Whisk together tomato paste, apple cider vinegar, Worcestershire sauce, fish sauce, liquid smoke, smoked paprika, mustard, garlic powder, turmeric, sage, cinnamon, and water in a 10-inch skillet over medium heat. Bring to a boil while stirring frequently, then reduce heat to a simmer.
Stir frequently and let simmer, uncovered, until desired thickness is achieved, about 20 minutes. Remove from heat and pour over spaghetti or roasted turkey/chicken, or anything else it strikes you that it would be delicious on.
Note: This was titled as a Keto Barbecue Sauce. I added the basil & sage, but otherwise, this was the basic recipe. It contained no sugar or sweetener, which is fine as I don't care for sweet BBQ sauce. When it thickened up, it was much more appropriate to be used as a spaghetti sauce. It made enough sauce for 2, or maybe 3 servings.