Keto Salisbury Steak
Published July 15, 2019 • Updated March 8, 2026
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My keto Salisbury steak is a one-skillet comfort meal where seasoned hamburger patties braise in a thick mushroom and onion gravy.
I started making this years ago when I wanted a filling, from-scratch dinner that tasted like the frozen TV dinners I grew up on, minus the flour. The patties are mixed with heavy cream and parmesan instead of the usual egg and breadcrumb binder, and that combination is what keeps them tender even after they sit in the braising liquid. One of my readers, Allison, told me she was hesitant about adding cream to the meat. She tried it anyway and said it kept the patties softer and moister than she expected. That tracks with what I’ve found after making this dozens of times.
Most versions of this dish use an egg plus almond flour or regular breadcrumbs to hold the patties together. I tested that approach early on and the result was denser, almost meatloaf-like. The cream and parmesan keep the texture lighter, and the parmesan adds a savory depth that an egg alone can’t match. If you’ve made my beef tips in mushroom gravy, this uses a similar braising logic, but the patties hold their shape better.
The gravy is the real reason I keep coming back to this recipe. I saute sliced onions and mushrooms in the same skillet where the patties browned, so all those pan drippings fold right into the sauce. A splash of red wine, some beef broth, a little arrowroot powder, and the whole thing thickens into a rich, savory gravy without any flour. I use arrowroot because it has roughly 7 times the thickening power of regular flour. Half a teaspoon does the job of two tablespoons, adding only 3 grams of carbs to the entire dish.
You’ll notice I don’t use Worcestershire sauce here. Most recipes include it, but between the red wine, tomato paste, and the fond from browning the patties, I get all the umami depth I need without it. I’ve tested batches with and without, and the version without lets the mushroom flavor come through cleaner. If you want it, a teaspoon in the gravy won’t hurt the macros.
This is one of those keto dinners I come back to on weeknights when my family wants real comfort food (not “healthy” comfort food, just comfort food). My boys don’t care that it’s low carb. They care that there’s gravy and they can put ketchup on it. The whole meal comes together in one skillet in about 30-35 minutes. If you like one-skillet ground beef meals, try my keto hamburger helper or skillet lasagna next. For something with more of a slow-braised feel, my shepherd’s pie uses a similar comfort food approach with a cauliflower top.
How to get tender patties and thick gravy
I mix the cream and parmesan into the ground beef with my hands, but I stop as soon as everything is combined. Overworking the meat makes the patties tough. Form them about 3/4 inch thick so they hold up during the braise without drying out. For the gravy, give the arrowroot powder a full 2 minutes in the pan with the tomato paste before adding liquid. That step cooks out the raw starch taste and gives you a smoother sauce.
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Ingredients
1 pound ground beef -
½ cup heavy cream
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½ cup shredded parmesan cheese
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4 tablespoons butter
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½ onion, sliced
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8 oz mushrooms, sliced
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1 tablespoon tomato paste
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½ teaspoon arrowroot powder
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1 cup chicken broth or beef broth
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¼ cup red wine
Step by Step Instructions
Step by Step Instructions
Mix ingredients
Mix together ground beef, cream, parmesan cheese, 1/2 teaspoon salt & 1/4 teaspoon pepper.
Cook patties
Melt 2 tablespoons butter in a skillet over medium-high heat. Add patties and cook until browned on each side. (5 minutes per side)
Saute mushrooms and onions
Melt 2 tablespoon butter in the skillet. Add onions and sauté onions until soft. Add mushrooms & 1/2 teaspoon salt.
Make sauce
Stir in tomato paste and arrowroot powder. Cook 1-2 minutes. Whisk in broth & wine. Bring to simmer.
Nutrition disclaimer
The nutrition information provided is an estimate and is for informational purposes only. I am a Doctor of Pharmacy (Pharm.D.); however, this content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician or other qualified health provider before making any lifestyle changes or beginning a new nutrition program.
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Get My Macros + Recipes →Frequently Asked Questions
Does this recipe use Worcestershire sauce?
I don't include Worcestershire sauce in this recipe. Between the red wine, tomato paste, and the fond from browning the patties, I get plenty of umami without it. I've made batches both ways and prefer the cleaner mushroom flavor without Worcestershire. If you want to add it, a teaspoon mixed into the gravy works fine and adds less than 1g carbs.
Can I use ground turkey instead of ground beef?
I've made this with ground turkey and it works, but the flavor is milder and the patties are a bit softer. I add an extra tablespoon of parmesan to the turkey mixture to compensate. The gravy carries most of the flavor, so the swap is solid if you prefer turkey.
What can I use instead of heavy cream in the patties?
I mix the cream into the meat to keep the patties tender during braising. If you're out of cream, I've used a couple tablespoons of cream cheese worked into the beef and it does the same job. Unsweetened almond milk plus a tablespoon of coconut oil is another option I've tried, though the patties come out slightly less rich.
