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Paleo Pesto Meatballs and Alfredo Sauce on gf pasta in bowl
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5 from 13 votes

Paleo Pesto Meatballs and Pesto Alfredo Sauce

Pesto Meatballs and Alfredo Sauce is a pesto-lover’s dream comfort food, with pesto in the meatballs and in the dairy-free Alfredo cream sauce. With a gluten-free pasta, also gluten-free; Paleo with zoodles. A healthy and delicious dinner recipe!
Prep Time 25 minutes
Cook Time 35 minutes
Servings 4
Author Beth


  • Cast Iron Skillet
  • Food Processor
  • Soup Pot
  • Spaghetti Server


For the non-dairy pesto:

  • 2 cups packed fresh basil large stems removed
  • 3 tablespoons macadamias pine nuts or walnuts, (if nut-free, try a 1:1 mixture of pumpkin and sunflower seeds, see note)
  • 3 large cloves garlic peeled and sliced or pressed
  • 3-4 tablespoons nutritional yeast
  • ½ teaspoon sea salt more to taste
  • 4-6 tablespoons extra virgin olive oil

For the meatballs

  • 1 pound lean ground beef
  • 1 medium shallot or half a medium onion minced or grated (about 1/2 cup)
  • 1 egg
  • 3 tablespoons almond or quinoa flour, if not Paleo
  • 2 tablespoons pesto
  • 1 teaspoon dried oregano
  • ½ teaspoon dried parsley
  • ½ teaspoon granulated garlic
  • ½ teaspoon pink sea salt
  • ¼ teaspoon baking soda
  • teaspoon freshly ground black pepper

For the Pesto Alfredo sauce

  • 1 can full-fat coconut milk
  • ½ cup broth
  • 5 teaspoons tapioca starch
  • 3 cloves garlic pressed
  • 1 teaspoon salt
  • ¼ teaspoon pepper
  • 2 tablespoons nutritional yeast optional
  • ½ cup vegan pesto or more to taste
  • 4-5 basil leaves julienned
  • Non-dairy Parmesan-type cheese for garnish


For the pesto

  • Blend all ingredients in food processor until they form a paste. Refrigerate until needed. If you will not be using the pesto right away, drizzle a little olive oil over the surface to keep the pesto from darkening.
  • Makes about ¾ cup.

For the meatballs

  • Place all ingredients in a large bowl and mix with your hands (see note) until all the ingredients are evenly distributed.
  • Form the mixture into balls of about 2 tablespoons each, using an ice cream or cookie scoop or your hands. I usually dollop them onto a plate first. You should have 20-24 meatballs.
  • Then, put a little olive oil on your hands and roll each of the meatballs smooth. The olive oil keeps the meat mixture from sticking while you are rolling them.
  • In a cast-iron skillet, sear the meatballs until browned on 2 or 3 surfaces and partly cooked through. You don’t need for them to be completely cooked because you will be simmering them in the pesto alfredo sauce until they are done. But searing them seals in the juices and flavor.

For the pesto alfredo sauce

  • In a saucepan, stir the coconut milk, the broth and the tapioca starch together until the starch is dissolved.
  • Add the garlic, salt and pepper and bring to a low boil, stirring, until the tapioca starch has dissolved and the sauce thickens. Turn down to a low simmer and add the nutritional yeast and pesto. Stir until the pesto and yeast are incorporated and the sauce is completely mixed.
  • Pour over the seared meatballs in the skillet. Simmer the meatballs in the sauce while you are cooking the pasta.
  • Serve over cooked pasta, spaghetti squash noodles or zoodles. Garnish with julienned basil and Parmesan.


To use sunflower or pumpkin seeds, soaking the seeds for at least an hour and preferably 4 hours will make the pesto blend more smoothly in the food processor.
Pesto with nutritional yeast will be less salty than pesto with parmesan cheese, so be sure to provide sea salt on the table for anyone who doesn’t find it salty enough. Serve grated parmesan on the side, non-dairy, dairy or both. 
Be sure to mix the meatballs with your hands. 
I wear my dishwashing gloves to make cleaning my hands easy, but the meatball mixture sticks to them, so once I have made the basic meatballs and washed the gloves, I oil my hands and roll the meatballs into, well, balls. 
To keep the meatball mixture from sticking to your hands, and to get nice round meat balls, gloves or not, coat your hands/gloves in a little olive or avocado oil before forming the mixture into balls. 
Searing the meatballs in a hot pan, then simmering them in a sauce, results in the moistest meatballs. 
Kw: pesto meatballs and pasta, pesto beef meatballs and pasta, ground beef pesto meatballs, meatballs no breadcrumbs, what to do with pesto
The meatball recipe is adapted from one on Gluten Free on a Shoestring.