop the meatballs into the sauce, place the lid back on the pot and slowly simmer for 20 minutes.
  • Serve over your grain-free noodle of choice, like spaghetti squash, spiraled zucchini (as pictured), roasted vegetables or gluten-free noodles.


From Caroline: I prefer to use spicy Italian sausage because I think it adds incredible flavor to this dish. However, if you are serving this for children or prefer something with less kick to it, use milk or sweet Italian sausage.


Calories: 714kcal