Mains
Mediterranean Meatball Casserole
Mains · serves 6 · 1-2-hours
Core AIP · Elimination phase compliant

This is a dish built for the week, not just the night. It makes extra meatballs and leftovers that get better as the squash drinks up the sauce, which is exactly the kind of cooking that carries you through a long elimination phase. When dinner is already made, the protocol gets easier to keep.
The red meat here is a real source of zinc and complete protein, both involved in immune regulation and tissue repair, and the spaghetti squash and spinach add fiber and magnesium from leafy greens, which support a calmer gut and nervous system. What makes this recipe worth knowing is the binding: cassava flour holds the meatballs together in place of egg or breadcrumbs, so you get a tender, Mediterranean-style meatball with nothing off-plan in it. Olives, lemon, and oregano do the flavor work that tomato usually does.
Source the beef and pork from animals raised well, and use the whole effort of this dish with a little gratitude. Make the plate beautiful when you serve it, a scatter of fresh parsley over the cream sauce, and take a breath before you eat. A meal you cooked with care lands differently in the body.
Ingredients
Meatballs and squash:
- 1 medium spaghetti squash
- 2 teaspoons olive oil
- 1 pound ground chuck
- 1/2 pound ground pork
- 3 tablespoons diced red onion
- 2 tablespoons fresh parsley, chopped
- 2 tablespoons fresh basil, chopped
- 2 garlic cloves, minced
- 5 kalamata olives, diced
- 1 1/2 tablespoons lemon juice
- 2 tablespoons cassava flour
- 1 1/2 teaspoons sea salt
- 1 teaspoon dried oregano
- 2 teaspoons garlic powder
Casserole sauce:
- 1 cup spinach
- 2 tablespoons olive oil
- 1/4 cup white onion, diced
- 5 garlic cloves, minced
- 1 1/4 teaspoons sea salt
- 2 teaspoons garlic powder
- cream from two 13.5 oz cans coconut cream (reserve about 4 tablespoons of the watery liquid)
- fresh parsley, to garnish
Method
Heat the oven to 400 F. Knead all the meatball ingredients together until evenly mixed, roll into 1.5-inch balls, set them on a parchment-lined baking sheet, and bake 30 to 40 minutes until cooked through.
While the meatballs bake, roast the spaghetti squash. Halve it, scoop the seeds, set the halves cut-side down on a tray, and roast about 45 minutes until the flesh shreds easily with a fork. Pull the strands into a 2 to 3 quart casserole dish and toss them with the spinach so the greens wilt into the warm squash.
For the sauce, warm the olive oil in a skillet and saute the white onion about 10 minutes until soft, then add the garlic for 2 minutes more. Stir in the coconut cream, salt, and garlic powder and let it simmer 7 to 10 minutes until it thickens slightly. Ladle the sauce over the squash, loosening it with a splash of the reserved coconut liquid if it is too thick. Press the meatballs into the casserole, return it to the oven for a final 15 minutes, and finish with chopped parsley.
Instant Pot variation
You can cook the spaghetti squash in the Instant Pot to save oven time. Add 1 cup water and the trivet, set the halved squash on top, and pressure cook on high for about 7 minutes with a quick release, then shred. The meatballs and the cream sauce still want the oven and stovetop as written, and the final 15-minute bake brings everything together. Squash time is an estimate and untested here.
*Adapted from asquirrelinthekitchen.com*
Nutrition
Estimated per serving (serves 6), calculated from the ingredients. Actual values vary with brands, sizes, and how much sauce or dressing you use.

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Further reading
Daniela Hess, MSEd, is a co-founder of Great Energy and an Autoimmune Educator and Functional Wellness Consultant who lives and thrives with Hashimoto’s. She is not a licensed medical provider.
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Words in this recipe you can look up. Tap or click a term to learn what it means.
Cassava flourCoconut creamFiberInstant PotMagnesiumSauteSpaghetti squashZincEvery ingredient in this recipe is on the Core Autoimmune Protocol food list.
Download the Core Food List (PDF) Explore the food list