Prep your low-carb “pasta” base: If using zucchini noodles, salt lightly and let them sit 10 minutes, then pat dry. For spaghetti squash, roast or microwave until strands pull apart. Rinse and drain shirataki well, then dry-sauté for 2–3 minutes to remove moisture.

Brown the sausage: Heat a large skillet over medium-high. Add a splash of olive oil and the Italian sausage. Break it up with a spatula and cook until browned with some crispy bits, about 6–8 minutes. Transfer to a plate, leaving a little fat in the pan.

Sauté veggies: In the same pan, add butter. Toss in mushrooms and broccoli (or zucchini). Cook until tender-crisp, 3–5 minutes. Add garlic and cook 30 seconds until fragrant.

Build the sauce: Lower heat to medium. Pour in heavy cream. Stir in cream cheese if using for a thicker, silkier texture. Simmer gently, 2–3 minutes, until slightly reduced. Avoid boiling hard to prevent separating.

Melt in the cheese: Stir in Parmesan a handful at a time until smooth. Season with Italian seasoning, red pepper flakes, salt, and black pepper. If the sauce is too thick, add a splash of chicken broth to loosen.

Add sausage and greens: Return the cooked sausage to the pan. Fold in spinach and let it wilt, 1–2 minutes. Taste and adjust seasoning.

Combine with your base: Add your prepared zucchini noodles, spaghetti squash, or shirataki. Toss gently to coat in the sauce and warm through, 1–2 minutes. Don’t overcook zoodles; you want them slightly firm.

Finish and serve: Sprinkle with fresh parsley and extra Parmesan. Plate hot with a crack of black pepper.