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Ingredients
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Pasta and sauce base
Finish and garnish
Method
Pasta and sauce base
Cook pasta
Bring a large pot of salted water (about 1 tbsp salt per 4-6 quarts) to a rolling boil. Add the fettuccine and cook according to package directions until just shy of al dente (about 1–2 minutes less than package time). Reserve 1 1/2 cups of the pasta cooking water, then drain the pasta and set aside.
Build the roux
In a large wide skillet or sauté pan over medium heat, add the butter and olive oil. Once the butter is melted and foaming (about 1 minute), add the minced garlic and cook, stirring, until fragrant and just beginning to color, about 45–60 seconds. Stir in the flour and cook, whisking constantly, for 60 seconds to remove the raw flour taste.
Make the cream sauce
Gradually whisk in the milk and then the heavy cream, bringing the mixture to a gentle simmer. Cook, stirring frequently, until the sauce slightly thickens, about 3–5 minutes. Reduce heat to low.
Incorporate cheeses and seasonings
Add the softened cream cheese and whisk until fully melted and incorporated. Stir in 1 1/4 cups of the grated Parmesan a little at a time, whisking until smooth. Season with 1 tsp Kosher salt, 1 tsp freshly ground black pepper, and 1/4 tsp freshly grated nutmeg. Taste and adjust seasoning; sauce should be creamy, garlicky, and seasoned but not overly salty.
Combine pasta and sauce
Add the drained pasta to the skillet and toss to coat. If the sauce is too thick, add reserved pasta water a few tablespoons at a time until you reach a glossy, clingy consistency that coats the pasta (you may not need the full reserved amount). Cook together over low heat for 1–2 minutes so the pasta finishes cooking and the sauce adheres.
Finish and garnish
Off the heat, stir in the remaining 1/4 cup grated Parmesan, chopped parsley, and lemon zest if using. Taste and add more salt or pepper as needed. If desired, sprinkle a pinch of red pepper flakes for a subtle heat.
Serve immediately in warmed bowls with additional grated Parmesan on the side. Leftovers: cool completely, store in an airtight container in the refrigerator for up to 3 days. Reheat gently in a skillet with a splash of milk or reserved water to loosen the sauce.