Every decade has its nutritional bogeyman, and for the last 10 years it’s been carbohydrates and sugar, which are being widely blamed for the “epidemics” of weight-gain, diabetes, cardiovascular disease, cancer, non-alcoholic liver disease and dementia.

As with most things in life, it’s not that simple. Sure, certain types of carbohydrate may increase certain disease risks, but a lot depends on the type of carb-rich food you eat, how much you consume, and what you’re eating alongside it. Not to mention non-nutritional factors like stress, sleep, physical activity and the bacteria in our guts, all of which can influence how our bodies process carbs.

Whole or minimally processed carb-rich foods like fruits, vegetables, grains and legumes contain fiber, vitamins, and minerals that are essential to good health. They also provide a steady source of energy, help you feel full (when they contain fiber), and make up a large proportion of the time-honored Mediterranean diet. Oh — and they’re delicious!

Refined carbohydrates, on the other hand, like those found in processed foods, sweets, and sugary drinks, don’t contain much in the way of nutrients (which have largely been removed during the refining process). They can cause a rapid spike in blood sugar followed by a blood sugar crash, mood swings and hunger pangs. If you experience these responses to refined carbs & sugar, you might want to consume these less-often and/or in smaller quantities. (How much and what type of carb is optimal varies from one person to another, depending on age, health status, activity level, muscle mass, hormone status and other factors. I’ll discuss this in a separate blog post.)

Pasta is somewhere in-between these extremes: while it consists of white flour and thus qualifies as a processed food, it is a single-ingredient food that has been enjoyed for thousands of years around the world.

Pasta isn’t terribly nutritious: it contains no fat and only around 8 g protein per serving (low-quality protein at that, lacking essential amino acids like lysine, threonine, and methionine). In fact, pasta is mostly starch: a serving contains 35 to 40 g carbohydrate. That’s why a plate of pasta eaten on its own or with a smidge of marinara sauce isn’t satisfying (and could spike your blood sugar), whereas pasta served with a nutritious sauce containing fat, protein and fiber can fill you up for hours. The nutrients are in the sauce; the pasta is just the “bit of fun on the side.”

If you have elevated blood sugar or some other manifestation of insulin resistance/metabolic syndrome (which include (pre)diabetes, triglycerides over 100 mg/dL, HDL cholesterol under 40 mg/dL, fasting glucose over 99 mg/dL,  hypertension, an elevated triglyceride-glucose index or an elevated waist-to-height ratio), your doctor may have told you to stop eating refined carbs, including pasta.

To be sure, a food that’s high in refined starch and low in nutrients shouldn’t make up a large part of anybody’s diet, least of all a person with insulin resistance. I generally recommend that these folks try to limit their carb intake to around 100 g carbohdyrate a day, mostly consuming carb-rich foods that are minimally processed and have a low-to-moderate glycemic load.

But since everybody, including my metabolically challenged clients, loves pasta, and because I want to help people eat the foods they love (restriction only works so long), I decided to come up with a way for us to enjoy it occasionally without blowing our blood sugar & insulin out of the water. All it takes is a few minor tweaks to our usual MO:

  • Stick to the serving size recommended on the package
  • Accompany pasta with the “Awesome Foursome:” protein, fat, fiber and acidity
  • Where possible, use less-glycemic, higher-fiber pasta (whole-wheat pasta, or pasta or enriched with legumes)
  • Cook the pasta al dente, 

Let’s take a closer look at these four factors:

Serving size

Did you know that a recommended serving size of pasta is 2 oz (dry), providing about 38-42 g carbohydrate? Thus, a typical one-pound pack of pasta should, theoretically, feed eight fully-grown adults. But let’s be honest — when did you last feed eight people with one box of pasta? More likely the box yielded three or four servings maximum — which could easily translate to 80-100 g carb per serving and a blood sugar surge.

If you’re used to eating large servings of pasta, the 2-oz recommended serving — which equals about 1 cup (cooked) (a typical serving in Italy) — may seem puny. Howver, you can trick your brain into accepting this reduced serving with a bit of deft window-dressing, as shown in the picture below.

I cook & drain the pasta, toss it in a little olive oil or pesto (as here), serve it onto the plate and create a “well” at the center into which I ladle the sauce. Once I’ve filled up the well, my brain thinks it’s a big plate of pasta, but my pancreas, which secretes the glucose-regulating hormone insulin in response to rising glucose levels, doesn’t need to work as hard as usual to regulate my blood sugar.

Awesome Foursome

Once you’ve adjusted your pasta portion size, bring in the “Awesome Foursome:” protein, fat, fiber and acidity.

Combining refined carbohydrates with these four food components slows down the speed at which the stomach empties and, thus, the rate at which the carbohydrate in the pasta is converted into glucose. So instead of a sharp spike in glucose, you might experience only a mild elevation, as well as longer-lasting satiety. (Not surprisingly, protein, fiber and olive oil have been found to trigger production of the satiety hormone GLP-1 in the gut.)

