Low Carb Italian Sausage Recipe with Spaghetti Squash

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I have a favorite Low Carb Sweet Italian Sausage Recipe that I make several times a month. It’s a mixture of sweet Italian sausage, mushrooms, spinach or kale and spaghetti squash. It’s super delicious and I’ve never served it without rave reviews.

Spaghetti Squash can be the start of so many healthy, grain free recipes. I encourage you to master the art of making spaghetti squash. Actually, I’m teasing you. It’s super easy to make. You can make it stove top like I did in this recipe or roast in the oven. 

low carb Italian sausage recipe, mushrooms, spinach, pecorino from Spinach Tiger

What are the health benefits of spaghetti squash?

Spaghetti Squash is anti-inflammatory, increases your intake of essential fatty acids omega-3 and omega-6 essential fatty acids. It’s a filling fiber, low in calories, 42 per cup, low in carbs (8 net carbs per cup) and can take the place of wheat and gluten in a wonderful way.

You can find out how to cook the spaghetti squash here.

How to cool spaghetti squash.

Is Spaghetti Squash Keto?

Yes, if you count the carbs. 8 net carbs per cup. 

What kind of Italian sausage do you use?

I am a member and affiliate for ButcherBox.  It’s the best Italian sausage we’ve ever had. We make this casserole and this sausage crusted pizza a few times a month. ButcherBox is a subscription service that delivers vacuum sealed, high quality sourced, meat chicken and seafood to your door at an affordable price. While they offer various curated boxes, I customize ours every month making sure Italian sausage is part of my box. 

What greens work best in this Sweet Italian Sausage Casserole?

I think kale is probably best but spinach works well also. Any green you want to add for color and interest is fine too. I hope you know you can freeze kale and spinach, and always have greens available for these kind of recipes.

Secret Ingredient also my favorite spice 

I love piment d’ espelette and is a go to for spicing up everything from vegetable dishes to seafood. 

What is piment d’espelette? 

Piment d’ espelette,  made from the Espelette pepper, also known as Piment d’Espelette, is a chili pepper cultivated in the French commune of Espelette, Pyrénées-Atlantiques. It is mildly hot, measuring up to 4,000 Scoville Heat Units. It’s sweet, spicy and smoky without overpowering a dish.  I like the way it gives heat to a dish, more nuanced than red chili flakes (which you could also use). 

You could cover this with pecorino cheese as I did or even use mozzarella. You could even dollop ricotta cheese in this casserole. 

I love my Le Creuset Braiser, because it goes from stove top to oven. A cast iron pan would do the same thing.

low carb Italian sausage recipe from spinach tiger

This is a flexible recipe. You could use turkey sausage if you choose. You could also choose a different meat, even leftover roast chicken, leftover carnitas

low carb Italian sausage recipe with spaghetti squash, mushrooms

How to Sauté Mushrooms

I use either white button mushrooms or cremini mushrooms. I like to slice my own, saute in butter or oil, keeping them separate so they brown a little, instead of steam. That brings out a true mushroom flavor. Mushrooms are a great partner for sausage and for spinach and are a great addition to this recipe. If you hate mushrooms, skip them. It’s that simple. You might choose to add in some chopped sun-dried tomatoes instead. 

This is a an easy dish, very forgiving. Make sure you use enough salt and pepper and a little heat to bring it together. Don’t plan on leftovers. You probably won’t have any. 

More Recipes Using Italian Sausage from Spinach Tiger

Italian Sausage Meals Your Family Will Love

Italian Sausage Meals

Italian Sausage Frittata with Ricotta

Baked Italian Sausage with Broccoli Rabe

Italian Sausage Crusted Pizza with Peppers

How to Cook Spaghetti Squash

Spaghetti Squash Lasagna

Print Recipe
3.60 from 10 votes

Low Carb Sweet Italian Sausage with Spaghetti Squash, Spinach, Mushrooms

Italian Sausage, Spaghetti Squash, Mushrooms, Spinach and Pecorino baked in Casserole for a low carb, keto friendly dinner.
Prep Time20 minutes
Cook Time40 minutes
Total Time1 hour
Course: Entree
Cuisine: Italian
Servings: 4
Author: Angela Roberts


Roast Spaghetti Squash

  • 1 Cooked Spaghetti Squash Recipe Here
  • salt and pepper
  • 2 cups mushrooms sliced
  • 1 pound Italian Sausage removed from casing
  • 1/2 cup freshly grated parmesan or pecorino Romano Cheese.
  • 2 cups spinach leaves or chopped kale
  • 1 teaspoon piment d'esplette or 1/4 teaspoon red pepper flakes


  • In a frying pan that will also go into oven, break up sausage and cook over medium heat. Drain sausage on paper towels.
  • Remove spaghetti squash and allow to cool.
  • Use the fork to shred the squash.
  • Add more oil to pan if necessary and sauté mushrooms in same pan.
  • Add sausage back into pan.
  • Mix together sausage, mushroom mixture.
  • Shred spaghetti squash and mix with sausage and mushrooms in frying pan you will use for oven.
  • Add spinach and mix. No need to cook. It will soften in oven.
  • Season with salt, pepper and piment d'esplette.
  • Sprinkle with parmesan or pecorino cheese and bake for 10 minutes at 400 degrees F. until melted. You could also add mozzarella if desired.



    Feel free to use turkey sausage. 
    Play around by adding dollops of ricotta cheese and topping with mozzarella before baking. 

    Please follow me on instagram. If you make this recipe,  please tag me #spinachtiger.

    If you love this recipe, please give it five stars. It means a lot. xoxo

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    One Comment

    1. 5 stars
      Very good one dish meal. I added onions/garlic as well as fresh basil and a bit of rosemary. Adding the mozzarella was a good tip.

    3.60 from 10 votes (9 ratings without comment)

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