A Recipe for the "Real" Fettuccine Alfredo, from a New 'Milk Street' Cookbook That Celebrates Italian Recipes That Haven't Crossed the Atlantic

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“Tourist food. An American bastardization. Nobody eats it.” That’s what J.M. Hirsch writes about Italians’ attitude towards fettuccine Alfredo in the new cookbook and travelogue Milk Street Backroads Italy. That’s because the thick, heavy dish Americans know as fettuccine Alfredo has morphed quite a bit in its journey across the Atlantic. But Milk Street Backroads Italy is about recipes that haven’t really crossed to the Americas, the sorts of dishes Italians eat in their everyday lives.

So what is a recipe for fettuccine Alfredo doing in the cookbook? It’s not the version Americans know. It’s instead the dish from which fettuccine Alfredo arose, the one variously called pasta in bianco (white pasta), burro e parmigiano (butter and parmesan), or pasta pancia sconvolta – upset belly pasta. Yes, fettuccine Alfredo originates in a meal fed to Italians when they feel sick.

Unsurprisingly, therefore, the recipe is simple: just fresh noodles, butter, cheese, salt, and – importantly, for its thickening starch – the pasta cooking water. (Try Milk Street’s version below.)

“We said, ‘Ok, this is going to be the first book where we really tell the stories of the people and the places that go with the recipes,’” Hirsch explains about Milk Street Backroads Italy, something they have done in their magazine, TV show, and on their podcast, but not in a cookbook. It’s also the first Milk Street book to list Hirsch, Milk Street’s editorial director, as a primary author alongside Milk Street founder Christopher Kimball – which makes sense, given the amount of vivid writing contributed by the James Beard Award-winning Hirsch, who travels the world to find recipes for Milk Street. Interspersed with the recipes in the book are the stories of how Hirsch, Kimball, and others tracked down their origins, learned versions from different cooks, and then translated those insights into optimized versions suitable for a North American home cook. They’re helping the recipes cross the Atlantic after all.

There’s the truer-to-Italy form of Italian wedding soup, which foregrounds greens and broth, with meat – never meatballs – as essentially an added seasoning. Or a version of spaghetti and meatballs that is actually eaten in Italy, despite many Americans’ assumption that it’s just an Italian-American invention. Or eggplant parmesan that is not breaded and only lightly fried. And that’s leaving aside all the recipes you’ve probably never heard of, like the Sardinian herb and bean soup s’erbuzzu, basil-free pestos made from lemon or parsley, or Roman gnocchi that are baked and flat and contain no potato.

“I love digging in a little bit deeper and blowing up conventional wisdom of the stuff we think we know,” Hirsch says. Speaking about fettuccine Alfredo, he adds, “Even Italians think they know, and they think it’s so uninteresting because it’s so commonplace. That’s one of the benefits of being the outsider.”

Fettuccine Alfredo

Excerpted from Milk Street Backroads Italy by Christopher Kimball and J.M. Hirsch. Copyright © 2025 by CPK Media, LLC. Used with permission of Voracious, an imprint of Little, Brown and Company. New York, NY. All rights reserved.

Made the Italian way, fettuccine Alfredo bears little resemblance to the unctuous, cream-based pasta dish that’s popular in the U.S. We scoured Italy for the best versions, and our favorite was prepared by Francesca Guccione in Castelnuovo di Porto, just outside Rome. Rich, luxurious and elegant but neither heavy nor cloying, Guccione’s fettuccine Alfredo, like other Roman recipes for the dish, consists of only fresh pasta, Parmigiano-Reggiano cheese, butter and salt. The secret lies in using high-quality ingredients and combining them in just the right way, and in just the right volumes. We adapted her winning formula but incorporated a technique we saw employed at a couple restaurants of putting softened butter (rather than melted) into the bowl in which the hot pasta will be tossed. Of utmost importance is the cheese. Purchase a hefty chunk of true Parmigiano-Reggiano—not the pre-shredded stuff—trim off the rind (save it for simmering into soups and stews), cut 6 ounces into rough 1/2-inch pieces and whir them in a food processor until very finely ground. This helps ensure the cheese melts readily. High-fat butter also is key. In Europe, butter typically has a fat content of around 85 percent; standard American butter is only about 80 percent fat. That 5 percent difference has a big impact on the flavor and consistency of the finished dish. At the grocery store, some types of high-fat butter are labeled “European-style”; Plugra and Kerrygold are two widely available brands. If the butter also happens to be cultured, all the better, but this is not essential. We learned from Guccione that patience also is an important ingredient. Tossing the pasta with the cheese in small additions and while gradually adding some starchy pasta-cooking water takes time but yields a sauce that is velvety-smooth. We highly recommend serving the pasta in individual bowls that have been gently warmed.

Ingredients

8 tablespoons salted European-style butter (see headnote), sliced about 1/2 inch thick
6 ounces Parmigiano-Reggiano cheese (without rind), cut into rough 1/2-inch chunks
16 to 18 ounces fresh fettucine, homemade or store-bought
Kosher salt

Directions

1. Don’t use more than 2 quarts water to cook the pasta. It’s a small amount by intention, as the starchy liquid is used as an ingredient in the sauce. Also, don’t drain the pasta in a colander. Use tongs to lift the noodles out of the water and drop them, with ample water clinging to them, into the bowl lined with the butter slices. You may need some pasta cooking water to adjust the consistency of the sauce just before serving, so don’t prematurely discard it. 

2. Line a large bowl with the butter slices, placing them in a single layer along the bottom and up the sides of the bowl; let stand at room temperature until the butter is softened.

3. Meanwhile, in a food processor, process the cheese until very finely ground, about 40 seconds; transfer to a medium bowl (you should have about 1 1/2 cups).

4. In a large pot, bring 2 quarts water to a boil. Add the pasta and 1 1/2 teaspoons salt, then cook, stirring often, until the pasta is al dente. Remove the pot from the heat. Using tongs, transfer the pasta from the pot, with ample water clinging to it, to the butter-lined bowl. Using the tongs, quickly stir and toss the pasta, incorporating the butter, until the butter is fully melted. Add 1/2 cup pasta water and toss until the water has been absorbed.

5. Add 1 cup of the cheese, tossing, 1/3 cup at a time, tossing and adding the next addition only after the previous one has been incorporated. Next, toss in 1/2 to 1 cup more pasta water, adding about 1/4 cup at a time, until the sauce clings to the pasta and only a small amount pools at the bottom of the bowl.

6. Let stand for 2 minutes to allow the sauce to thicken slightly. If needed, toss in additional pasta water a little at a time until the sauce once again clings to the pasta and only a small amount pools at the bottom of the bowl. Taste and season with salt. Divide among warmed serving bowls and serve immediately with the remaining cheese on the side for sprinkling at the table.