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Add vegetable stock, garlic, carrot, apple, butternut squash, sage, onion, salt, pepper, cayenne, cinnamon and nutmeg to an Instant Pot pressure cooker. Toss to combine. Close lid securely and set vent to “Sealing”.
Press “Manual”, then press “Pressure” until the light on “High Pressure” lights up, then adjust the +/- buttons until time reads 8 minutes. Cook. Then very carefully, turn the vent to "Venting" for quick release, and wait until all of the steam has released and the valve has dropped. Remove the lid.
Remove and discard the sage. Stir in the coconut milk.
Use an immersion blender to puree the soup until smooth. (Or you can transfer the soup in two batches into a traditional blender, and puree until smooth, being very careful when working with the hot liquid.) Taste, and season with additional salt, pepper and cayenne if needed.
Serve warm, with optional garnishes if desired.