Do I need an egg or almond flour to bind the patties?
Most Salisbury steak recipes use an egg and breadcrumbs (or almond flour for keto). I skip both. The heavy cream and parmesan hold the patties together without making them dense. I tested the egg-and-almond-flour approach early on and the texture reminded me of meatloaf, not steak. The cream version stays lighter and more tender through the braise.
Can I make this in a slow cooker or Instant Pot?
I've only tested the stovetop and oven methods for this recipe. If I were adapting it for a slow cooker, I'd sear the patties and build the gravy on the stovetop first, then transfer everything and cook on low for 3-4 hours. For the Instant Pot, I'd use the saute function for browning, build the gravy in the pot, then pressure cook on high for 8-10 minutes with a natural release. I haven't dialed in exact times yet, so start conservative if you try it.
How do I make this dairy-free or Paleo?
I swap the heavy cream for coconut cream and drop the parmesan entirely (or use nutritional yeast if I have it). The butter in the skillet gets replaced with ghee or avocado oil. My dairy-free version still comes out with a thick, rich gravy because the arrowroot and broth do most of the work. If you're eating Paleo or Whole30, this version fits those frameworks too since there's no added sugar or grains.
Can I double the arrowroot powder for thicker gravy?
I use half a teaspoon, which gives a lighter coat on the patties. If you want thick diner-style gravy that really coats everything, use a full teaspoon. One of my readers, Roberto, tried doubling it and said the difference was real. I've confirmed the same in my own kitchen. A full teaspoon won't change the carb count by much (maybe 1-2 extra grams for the whole batch) and the gravy sets up nicely once you pull it off heat.
What's the best way to reheat leftovers without drying out the patties?
I reheat mine in a covered skillet over medium-low heat. The key is keeping the lid on so the gravy creates steam around the patties. It takes about 8-10 minutes. The microwave works in a pinch, but I cover the dish and add a splash of broth to keep things from getting rubbery. These leftovers reheat better than most of my ground beef recipes because the gravy protects the meat.
Splash of Worcestershire while the mushrooms were softening and it changed everything. Already smelled great, but that one thing made it taste like it had been going for hours. Made the patties thicker too. The parmesan gives them this creamy center that holds everything together. Pull them earlier than you think. Mine dried out the first round, second time was perfect, and now I'm making this on rotation.
Used beef broth instead of chicken and added a splash more red wine, and the gravy came out richer and darker than I expected. Tip for anyone who wants it thicker: give the arrowroot a couple extra minutes to work after you pull the heat, it sets up nicely.
Beef broth plus extra red wine gets you a completely different gravy. Darker, more savory. That's the version I make when I want it to feel like it simmered all day.
Cold Tuesday evening, wanted something that felt like actual comfort food. This delivered. The gravy is the thing. Mushrooms, onion, red wine all built in the same pan where you browned the patties, and every bit of that comes through. Freaking good. My only tweak: double the arrowroot powder if you want thick diner-style gravy that coats everything (what's listed is fine but the difference a full teaspoon makes is real). The parmesan mixed into the patties is now going into my regular burger recipe too. Didn't know I needed that combination.
The arrowroot tip is real. Half teaspoon gives you a lighter coat, full teaspoon is proper diner gravy. And yeah, parmesan in the beef is one of those things you can't un-know.
Planning to prep this on Sunday and reheat it Thursday for dinner. Should I make the whole thing and just reheat it in the pan, or cook the patties and make the sauce fresh that day? Not sure if the sauce will get weird sitting in the fridge for a few days.
Make the whole thing Sunday. The patties actually get better sitting in the gravy (they soak it up). Thursday is day 5 for me and I've done it, flavor holds. Reheat covered skillet on medium-low, lid on, about 8-10 minutes. The gravy won't get weird, the cream cooks out and it's mostly butter and broth at that point.
So yummy! My family just loved it! Thank you :)
My family too. The mushroom gravy is the part that gets them every time.
For me, the patties were like mush and REALLY hard to flip.
I'm sorry you had difficulty. It sounds like the patties didn't cook long enough on the first side before flipping.
We loved the flavors and the ease of preparing this. I was skeptical about adding cream to the meat, but it really worked to keep the burgers softer and moister. Used steak seasoning instead of salt and pepper in the burgers. Served it over mashed cauliflower which was great!
Never tried steak seasoning in the patties but that makes a lot of sense. Gets you garlic and pepper without measuring. Cauliflower mash is what I always serve this with.
Delicious Recipe. I even used my dehydrated mushrooms and just rehydrated them. Adding this to our family dinner rotation. (teen boy approved)
My boys are not teens yet, however we are close. They put ketchup on theirs.