In a large pot, cook the Fettuccine until just undercooked. It will finish cooking in the sauce. Reserve a half cup of the cooking water before draining.
While the pasta is cooking, heat the cream and garlic (if using) over low-medium heat in a deep saute pan.
Add butter and whisk gently until melted. Mix in the nutmeg and cheese. Season with freshly grated black pepper. Simmer over medium heat 5 to 7 minutes to thicken slightly. Remove and discard the garlic.
Add the pasta to the pan, and gently toss the pasta to coat in the Alfredo sauce (adding some of the pasta water if needed to loosen).
Taste for seasoning and add salt as needed. Serve immediately.
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Notes
Cook the pasta until it’s just underdone, as it will finish cooking in the sauce, allowing it to absorb the flavors and marry with the sauce.
Be sure to save some pasta water before draining the pasta to thin out the sauce.
Use high-fat, heavy, or whipping cream, as it thickens when cooked without a roux or thickening agent. Using low-fat cream can result in a watery and thin sauce.
When cooking the pasta, add enough salt to the water to season it. There's nothing worse than bland pasta!
Avoid using oil in the pasta water, as it can make the sauce slip off the pasta instead of coating it.
Salt sparingly until the end as Parmesan cheese can be salty. Taste before seasoning the sauce with salt before serving.