Mix the meatballs: In a large bowl, combine ground beef, ground pork, Parmesan, almond flour, egg, garlic, onion powder, Italian seasoning, red pepper flakes, salt, pepper, and parsley.
Use your hands to mix gently until just combined. Don’t overwork the meat.
Form the balls: Roll into golf ball–sized meatballs, about 1.5 inches wide. You should get 22–26 meatballs, depending on size.
Optional sear (recommended): Heat a large skillet over medium-high heat with a drizzle of olive oil.
Brown the meatballs in batches, turning to get some color on all sides, 4–5 minutes total. They don’t need to be cooked through—just browned. This adds flavor and helps them hold together.
Make the sauce base: In the slow cooker, whisk together heavy cream, chicken broth, Parmesan, garlic, Italian seasoning, paprika, salt, pepper, and cream cheese (if using).
Add butter.
Add meatballs: Place the meatballs into the slow cooker, nestling them into the sauce. Spoon some sauce over the top.
Cook: Cover and cook on Low for 4–5 hours or on High for 2–3 hours, until the meatballs are fully cooked and tender.
Thicken if needed: If the sauce is thinner than you like, uncover and cook on High for 20–30 minutes. You can also stir in a little extra Parmesan to tighten it up.
Taste and finish: Adjust salt and pepper.
Sprinkle with fresh parsley and extra Parmesan before serving.
Serve: Try these over zucchini noodles, spaghetti squash, cauliflower mash, or sautéed spinach for a complete keto meal.