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Creamy Zucchini & Italian Sausage

Creamy Zucchini & Italian Sausage

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This is a perfect weeknight meal that would be delicious with a nice salad (and maybe even some additional grilled meat if you’re serving a hungry crowd)!

Slicing zucchini or yellow squash into penne pasta shapes is one of my favorite keto cooking hacks! Visually, it looks a lot like pasta and—if you close your eyes—the texture isn’t too far off from the real thing either!

This pasta-shaped veggie preparation is perfect for quick sauces like the one in this recipe (it’s also great with classics like alfredo or pesto)!

Do yourself a favor and make this your new go-to weeknight Italian dish!

zucchini in creamy tomato sauce with italian sausage plated in a bowl next to napkin

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zucchini with italian suasage in creamy tomato sauce on plate

Creamy Zucchini & Italian Sausage

  • Total Time: 45 minutes
  • Yield: serves 4-5 1x


Quick, Italian-inspired keto dinner with zucchini, hot sausage and a creamy tomato sauce.


  • 5 medium zucchini
  • 1 tablespoon extra virgin olive oil
  • 5 hot Italian sausage links, casing removed (19 ounces)
  • ½ medium red onion, finely chopped
  • 2 garlic cloves, minced
  • ½ tablespoon dried basil
  • Salt to taste
  • ½ teaspoon black pepper
  • 1 cup low-carb marinara sauce
  • ½ cup heavy cream
  • ½ cup grated Parmesan cheese


  1. Cut the ends off each zucchini then slice into quarters, lengthwise. Carefully slice away the soft core of each quarter (save for blended soups) then cut on a bias to form penne pasta shapes. Reserve.
  2. Add oil to a preheated pot and brown sausage (after removing the outer casing/skin) over medium-high heat for 5 minutes—breaking it up into smaller pieces as it cooks.
  3. Reduce heat to medium and add onion, garlic, dried basil, salt and black pepper. Cook for 5 minutes (or until veggies are softened).
  4. Mix in marinara sauce and heavy cream then reduce for 5 minutes—stirring occasionally.
  5. Mix in zucchini, cover and cook—stirring every few minutes—for 5 minutes. Remove lid and cook for 5 more minutes—stirring every few minutes (zucchini should be just tender).
  6. Remove from heat and fold in Parmesan for 1-2 minutes until cheese is melted and sauce thickens slightly.
  7. Serve with more Parmesan cheese (and chopped parsley if you’re feeling fancy). Enjoy (see notes)!


Net carbs: 5.1g

I’d serve this recipe with an additional side or a salad to stretch it a little further (maybe even some additional protein like grilled chicken or baked fish).

  • Prep Time: 20 mins
  • Cook Time: 25 mins
  • Category: Dinner
  • Method: Sauteing
  • Cuisine: Italian

Keywords: keto Italian dinner, low-carb recipes, zucchini and Italian sausage

View Comments (5)
  • Lori
    WOW!! Thank you for sharing this fantastic recipe. Will be one our favorite go to recipes

  • Tried this today and you did not disappoint with flavor and taste! My husband really enjoyed it! The only change to ingredients: fresh basil (from garden still), 1# ground pork (not links) and 16 oz tomato sauce (all I had). Thanks for a great carb free meal!!

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