Low-Carb Sausage "Pasta" with Sage Cream Sauce

This low-carb sausage “pasta” with sage cream sauce makes a creamy, hearty, and satisfying meal.    The noodles are zoodles-noodles made from spiralized zucchini.  The zoodles provide the canvas for the creamy, garlicky goodness on top.  Add in sausage and sage and yum, what a treat!   It’s like a trip to Italy in your mouth.

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I remember the day when the only low carb pasta substitute was spaghetti squash.  Don’t get me wrong, spaghetti squash was and still is God’s gift to the low carb diet. Unfortunately, the noodles from the squash are just too fine to stand up to heavier spicy cream sauces.  The spiralizer offers a powerful alternative. The machine boasts a variety of settings allowing us to make low carb noodles in different diameters–from an angel hair diameter all the way up to thin wide spirals.  Yes, it is a creative low-carbs cook’s dream!

If you don’t have a spiralizer, you can find some tips in this article on how to make zoodles without using one. 

Low-Carb Sausage "Pasta" with Sage Cream Sauce

In this dish, I spiralized the squash into spaghetti sized strands.  I steamed it separately, which makes an extra step, but gives me perfectly cooked noodles in a sauce with the consistency I choose.  If you want a one dish meal, you can cook the noodles right in the sauce.  This method gives fewer dishes to wash, but doesn’t give as much control over the thickness of the sauce.  When cooked in the sauce, the juice from the zucchini will thin the sauce a bit.  To help prevent this from being a problem, just cook the sauce until it is a little thicker than desired, then, when the zucchini is added, the sauce will thin to the correct consistency.  

For for information on spiralizing, check out our Greek Cucumber Salad recipe.  Other recipes we have that use a spiralizer are Low Carb Sweet and Sour Cucumber SaladGrain-Free “Spaghetti” with Tomato Basil Cream Sauce and Paleo Cajun Shrimp Pasta with Cream Sauce.  Clearly we love our spiralizer and use it frequently.

If you eat low carb, but love pasta, this recipe is for you.  So get out your spiralizer, pour a glass of wine, and put on some Puccini. Italy awaits.


PS: If you’re craving pasta, but not a big fan of zucchini, you might want to try this recipe for low carb gnocchi from Tasteaholics. It would work perfectly with this sauce.

5 from 1 vote

Low-Carb Sausage "Pasta" with Sage Cream Sauce

This low-carb sausage "pasta" makes a creamy, hearty, satisfying meal. The noodles are zoodles-noodles made from spiralized zucchini. The zoodles provide the canvas for the creamy, garlicky goodness on top. Add in sausage and sage and yum, what a treat!
Course Main Course
Cuisine American, Italian, low-carb
Servings 6
Author Annissa Slusher


  • 1 tablespoon grass-fed butter
  • 12 ounces sweet Italian sausage sliced into about ¼ inch thick pieces
  • 1 large yellow onion diced
  • 2 cloves garlic crushed
  • 2 tablespoons white balsamic vinegar
  • 1 ½ cup grass-fed heavy cream
  • ¼ cup fresh sage leaves thinly sliced
  • pinch of red pepper flakes optional
  • sea salt and freshly ground pepper to taste.
  • 4 medium zucchini spiraled into spaghetti sized noodles


  1. Heat a large skillet over medium high heat.
  2. Add butter in skillet and heat until bubbling slows
  3. Place sausage in pan a brown on the first side. Turn and brown on the other side.
  4. Turn heat to medium-low and allow sausage to cook through.
  5. Remove sausage to a plate and set aside.
  6. Using the same skillet, turn stove to medium heat. Add another tablespoon of butter if necessary.
  7. Add onion to skillet and cook until edges are brown and onion is slightly translucent.
  8. Stir in garlic and cook for one minute.
  9. Add vinegar to the skillet and stir, scraping up brown bits.
  10. Cook until vinegar is reduced to about ½ tablespoon.
  11. Stir in heavy cream and bring mixture to a simmer.
  12. Turn heat to low. Stir occasionally until mixture has thickened.
  13. Add sausage and drippings into the sauce and stir.
  14. When sausage is reheated, stir in sage leaves, red pepper flakes, salt and pepper.
  15. Taste and adjust seasoning.

For the noodles

  1. Lightly salt zucchini noodles.
  2. Steam for 5-7 minutes.
  3. Stir into sauce and serve.

Recipe Notes

Per serving: Calories 322, Fat 26.8 grams, Carbs 6.1 grams, Net carbs 4.9 grams