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Grass-fed Beef Meatballs with Zucchini Noodles

Spaghetti and meatballs.



Food for the soul.

Buuuuut, not exactly the most healthful meal.

For many of us (me included), the wheat in pasta causes bloating, gas, and for lack of a better term, digestive turmoil. And if you do better on a lower carb diet, even wheat-free/gluten-free noodles aren’t the best option.

And then there’s the meatballs, which are usually made with low-quality meat and a bunch of unhealthy fillers, like bread crumbs. If your meatball recipe calls for sausage, you might be ingesting BHT, a harmful food additive.

That’s why I decided to remake spaghetti and meatballs with a nutrient-dense, real food twist:

Grass-fed Beef Meatballs with Zucchini Noodles

Instead of pasta I make noodles out of zucchini. There’s simply no denying that replacing refined carbohydrates with low-carb vegetables is a nutritional win. Nixing the wheat helps your digestion (yes, a “pasta” meal minus uncomfortable bloating is possible) and your blood sugar will stay nice and even-keeled (perfect if you have diabetes – gestational or otherwise – or if weight loss is something you’re striving for).

Instead of low-quality meat or sausage, I use grass-fed beef. (Read why it’s so much better for you and 7 reasons grass-fed beef is worth the money HERE).

Then I up the nutrients exponentially by mixing in some grass-fed beef liver, an incredible superfood rich in iron, zinc, vitamin A, folate, vitamin B12, choline, and much, much more. (Read about why liver is so healthful and why I especially recommend pregnant women eat it HERE).

–> This recipe is a great way to include liver in your diet if you’re not a fan of the taste or texture on its own.

A similar recipe for these grass-fed beef meatballs appears in my book, Real Food for Gestational Diabetes. It’s one of the recipes I get consistent praise for, and that’s from the discerning taste buds of pregnant women!

I hope you enjoy it.

Grass-fed Beef Meatballs with Zucchini Noodles

yield 4 servings

  • Meatballs:
  • 1 small onion, finely diced
  • 8 oz mushrooms, finely diced
  • 2 cloves garlic, minced
  • 2 tablespoons coconut oil
  • 1 lb grass fed ground beef
  • 3 ounces grass-fed beef liver, finely chopped or ground (optional)*
  • 1 egg, ideally from pastured chickens
  • 1 teaspoon sea salt
  • 1/4 teaspoon black pepper
  • 1/2 teaspoon dried oregano
  • 1/8 teaspoon red pepper flakes (optional)
  • Zucchini Noodles:
  • 2-3 medium zucchini
  • 2 tablespoons butter (or other fat/oil)
  • Sea salt to taste
  • 16 oz tomato sauce (jarred or homemade)
  • Garnish: sauteed mushrooms, fresh oregano (optional)


  1. In a large, cast-iron skillet over medium-high heat, sauté onion, mushrooms, and garlic in coconut oil until lightly browned and all water (released from the vegetables) has evaporated from the skillet. Set aside to cool.
  2. In a large mixing bowl, mix meat with cooked vegetables and remaining ingredients.
  3. Form into 12 meatballs.
  4. Place meatballs on a greased baking dish, at least 1 inch apart.
  5. Bake in a 350 degree oven for 15-20 minutes, or until cooked through.
  6. While meatballs are baking, heat up tomato sauce in a small saucepan and prepare zucchini noodles. For wide noodles (as pictured), slice zucchini into ribbons (using a vegetable peeler or mandolin). For thin noodles, use a spiralizer.
  7. In a large, cast-iron skillet over medium-high heat, melt butter (or other fat/oil). Add zucchini noodles. Toss to coat with butter cook evenly.
  8. Cook no more than 5 minutes to prevent zucchini noodles from getting soggy.
  9. Transfer noodles to serving platter. Add a light sprinkle of sea sale. Top with tomato sauce, grass-fed meatballs, and optional garnishes.

Recipe Notes

*NOTE: If you have some on hand, you can substitute grass-fed beef liver pate for the liver in this recipe. When I make a batch of pate, I freeze some in small quantities for use in recipes like this.

And there you have it – a healthy remake of spaghetti & meatballs that’s easy on the tummy, rewarding for your taste buds, and friendly to your waistline.

Grass-fed Beef Meatballs with Liver and Zucchini Noodles

Grass-fed Beef Meatballs and Zucchini Pasta

Grass-fed Beef Meatballs and Low Carb Zucchini Noodles

If you like this recipe for grass-fed beef meatballs with zucchini noodles or have questions about the preparation, tell me in the comments below.

Until next week,


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Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. Her work is known for being research-focused, thorough, and unapologetically critical of outdated dietary guidelines. She is the author of two bestselling books, Real Food for Pregnancy and Real Food for Gestational Diabetes.


Leave a comment
  1. Hi Lily! Happy New Year! Love this recipe. I love making a lighter spaghetti and meatballs… I make mine with turkey meat mixed with goat cheese, rosemary, and mustard for a Scandinavian flare. But Rob got me a spirilizer for Christmas, so I’m super excited to make some faux-noodles! Thanks for the recipe!! Hope you are feeling wonderfully!

    • You’re gonna love your spiralizer, Jill. Veggie noodles for the win!

  2. I love zucchini noodles and delicious but healthy meatballs! Romantic and also very hearty!

  3. I made these last week and they were a total hit with the family. You couldn’t even taste the liver. I had been searching like crazy for recipes to “hide liver” in because I’ve heard it’s so healthy, but usually can’t stomach the taste. These are a definite winner!!

    Even the wide zucchini noodles were a hit. I’d only tried skinny spaghetti noodles made with my spiralizer, but I liked these much better. Thanks Lily!

  4. If I don’t have mushrooms or don’t like them, what would be a good substitute in the meatballs mix? Can I omit them?

  5. Can you make a batch of these and freeze them?

  6. I’m sorry if this is a super silly question but I’m super curious how you actually add in the liver. Do you chop it finely or blend / process is while raw?

  7. How many meatballs is a “serving” approximately? Trying to mass produce some for postpartum

    • 3 meatballs

  8. If you add the pate, how much do you recommend? Still 3 oz?

    • I have always stored my pate in the little 4oz mason jars. I use a whole jar for this recipe.

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