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Spaghetti with meatballs, paleo style: the spaghetti is scraped from a microwave-softened spaghetti squash, and the meatballs hide a nutritional secret — ground beef liver worked into the meat. The sauce starts from two puréed cans of diced tomatoes simmered with oregano, thyme, apple cider, and ten torn basil leaves, the way an Italian grandmother's "gravy" would.
Pro Tips
- Microwave both squash halves cut side down on a plate for about 10 minutes, until a fork slides in easily — then scrape out the noodle strands into the serving bowl.
- No liver on hand? One egg binds the meatballs just as well; the liver option is purely a nutrient boost, not a structural one.
- Bake the tablespoon-sized meatballs for 15 minutes at 350°F before they meet the sauce — a pre-bake keeps them from falling apart in the simmer.
- Drain and purée the canned tomatoes first; that smooth texture is what makes the sauce read like real spaghetti gravy rather than chunky stew.
- Add the tomato paste and basil only after the sauce drops to low heat, then cover and simmer 20 minutes so the paste deepens without scorching.
Frequently Asked Questions
Can I skip the beef liver in the meatballs?
Yes — the recipe itself gives you the out: one egg in place of the liver keeps the meatballs bound, and the flavor difference is barely noticeable under the sauce.
Does spaghetti squash really pass for spaghetti?
It's not flour pasta and doesn't pretend to be — the strands are mild and slightly sweet, and under a robust tomato-meatball sauce they do the job beautifully.
Why microwave the squash instead of baking it?
Ten minutes cut side down in the microwave versus close to an hour in the oven — for a weeknight dinner, it's the fastest route to tender, scrapeable noodles.
Can I make spaghetti with meatballs ahead?
The meatballs and sauce reheat well together; store the squash noodles separately, since they water out when they sit in sauce overnight.
Recipe Card

Ingredients
Method
- 1. Microwave both halves of the squash on a plate cut side down about 10 minutes or until easily pierced with fork.
- 2. Scrape out the “noodles” from the squash into serving bowl.
- 3.
- Combine meats together by hand and roll into tablespoon-sized balls.
- 4.
- Bake meatballs in oven for 15 minutes at 350 degrees.
- 5. Over high heat add tomatoes, salt, pepper, oregano, thyme, and cider, into medium saucepan and let come to a boil—let little hands stir occasionally.
- 6. Decrease heat to low and add paste and basil—let little hands stir occasionally.
- 7.
- Cover tomato sauce and let simmer for 20 minutes.
- 8.
- Add cooked meatballs and sauce over the squash noodles.




