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Trim and peel 4 pounds whole butternut squash. Halve, remove the seeds, and cut the flesh into 1-inch chunks (about 3 1/4 pounds). If using pre-cut butternut squash, use 3 to 3 1/4 pounds and cut down any pieces that are larger than 1-inch. Peel, core and dice 1 large Granny Smith apple. Dice 1 medium yellow onion.
Heat 2 tablespoons unsalted butter or oil of choice in a 6-quart or larger Instant Pot or electric pressure cooker on the highest Sauté setting. Add the apple, onion, and 10 fresh sage leaves or 1 teaspoon dried sage. Cook, stirring occasionally, until the onion is starting to soften, about 5 minutes.
Add the butternut squash, 1 box vegetable or chicken broth, 2 teaspoons kosher salt, and 1/4 teaspoon black pepper. Lock the lid on and make sure the valve is sealed. Cook under HIGH pressure for 10 minutes. It will take about 15 minutes to come up to pressure.
When the cook time is up, quick release the pressure. Stir in 1/3 cup heavy cream or coconut milk. Blend directly in the pot with an immersion blender until smooth, or blend in batches in a stand blender. If the soup is too thick, add water or more broth to thin out as needed.
Taste and season with more salt and pepper as needed. Serve garnished with toasted pumpkin seeds, a drizzle of cream or coconut milk, and coarsely cracked black pepper if desired.