Cook the Pasta: Bring a large pot of generously salted water to a rolling boil. Add your pasta and cook al dente, according to the package directions. Just before draining, carefully scoop out and reserve about 1 1/2 cups of the starchy pasta water. Drain the pasta and set it aside.

Sauté the Aromatics: While the pasta is cooking, melt the butter in a large skillet or Dutch oven over medium heat. Add the minced garlic cloves and chopped fresh sage leaves. Cook for 1-2 minutes, stirring constantly, until the garlic is fragrant and the sage becomes slightly crispy.

Build the Pumpkin Sauce: Add the canned pumpkin puree to the skillet with the garlic and sage. Stir it all together and cook for another 2 minutes, allowing the pumpkin to heat through and meld with the aromatics.

Make it Creamy: Pour in the heavy cream and whisk until the sauce is smooth and uniform in color. Bring the mixture to a gentle simmer, but do not let it boil. We just want to simmer the sauce lightly to allow the flavors to marry. Stir in the ground nutmeg, a generous pinch of salt, and a few grinds of black pepper.

Add the Cheese: Turn the heat down to low. Slowly sprinkle in the freshly grated Parmesan cheese, whisking continuously until the cheese is completely melted and the sauce is smooth.

Bring it All Together: Add the drained pasta directly into the skillet with the pumpkin alfredo sauce. Use a pair of tongs to toss everything together, coating every piece of pasta. If the sauce seems too thick, add a splash of the reserved pasta water and toss again. Continue adding a little water at a time until the sauce reaches your desired consistency, making it glossy and perfect.

Serve and Garnish: Taste the pasta and adjust the seasoning if needed. Serve immediately in warm bowls, garnished with extra Parmesan cheese, a few more fresh sage leaves, and maybe a tiny pinch of smoked paprika for color.