RA-Friendly Comfort Food: Spaghetti Squash Pesto Bake

by Emil DeAndreis Patient Advocate

During the fall and winter months, produce departments and farmer’s markets everywhere are featuring lopsided pumpkins and squash in search of homes. But what do you do with these unique seasonal veggies? Recently, I came home from my local market with a spaghetti squash. I was interested in it not only because it was in season, but because I knew it was rich in antioxidants, such as vitamins C and A, as well as fatty acids, which are all good things in the fight against my symptoms of rheumatoid arthritis (RA). I ended up making a comfort dish worth sharing.

I will admit, while the stringy quality of the spaghetti squash looks like pasta, it does not taste like it. However, it does a really nice job assuming the flavors of the ingredients with it, allowing them to interact and fuse nicely, much like the cauliflower does in my RA-friendly Sriracha Pineapple Cauliflower Fried Rice. The squash also has a pleasant crunch.

In the spirit of fall and winter, I recommend this dish for anyone looking to add RA-friendly ingredients, without sacrificying the taste of familiar comfort foods.


Ingredients for Spaghetti Squash Pesto Bake.
Emil DeAndreis
  • 1 medium spaghetti squash

  • 2 sausages, sliced (I used Andouille because it was what I had, but Italian would be fine.)

  • ½ cup kalamata olives, chopped

  • ½ cup sun dried tomatoes in oil

  • ¼ cup fresh basil basil, chopped

  • ½ cup pesto sauce

  • 1 can tomato sauce

  • ¼ cup mushrooms, chopped

  • ¼ cup cherry tomatoes, halved

  • ½ red onion, minced

  • 3 cloves of garlic, minced

  • ¼ cup red wine (for cooking)

  • Salt (to taste)


  1. Preheat oven to 400 degrees.

  2. Fill a baking dish with one inch of water. Slice spaghetti squash in half, remove seeds from center and place face down in water. Bake spaghetti squash for 30 minutes, or until soft enough to easily stick fork through the flesh.

  3. While spaghetti squash is cooking, sauté mushrooms, sausage, cherry tomatoes, onion, garlic in olive oil, and red wine (I recommend sautéing in that order to prevent burning). Cook until wine is cooked into ingredients.

Spaghetti squash ingredients sautéing in a pan.
(If you’re wondering what the green in this photo is, I added a bit of kale and spinach to the sauté, but it is not essential to the recipe) / Emil DeAndreis
  1. When squash is done, shred with a fork into spaghetti-like strands. Be careful; it’s hot!

Shredding a spaghetti squash with a fork.
Emil DeAndreis
  1. Place all the shredded squash in a strainer. Strain out as much of the water as possible.

  2. In a bowl, add shredded spaghetti squash, sautéed ingredients, olives, pesto, sundried tomatoes, and tomato sauce.

  3. Mix all ingredients until combined, salt to taste, and place in a greased glass baking dish.

  4. Bake at 400 for 20-25 minutes until the top starts to brown.

  5. Put it on a plate, sprinkle fresh basil on top. (I also recommend red chili flakes for a kick!)

  6. Serve and enjoy!

Finished product of Spaghetti Squash Pesto Bake recipe.
Emil DeAndreis
Emil DeAndreis
Meet Our Writer
Emil DeAndreis

Emil DeAndreis is a baseball coach, and an English professor at College of San Mateo. His memoir, Hard To Grip, chronicles his journey of losing a professional baseball career to rheumatoid arthritis. He lives in San Francisco with his wife. Follow along with Emil on Twitter @EmilDeAndreis).
Emil is also a Social Ambassador for the RAHealthCentral Facebook page.