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Heat 3 cups of milk in a saucepan. Stir in about ½ can of tomato paste (or tomato soup) until combined.
Add a generous amount of black pepper, a pinch of cayenne pepper, and 1 teaspoon of salt.
Stir in grated white cheddar (and/or Swiss) until melted into a smooth sauce.
Separately, cook elbow macaroni until just al dente. Drain.
Toss cooked macaroni with hot cheese sauce until fully coated.
Pour into a buttered casserole dish. Dot the top with small pieces of butter.
Bake at ~350°F for about 30 minutes, until hot and slightly browned on top.
Serve with sour cream on the side, as Big Martha traditionally did.