
This hearty low carb pizza casserole brings all the mouth-watering flavors of pizza without the carbs. Perfect for those following keto or gluten-free diets, this casserole is packed with protein, veggies, and of course, cheese. One bite and you will forget you are enjoying a low carb meal.
I developed this recipe during my own keto journey when I desperately missed pizza night with my family. Now it's requested more often than traditional pizza, even by my carb-loving teenagers.
Ingredients
- Italian Sausage: provides rich flavor and hearty texture as the protein base
- Cauliflower: replaces traditional pasta for a low carb option that still provides satisfying texture
- Mushrooms: add umami depth and meaty texture choose cremini for enhanced flavor
- Green Pepper: brings fresh crunch and classic pizza flavor
- Pepperoni: delivers that authentic pizza experience with spicy notes
- Low Carb Pasta Sauce: watch labels carefully Raos Homemade Marinara has minimal added sugars
- Mozzarella Cheese: creates that stretchy pizza experience use full-fat for best flavor
- Parmesan Cheese: adds savory complexity to the topping
- Italian Seasoning: ties everything together with classic pizza herbs
Step-by-Step Instructions
- Steam the Cauliflower:
- Cut cauliflower into bite sized pieces then place in a microwave safe bowl with water and cover with a damp paper towel. Microwave for approximately 3 minutes until just tender but not mushy. This quick cooking method preserves texture while ensuring the cauliflower integrates well with other ingredients.
- Brown the Sausage:
- Cook Italian sausage in a large skillet over medium high heat breaking it into crumbles as it cooks. Take your time with this step about 15 minutes to ensure the sausage develops a nice caramelization which adds significant flavor depth. Drain excess fat to prevent your casserole from becoming greasy.
- Sauté the Mushrooms:
- Add olive oil to the same skillet you used for the sausage and cook mushrooms thoroughly for 10 minutes. This extended cooking time removes excess moisture which prevents a watery casserole. The mushrooms will shrink considerably and develop a concentrated flavor.
- Layer the Casserole:
- Start with pasta sauce on the bottom of your prepared baking dish then add half the protein veggie mixture. Continue building flavor layers with more sauce pepperoni and a generous helping of mozzarella. Repeat layering ending with a special Parmesan and Italian seasoning blend for an extra flavorful crust.
- Bake to Perfection:
- Bake at 400°F for 30 minutes until bubbly and golden. Allow the casserole to rest for 5 minutes before serving this helps the layers set and makes serving easier. Look for bubbling edges and a slightly browned top as indicators of doneness.

The cauliflower is my secret weapon in this recipe. I was skeptical at first about using it as a pasta replacement, but its neutral flavor and ability to soak up the Italian seasonings won me over completely. My husband actually commented that this casserole has more flavor than regular pizza because every bite contains all the toppings.
Make-Ahead and Storage Tips
This pizza casserole actually improves in flavor when made a day ahead. Prepare all steps up to baking, cover tightly with foil, and refrigerate for up to 48 hours. When ready to enjoy, bake as directed, adding about 10 minutes to the cooking time since you're starting from cold.
Leftovers store beautifully in airtight containers in the refrigerator for up to 4 days. For longer storage, portion cooled casserole into freezer-safe containers and freeze for up to 3 months. Thaw overnight in the refrigerator before reheating in a 350°F oven until hot throughout.
Perfect Pairings
Serve this pizza casserole alongside a simple arugula salad dressed with olive oil and lemon juice for a complete meal. The peppery greens provide a nice contrast to the rich casserole. For those not counting carbs, garlic bread makes an excellent accompaniment for family members with higher carb allowances.
For a pizza night experience, set out small bowls of additional toppings like red pepper flakes, fresh basil, and extra Parmesan cheese so everyone can customize their portion. This interactive element makes dinner more fun, especially for children.

Topping Variations
This versatile recipe welcomes endless customization. Try these popular variations for different flavor experiences:
- Meat Lovers Version: add crispy bacon and diced ham to the existing proteins
- Veggie Supreme: incorporate olives, onions, and diced zucchini
- Buffalo Chicken: substitute shredded chicken tossed in buffalo sauce for the Italian sausage
- Mediterranean Style: use feta cheese, olives, and artichoke hearts
Frequently Asked Questions
- → Can I use a different vegetable instead of cauliflower?
Yes, you can substitute cauliflower with broccoli or zucchini, both of which work well with the other ingredients in this casserole.
- → What type of marinara sauce should I use?
Choose a low-carb marinara sauce, such as Rao's Homemade, to keep the dish keto-friendly and flavorful.
- → Can I make this dish ahead of time?
Yes, you can assemble the casserole a few hours ahead and refrigerate it. Bake it just before serving for the best results.
- → How can I store leftovers?
Store leftovers in an airtight container in the refrigerator for up to 3 days. Reheat in the oven or microwave before enjoying.
- → Can I use ground beef instead of Italian sausage?
Absolutely, ground beef is a great alternative. Add extra seasoning, like garlic or dried oregano, to amplify flavor.
- → Is this dish kid-friendly?
Yes, many kids will enjoy this dish since it has familiar pizza flavors. You could leave out ingredients like mushrooms if they are less preferred.
- → Can I make this dish vegetarian?
You can make it vegetarian by omitting the sausage and adding more vegetables like spinach, zucchini, or eggplant.