Heat a large saucepan over medium heat. Add 1 tablespoon olive oil, once hot add sausage. Break the meat up into smaller pieces as it cooks and is no longer pink, about 5 minutes.
Add onion and garlic to a pan, stir and cook for 2 minutes. Add tomato paste and cook for 1 minute. Add crushed tomatoes, oregano, ¾ teaspoon salt, and ¼ teaspoon black pepper, stir well to combine.
Increase heat to medium-high and bring sauce to a simmer. Cover the pan, leaving a small opening for steam to escape, and lower the heat to low so that the sauce simmers.
Cook for 15 minutes, stirring occasionally. Add some water if the sauce starts to look dry. Taste and season with salt and pepper.
Add meat sauce to a 9x13-inch baking dish, spread evenly in the pan.
Stuffed Shells
Set the oven rack to the center position. Preheat to 400°F (204ºC) degrees.
Bring 3 quarts of water to a boil in a large pot. Cook pasta according to package directions. Drain and place shells on a sheet pan then set aside.
Heat a large saute pan over medium heat. Add 1 tablespoon of olive oil, once hot add 2 teaspoons garlic and saute until fragrant but not browned, 30 seconds.
Add spinach and cook, occasionally stirring until the leaves begin to wilt but are still bright green, 3 minutes. Remove from heat and let cool.
Stir together cooled spinach, ricotta (1 ½ cups), mozzarella, Parmesan, egg, parsley, basil, 1 teaspoon salt, ½ teaspoon pepper, and nutmeg until thoroughly combined.
Transfer cheese filling into a large resealable plastic bag or piping bag. Cut off one edge of the bag and pipe each pasta shell with ricotta mixture, and place it in the baking dish.
Cover the shells with aluminum foil and bake for 30 minutes.
Remove the foil and continue cooking until the sauce begins to bubble about 5 minutes.
Serve warm with a sprinkling of Parmesan cheese.
Notes
Store-bought tomato sauce can be used, add 3 cups (28 ounces) with the browned sausage and simmer for 15 minutes.
Ground chicken, turkey, or beef can be substituted for sausage.
MAKE IT LOW-CARB: Instead of pasta shells, use zucchini (thin sheets or boats), small bell peppers, or mushrooms caps (portobello medium or large sizes).