We were introduced to this spectacular Italian meatballs with spaghetti sauce recipe at a friend’s dinner party. It was the best meatball and sauce dish we’d ever tasted! It took quite a while to convince the host to share the recipe, but our pestering finally paid off. We thought for sure it was a family recipe, thus the reluctance to give it up, but discovered it was created by celebrity Italian-American chef, Lidia Bastianich.

Keto-izing this spectacular dish was a snap. We replaced the bread crumbs with almond crumbs and coated the meatballs in almond flour rather than white flour. Same results, same fabulous flavor.

My husband Mike and I like spicy foods, which is why we use the hot variety of pork sausage. The crushed hot red pepper also gives the sauce just the perfect amount of heat. If you’re not a fan of the spicy, any regular sausage variety will do. Always use good quality extra virgin olive oil (first cold-pressed) sourced from a single country.

And don’t be tempted to buy any old canned tomatoes. We know San Marzano tomatoes are a little more expensive than most, but in this case, it’s worth the extra cost. These Italian plum tomatoes are grown in the rich volcanic soil at the base of Mount Vesuvius, resulting in a tomato with lower acidity and fewer seeds. They are the sweetest plum tomatoes on the market, but make sure you are buying the real deal – they are only sold in stores as canned, peeled, whole, or halved.

Mike and I set aside some time on a Sunday afternoon to make a double batch. Trust me, a double batch of this recipe, there’s no better keto meal! You’ll get about 25 meatballs from a single recipe and 50 for a double. We freeze the leftovers in plastic containers and thaw whenever we don’t feel like cooking. While this recipe takes a little more effort up front, it’s well worth it when you consider the number of future meals you’ve already made.

Meatballs with Spaghetti Sauce Keto Goodness

Instead of pasta we use zoodles (zucchini spirals, made with my can’t-live-without vegetable spiralizer). We’ve found the best way to cook zoodles is the microwave. Put about a cup of zucchini spirals in a bowl with a splash of olive oil, then microwave for 45 seconds for al dente zoodles, or you can try our latest discovery, (thanks, Amy), Palmini Hearts of Palm Angel Hair. It’s absolutely fabulous. 

For a quick lunch or dinner, heat up a few meatballs with sauce, and top with a burrata cheese ball. The perfect low-carb comfort food!

Keto Meatballs with Spaghetti Sauce | Adapted from Lidia’s Italian-American Kitchen

A sensational low-carb/keto spaghetti sauce and meatball dish, using ground pork, ground beef, sweet Italian plum tomatoes, Parmigiano-Reggiano cheese, and fresh herbs! A savory comfort dish with a spicy kick. My favorite meatball recipe!


  • 70 ounces of canned Italian plum tomatoes and their liquid (I use San Marzano.)
  • 1/4 cup extra virgin olive oil
  • 1 medium onion chopped (about 1 cup)
  • 1 teaspoon crushed hot red pepper
  • 2 bay leaves
  • Salt and Pepper


  • 1/2- pound ground pork (I use hot variety but regular is great too.)
  • 1/2- pound ground beef
  • 1 cup finely chopped almond crumbs (I use whole almonds and finely chop in food processor.)
  • 1/3 cup freshly grated Parmigiano-Reggiano cheese
  • 1/4 cup chopped fresh Italian parsley
  • 2 cloves garlic peeled and finely chopped
  • 1 large egg
  • 1 teaspoon salt
  • 1/4 teaspoon freshly ground black pepper
  • Almond flour
  • 1/2 cup extra virgin olive oil
  • 2/3 cup freshly grated Parmigiano-Reggiano cheese (Sprinkle over meatballs and sauce, or add to zucchini spirals before serving.)
  1. Heat 1/4 cup of olive oil in 4-5-quart saucepan. (When doubling the recipe, use 8-10- quart stock pot.) Add the chopped onion and a pinch of salt. Stir over medium heat until onions are translucent – about 5 minutes. Add in the canned tomatoes, crushed red pepper, bay leaves, salt and pepper to taste. Bring to a boil, then reduce heat and simmer for 30 minutes. Stir every few minutes to prevent scorching.

  2. Crumble the pork and beef into a large bowl. Add almond crumbs, 1/3 cup of grated cheese, parsley, and chopped garlic. In small bowl, whisk the egg, salt and pepper together. Add to the meat mixture. At this point I use disposable gloves to mix everything together, but only until ingredients are blended. Shape into balls - about 1 to 1.5 inches. For a single batch, I get about 25 meatballs.

  3. Sprinkle about 1/2 cup almond flour onto plate or parchment paper and roll meatballs until lightly coated. Pour 1/2 cup olive oil into a large skillet and heat over medium-high heat. At this point, I reduce heat a tad, so meatballs don’t over-brown. Place as many meatballs that fit in skillet without crowding. Turn until golden brown on all sides (10 – 15 minutes) and remove. Repeat until all meatballs are browned.

  4. Add meatballs into tomato sauce and simmer until meatballs are cooked throughout – about 30 minutes – stirring occasionally.

  5. Top individual servings with remaining Parmesan cheese.

Real Keto Recipes, Real Easy

Joanie and Amy Robach show you just how easy it is to cook incredibly healthy meals that taste great and ensure healthy nutrition

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