Paleo Spaghetti and Meatballs from All American Paleo Table


The ultimate comfort food, these meatballs are a great place to start if you are new to a grain-free and Paleo way of eating. They are simple, full of flavor and something everyone enjoys!

Ground beef is an economical choice of meat, and I always keep grass-fed ground beef in my freezer for a simple weeknight dinner.  Serve over spaghetti squash, spiraled zucchini, roasted vegetables, or even gluten-free noodles if you are hosting company and want to have options to make everyone comfortable!

For the sauce:

  • 2 tablespoons olive oil
  • 1/2 small sweet yellow onion, chopped
  • 2 large cloves garlic, crushed
  • 1 teaspoons fresh rosemary, chopped
  • 1 teaspoon dried oregano
  • 1/2 teaspoon salt
  • 28 ounces crushed tomatoes
  • 15 ounces tomato sauce
  • 1/4 cup good red wine (merlot or cabernet is best)
  • 8 fresh basil leaves, chopped

For the meatballs:

  • 2 tablespoons olive oil or bacon grease, for frying
  • 1 egg
  • 1 tablespoon balsamic vinegar
  • 1 1/2 teaspoons salt
  • 1 teaspoon dried oregano
  • 1/2 teaspoon fresh cracked black pepper
  • 1 pound ground beef
  • 1 pound pork Italian sausage, casings removed
  • 3/4 cup almond flour
  • 1/2 cup finely shredded Parmesan (optional- omit for dairy free)
  1. To make the sauce, warm a large stockpot to medium heat and add the olive oil. Saute 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.
  2. Meanwhile, start making the meatballs. Warm a large skillet to medium heat and add the olive oil.
  3. In a large mixing bowl, add the egg, balsamic vinegar, salt, oregano and pepper. Whisk together.  
  4. Add the ground beef, sausage, almond flour and Parmesan to the bowl.  Use your hands to crumble and mix together the meat until incorporated.
  5. Next, shape the meatballs into medium-size round balls.
  6. 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.
  7. Once your tomato sauce has simmered, use an immersion blender to carefully puree the sauce.
  8. Drop the meatballs into the sauce, place the lid back on the pot and slowly simmer for 20 minutes.
  9. Serve over grain-free noodle of choice.

Note: 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.

Yields: 16 meatballs

Per serving (1 meatball): Sauce = 4.5 g carbohydrates, Meatballs = 1.6 g carbohydrates

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WRITTEN BY Caroline Potter, POSTED 05/02/16, UPDATED 11/28/22

Caroline Potter is an NTP and author of the cookbook All American Paleo Table and blog Colorful Eats. She lives on Pearl Harbor in Hawaii with her husband, Stephen and their fluffy golden retriever, Libby. Caroline loves all things outdoors, hot cappuccinos and grilling on the weekends!