Mix the meatball base: In a large bowl, combine ground meat, almond flour, grated Parmesan, one beaten egg, minced garlic, finely minced onion, Italian seasoning, chopped parsley, a pinch of red pepper flakes, salt, and pepper. Mix gently with your hands until just combined.

Shape the meatballs: Form into golf ball–sized rounds, about 1.5 inches across. You should get 16–20 meatballs depending on size. Place them on a parchment-lined tray.

Brown the meatballs: Heat olive oil and a pat of butter in a large skillet over medium-high heat. Brown meatballs on all sides, about 5–7 minutes total. Work in batches to avoid crowding. Transfer to a plate; they’ll finish cooking in the sauce.

Build the sauce base: Lower heat to medium. In the same skillet, add a bit more butter if needed. Sauté minced garlic and a small amount of finely chopped onion until fragrant and softened, 1–2 minutes. Don’t let the garlic burn.

Deglaze and simmer: Pour in broth and scrape up the browned bits from the pan. Let it bubble for 1–2 minutes to reduce slightly.

Add the cream: Stir in heavy cream and a small scoop of cream cheese if using. Whisk until smooth and lightly thickened, 2–3 minutes. Season with salt, pepper, and a pinch of Italian seasoning.

Finish cooking the meatballs: Nestle meatballs back into the skillet. Reduce heat to medium-low, cover loosely, and simmer 8–10 minutes, or until cooked through (internal temp 160°F for beef/pork; 165°F for turkey).

Adjust thickness and flavor: If the sauce is too thick, add a splash of broth. If it’s thin, simmer uncovered for a few minutes. Add a squeeze of lemon to brighten, then stir in a handful of grated Parmesan.

Garnish and serve: Sprinkle with fresh parsley and extra Parmesan. Serve over sautéed spinach, zucchini noodles, spaghetti squash, or cauliflower mash.