Creamy Spaghetti Squash Casserole Recipe with Italian Sausage

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Can I be honest with you?  I think I may have cracked the spaghetti squash code with this spaghetti squash casserole recipe.

I made this dish on a Wednesday of last week, and then made it all over again. The honest part is that I was never the biggest fan of spaghetti squash. I’ve made recipes with it before, but this one busted to the top of my all time favorite Fall dishes.

Italian Sausage Spaghetti Squash Casserole Recipe (Low Carb) from Spinach Tiger #spaghetti squash #squash #sausage #mushrooms #easydinner #keto #lowcarb #paleo

Italian sausage, mushrooms, onions, sage, thyme, pecorino Romano and a splash of heavy cream come together to bring one of the best Italian comfort dishes of the season and it’s still low-carb!

I talk to you all the time about my favorite Pecorino Romano cheese and why I love it so much. It’s a sheep’s milk cheese that has a salty tang, and can be used interchangeably with Parmesan Cheese.

Spaghetti squash tastes best when it is properly softened. This squash is twice baked and tender.

Spaghetti Squash Casserole Recipe From Spinach TIger

Each bite delivers a moment of comfort with the flavors of the sausage with the grated cheese, the earthiness of mushrooms and slight sweetness of the squash, all pulled together by heavy cream.

Italian Sausage Spaghetti Squash Casserole Recipe (Low Carb) from Spinach Tiger #spaghetti squash #squash #sausage #mushrooms #easydinner #keto #lowcarb #paleo

Spaghetti Squash Casserole Roasted and Rebaked

The spaghetti squash is roasted and then rebaked in a casserole. This also happens to be a very pretty dish that makes a beautiful presentation if you decide to put it back into the shell of the squash.

Spaghetti Squash Casserole Recipe From Spinach TIger #Sausage #Italian #spaghettisquash #mushrooms #casserole

Spaghetti Squash is only 31 calories per cup and about 5.5 net carbs.

You might also like these Squash Recipes from Spinach Tiger

Three Cheese Spaghetti Squash Lasagna Casserole

Italian Shrimp Spaghetti Squash, Tomato, Basil

Spaghetti Squash Hash Browns

Butternut Squash Stacks with Crispy Quinoa Cakes

Butternut Squash Soup with Browned Butter, Sage and Crispy Pecans

Print Recipe
5 from 6 votes

Spaghetti Squash Casserole Recipe with Italian Sausage

Italian Sausage and Mushrooms come together with Spaghetti Squash and Heavy Cream for delicious Winter Comfort Food.
Prep Time20 minutes
Cook Time40 minutes
Total Time1 hour
Course: Entree
Cuisine: Italian
Servings: 4
Author: Angela Roberts


Roast Spaghetti Squash

  • 1 large Spaghetti Squash
  • 1 tablespoon olive oil or butter
  • salt and pepper

Squash Filling

  • 2 pieces bacon
  • 1/2 onion finely diced
  • 2 cups mushrooms sliced
  • 1 pound Italian Sausage removed from casing
  • 1/2 cup freshly grated parmesan or pecorino Romano Cheese.
  • 1/4 cup heavy cream
  • salt
  • pepper


Roast Spaghetti Squash Instruction

  • Microwave spaghetti squash for 3 to 5 minutes, to make it soft enough to cut it.
  • Carefully cut in half lengthwise using a towel to hold the squash.
  • Scoop out seeds. It's important to do that now, as they are harder to separate out once baked.
  • Brush olive oil or butter over spaghetti squash.
  • Put into baking dish open squash side down.
  • Roast for 30 minutes at 400 degrees F. or until it's easy to shred squash into tendrils with a fork.

Squash Filling

  • While squash is roasting, slice bacon across into small lardons.
  • Fry bacon until you have crispy pieces. Drain on paper towels and set aside.
  • Keep just enough of the bacon grease to sauté the onions and mushrooms for about 5 minutes until soft. Once cooked add to dish with the bacon.
  • Wipe out grease from pan and cook sausage, removing it from casing.
  • Drain sausage on paper towels.
  • Remove spaghetti squash and allow to cool.
  • Use the fork to shred the squash.
  • Mix together sausage, bacon mushroom mixture, squash.
  • Add half cheese and heavy cream.


  • Put into a baking dish or back in reserved squash shells.
  • Season with salt and pepper.
  • Sprinkle remaining grated cheese and bake for twenty minutes at 400 degrees.

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





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  1. 5 stars
    Easy recipe with delicious results. I didn’t have bacon on hand but it still tasted great. I’ve only cooked spaghetti squash a few times, and this will be my go to recipe now.

  2. 5 stars
    I’ve been cooking more recipes with spaghetti squashthis past year and my husband loved this one…his favorite so far.

  3. 5 stars
    I made this recipe for my husband and me for dinner tonight. I was absolutely wonderful! My husband doesn’t like mushrooms and will pick them out of everything ate every one and didn’t complain once. I wish there was an easier way to prepare the spaghetti squash because that’s the only drawback but the final result is well worth the extra trouble.

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