Ginger / Garlic - Prep as directed and combine. (Can be done up to 5 days ahead)
Pickle carrots - Combine carrots with vinegar and oil (portion for lettuce cups). Toss everything together. Marinate for at least 20 minutes and up to 2 days. (Can be done up to 2 days ahead)
Lettuce / Pears - Prep as directed. Store separately. (Can be done up to 2 days ahead)
Make meatballs - Chop cilantro. Combine cilantro, ginger, garlic, beef, eggs, almond flour, salt, and fish sauce. Form into 1” / 2.5 cm meatballs. (Can be done 1 day ahead)
Make smoothie - Blend pears, mangos, lime juice, and coconut water in a blender.
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Heat a skillet over medium heat. Add oil (portion for meatballs) and then meatballs. Gently saute meatballs until golden brown on all sides, ~5 minutes total.
Whisk together stock, aminos, and honey. Add to skillet. Cover meatballs with a lid or foil. Reduce heat to low. Cook meatballs, covered, until cooked through, 7 to 8 minutes more.
Stir carrots and season with a pinch of salt.
Assemble lettuce cups by filling lettuce leaves with pickled carrots, meatballs, and cashews. Add some hot sauce, if you’d like. Enjoy smoothies on the side.