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Paleo Italian Spaghetti Meatball Bake

Louise | December 5
Paleo Italian Spaghetti Meatball Bake #paleo

There is nothing quite like a pasta bake to remind you of childhood. Growing up, we ate pasta bakes at least once a week and most were heavy, packed with wheat from the pasta, and smothered in so much cheese you could barely taste anything else. This Paleo Italian spaghetti meatball bake is nothing like the dense casseroles you may remember. The meatballs are homemade, the flavor comes from savory meats and satisfying spices, no heavy dairy in sight, and of course, there are the noodles. This casserole is the best of both worlds with the nostalgic flavors of childhood and none of the wheat or dairy.

A Short History of Spaghetti and Meatballs

They are so popular now that it is hard to believe that there was ever a time without spaghetti and meatballs! However, spaghetti and meatballs didn’t come together as a dish until the late nineteenth or even early twentieth century.

The dish was invented by Italian immigrants to America. In Italy, meatballs, known as polpettes and made from a wide variety of proteins, were generally served alone, without pasta. However, as meat became a staple for immigrants in the US, people wanted a starch to round out the meal.

Spaghetti and marinara sauce were a popular nostalgic dish for many Italian-American families at this time because the ingredients to make them were readily available, unlike the ingredients for many other traditional Italian dishes. Eventually, someone thought to combine them with meatballs, and the rest is history!

Need (Paleo) Noodles? No Problem

The biggest change in this recipe from a traditional pasta bake is, of course, the noodles. Wheat is not Paleo-friendly so in this recipe, it’s replaced with zucchini noodles, often called zoodles! If you make a lot of Paleo pasta, it may be worth investing in a spiralizer. There is no easier way to make zucchini noodles or any other veggie noodle for that matter. However, if you don’t have or need a spiralizer, you can still make this recipe. Read on for suggestions.

  • Buy them premade – many grocery stores have begun to sell pre-made veggie noodles in the produce section, which can be a great option if you’re short on time or don’t cook a lot of Paleo noodles. Just make sure that your premade noodles are fresh and haven’t had anything added to them.
  • Invest in a smaller gadget – If lack of space is keeping you from buying a spiralizer, you may want to look into buying a julienne peeler. It looks exactly like a regular peeler but cuts thin ribbons.
  • Use a different squash – The simplest solution is to skip zucchini entirely. Spaghetti squash is an easy replacement that doesn’t need any extra prep work.

More Italian-Inspired Paleo Recipes

Paleo Italian Spaghetti Meatball Bake #paleo

Paleo Italian Spaghetti Meatball Bake #paleo

Paleo Italian Spaghetti Meatball Bake

  • Author: Louise Hendon
  • Prep Time: 15 minutes
  • Cook Time: 45 minutes
  • Total Time: 1 hour
  • Yield: 8 servings 1x
  • Category: Dinner, Entrée, Beef
  • Cuisine: American


A fresh and light take on a classic pasta-bake.


For the meatballs –

  • 2 lbs (900 g) of ground beef
  • 1 cup (32 g) fresh basil leaves
  • 1 cup (32 g) fresh parsley
  • 1 medium egg
  • Salt and pepper, to taste
  • 1/4 cup (60 ml) avocado oil, to cook with

For the bake –

  • 6 oz of pepperoni or salami slices, diced
  • 1 can (400 g) diced tomatoes
  • 2 medium onions, diced
  • 1/2 400g-can of tomato sauce
  • 6 cloves of garlic, finely diced or minced
  • 1 cup (32 g) fresh basil leaves
  • Salt and pepper, to taste

For the pasta –

  • 2 zucchinis, spiralized or shredded or peeled into long noodle-like strands (or use spaghetti squash)
  • Extra basil leaves, for garnish


  1. Preheat oven to 350 F (175 C).
  2. To make the meatballs, food process the basil, parsley and egg together and mix with the ground beef and salt and pepper.  Form small meatballs from the mixture.
  3. Add avocado oil to a large frying pan and fry the meatballs in batches until browned.
  4. Add the meatballs and the rest of the bake ingredients (except for the zucchini noodles) into a large bowl and mix together.
  5. Pour into a large casserole or baking dish (spread the meatballs apart so that they’re evenly spread).
  6. Bake for 30 minutes.
  7. Then carefully stir in the zucchini noodles, let sit for 5 minutes, and serve.


All nutritional data are estimated and based on per serving amounts.


  • Calories: 508
  • Sugar: 4 g
  • Fat: 40 g
  • Carbohydrates: 7 g
  • Fiber: 2 g
  • Protein: 25 g