So while this dish looks like good-ole, high-carb “Spaghetti with meatballs,” I’ve named it “Meatballs with spaghetti” because I’ve flipped the macronutrient ratios on their heads: 72% of the energy (calories) in this dish is supplied by the meatballs, sauce and pesto — all of which are packed with high-quality protein, healthy fats and antioxidant herbs and spices — with only 28% accounted for by the pasta, which supplies some nutrients but whose main job is to provide gustatory delight.

While this amount of carbohydrate may not be compatible with “ultra-low-carb” or “keto” diets, most people should be able to eat this dish without adverse effects. (If your doctor has recommended that you eat an ultra-low-carb diet, you can replace regular pasta with keto-friendly carb alternatives like spaghetti squash, shirataki noodles or heart-of-palm “pasta”.)

Less-glycemic, higher-fiber pasta

Recent years have seen the emergence of a wide range of “low-carb” pastas. These are typically made of alternative flour sources such as beans, chickpeas, or vegetables that are high in dietary fibers (which are indigestible and don’t affect blood sugars); some are gluten-free. Because they are made with legumes, some types of low-carb pasta contain more protein and/or fiber. If you’re not used to eating much fiber, consuming large amounts of lagume-based pasta can lead to digestive discomfort like gas & bloating. So if you try these, start with a small serving and see how your body reacts.

My new favorite pasta these days is a range of lower-carb, higher-protein-&-fiber pasta made by Italian pasta giant, Barilla (Protein+). It is made of durum wheat, spelt and barley flour as well as lentil and chickpea flour, and pea protein. Granted, that’s a lot more ingredients than tranditional wheat pasta, but given that it provides 10 g protein, 5 g fiber and 33 g net carbohydrate per serving and tastes exactly like “real pasta,” I’ll take that. Another thing I like about this brand is that it cooks to al dente perfection, whereas many other legume-based pastas I have cooked went from crunchy to soggy in a matter of seconds. Which brings us to…

Cooking pasta al dente

Pasta cooked “al dente” means pasta that has been cooked so that it is still firm to the bite, but not hard or crunchy. The term “al dente” is an Italian phrase that literally means “to the tooth.”

When pasta is cooked to an ideal al dente texture, it retains a lower glycemic load. (A food’s glycemic load, or GL, reflects its impact on blood sugar: the higher the GL, the more sharply your glucose and insulin levels are likely to rise.) According to the International Tables of Glycemic Index and Glycemic Load Values, for example, spaghetti cooked for 5 minutes (al dente) have a medium GL of 15, spaghetti cooked for 20 minutes has a high GL of 23.

Cooking pasta al dente also requires us to chew more than when we’re slurping down soft-cooked noodles. Chewing stimulates the receptors that effect our feeling of satiety, reducing our sense of hunger that leads to eating more. What’s more, mastication is the first stage of digestion. Breaking food into smaller pieces makes it mix better with saliva, which is essential for the metabolism and easier to digest.

So there you have it: you can have your pasta and eat it, too. Buon Appetito!

P.S.: I taught this dish under time pressure at a webinar, which is why I used ready-made meatballs, tomato sauce anbd pesto. Of course it’s perfectly fine to make your own meatballs and sauce if you prefer. Since most of my clients struggle to find time to cook, however, I wanted to show you the fastest-possible way of getting a tasty, nutritious meal on the table that’s nutritionally very similar to one you might have made from scratch. As I recover from a lifetime of crippling perfectionism, I regularly allow myself to use tasty, good-quality ready-made foods — so far without any adverse consequences! 🙂

Meatballs & Spaghetti

Keyword: 15 Minutes Max., 30 Minutes Max., Dairy-Free (or can be), Keto (or can be), Low-Carb, Meat & Chicken
Prep Time: 5 minutes
Cook Time: 10 minutes
Servings: 4
Calories: 389kcal
A super-simple, delicious and (yes!) low-carb weeknight recipe
Print Recipe



  • Bring a large pot of salted water to boil.
  • While you're waiting on the water, warm the olive oil in a large skillet over medium-high heat and saute the meatballs until they are golen-brown all-around. If they're already cooked, this shoudl only take about 3 minutes. If you're making them with fresh meat, count 10 minutes to ensure they're cooked through.
  • Once the water boils, add the pasta and set timer.
  • While the pasta is cooking, pour the tomato sauce over the meatballs in the skillet. Bring to a gentle boil and simmer for 5 minutes.
  • Drain pasta through a strainer or colander and return to the pot. Add the pesto and stir to coat the pasta evenly with it.
  • Serve pasta onto plates, create wells to make it look like more (if desired). serve meatballs into the wells and spoon sauce over the lot.
  • Dust with freshly grated Parmesan cheese and garnish each plate with a few fresh basil leaves. Serve immediately.


Serving: 1serving | Calories: 389kcal | Carbohydrates: 31g | Protein: 24g | Fat: 20g | Saturated Fat: 5g | Polyunsaturated Fat: 0.4g | Monounsaturated Fat: 3g | Trans Fat: 0g | Cholesterol: 78mg | Sodium: 838mg | Potassium: 205mg | Fiber: 4g | Sugar: 2g | Vitamin A: 372IU | Vitamin C: 0.2mg | Calcium: 59mg | Iron: 2mg