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My PCOS Kitchen - Paleo Italian Meatballs and Spaghetti Squash - Delicious homemade Italian meatballs full of seasoning served over baked spaghetti squash.
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5 from 1 vote

Paleo Italian Meatballs & Spaghetti Squash

Amazing gluten-free and paleo Italian meatballs stuffed in a spaghetti squash and covered with an amazing homemade marinara sauce.
Course Dinner
Cuisine Italian
Keyword meatball casserole, spaghetti squash
Prep Time 20 minutes
Cook Time 1 hour 10 minutes
Total Time 1 hour 20 minutes
Servings 8 servings
Calories 375kcal
Author Mira


  • 2 large spaghetti squash
  • 120 g mozzarella cheese SKIP if Paleo
  • As needed Fresh basil leaves


  • 450 g ground pork
  • 1/2 onion
  • 2 cloves garlic cloves
  • 1/4 cup fresh curly parsley about 2-3 sprigs
  • 1 egg
  • 1 tsp italian seasoning
  • 1 tsp salt
  • 1 tsp black pepper
  • 30 g blanched almond flour

Marinara Sauce

  • 1/2 onion
  • 2 cloves garlic
  • 1 tbsp olive oil
  • 8 crimini mushrooms
  • 800 g diced tomato can
  • 10 leaves basil
  • 2 sprigs parsley
  • 1 tbsp oregano
  • 2 bay leaves
  • 1 tsp salt
  • 1 tsp black pepper
  • 180 ml water


  • Preheat the oven to 200C/400F.
  • Slice the spaghetti squash and scoop out the seeds, if any. Line baking trays with parchment paper and place the squash face down over the paper. Bake in oven 45-60 minutes depending on how big your squash are.
  • Shred the mozzarella cheese and thinly slice the decorative basil leaves.
  • While the squash are baking, let's make the meatballs.
  • Thinly dice the onion and garlic cloves. Mince the parsley.
  • In a large bowl, knead together the onion, garlic, pork, parsley, italian seasoning, salt & pepper, egg, and almond flour.
  • Line a parchment paper over a baking tray. Make 20 meatballs the size of golf balls.
  • Place inside the oven, where the squash is already cooking, and bake for 20 minutes. Take out of the oven once cooked!
  • While the meatballs and squash are cooking, let's make the sauce!
  • Thinly dice the onion. Mince the garlic, fresh basil and parsley. Slice the mushrooms.
  • In a large pot, add the olive oil and cook the onion and garlic on medium-heat. When soft, add the mushrooms. Sautee for 2-3 minutes.
  • Add the tomato cans, water, and all of the spices. Stir well and simmer on medium-heat, uncovered, for 20 minutes. Stir once in a while to make sure the bottom of the sauce doesn't stick to the pot.
  • Add the cooked meatballs to the sauce and simmer another 10 minutes, or until desired thickness.
  • Take the spaghetti squash out of the oven, DON'T turn off the oven.
  • Scoop the noodles out of the shell so that they're easier to take, cover each shell with meatballs and tomato sauce. Sprinkle the shredded cheese over the meatballs and put back in the oven. Bake for an additional 5 minutes, or 10 minutes if you want your cheese to brown.
  • Take out of the oven and sprinkle some of the shredded basil over!


Serving: 1serving | Calories: 375kcal | Carbohydrates: 26.54g | Protein: 17.26g | Fat: 24.02g | Saturated Fat: 7.55g | Cholesterol: 70mg | Sodium: 744mg | Fiber: 6.2g | Sugar: 7.58g | NET CARBS: 20.34g