Brown the sausage: Heat olive oil or butter in a skillet over medium heat.
Add sausage and cook, breaking it up with a spatula, until browned and cooked through, about 6–8 minutes. Drain excess fat if there’s a lot.
Sauté aromatics: Add diced onion to the skillet and cook 3–4 minutes until softened. Stir in minced garlic for 30 seconds until fragrant.
Transfer sausage, onion, and garlic to the slow cooker.
Build the base: Add chicken broth, drained diced tomatoes (if using), Italian seasoning, crushed red pepper flakes, smoked paprika, black pepper, and salt to the slow cooker. Stir to combine.
Slow cook: Cover and cook on Low for 5–6 hours or on High for 2.5–3 hours. This allows the flavors to meld and the broth to deepen.
Add low-carb veggies: About 45 minutes before serving, stir in the sliced zucchini.
This keeps it tender, not mushy.
Make it creamy: In the last 20–30 minutes, add the cream cheese cubes and heavy cream. Stir gently, cover, and let the cream cheese melt. Give it another stir to fully incorporate.
Add spinach and cheese: Stir in the spinach and Parmesan, then cover for 5–10 minutes until the spinach wilts and the cheese melts.
Taste and adjust seasoning with more salt or pepper if needed.
Serve: Ladle into bowls and top with extra Parmesan and chopped parsley. Enjoy hot.