Preheat your oven to 375 degrees.

Make your meat balls. Combine meat with garlic powder, basil, sage, and almond flour. Mix until all ingredients are incorporated. Whisk the egg, and add to mixture. Roll into 1-2 inch balls and place on a large roasting pan. Bake for approximately 22-25 mins, or until meatballs are cooked through. Set aside to cool.

Meanwhile, make your sauce. Heat a large skillet to medium high heat. Coat the pan with olive oil and add the onion. After a few minutes, add the garlic. Cook for an additional 2-3 minutes until fragrant. Add the canned tomatoes and pumpkin. Mix well and reduce heat to medium low once the sauce begins to bubble. Slowly add in vinegar and salt. Simmer for at least 15-20 minutes. Add the meatballs once cooked. Let cook with the meatballs for an additional 15 minutes.

Top with fresh basil to serve over noodles, zoodles, or spaghetti squash.

Preheat your oven to broil.

Make your meat balls. Combine meat with garlic powder, basil, sage, and almond flour. Mix until all ingredients are incorporated. Whisk the egg, and add to mixture. Roll into 1-2 inch balls and place on a large roasting pan. Place in oven and broil for just a few minutes until golden brown (will not be cooked all the way).

Now set your Instant Pot to saute. Add in oil to coat the pot, then place onion in the pot. Saute for 2-3 minutes until fragrant, add garlic and saute another minute.

Now add canned tomatoes, pumpkin, vinegar, salt, and tomato paste. Place meatballs in the sauce mixture. Press cancel.

Now secure the lid, and select the manual function. Cook on high pressure for 7 minutes. Use a natural release for 15 minutes. Release any remaining steam, then remove the lid.

Top with fresh basil to serve over noodles, zucchini noodles, or spaghetti squash.