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Bring a large pot of salted water to a boil. Cook the fettuccine according to package directions until al dente, stirring occasionally.
Before draining, reserve ½ cup of the pasta water.
Drain the pasta, then toss with olive oil to prevent sticking.
Meanwhile, add the cottage cheese, cooked cauliflower, milk, parmesan cheese, garlic, butter, flour, salt, and pepper to a high-speed blender.
Blend until smooth and creamy.
Pour the sauce into a large skillet and bring to a gentle simmer over medium heat.
Cook for 8–10 minutes, stirring often, until the sauce thickens.
Add the cooked pasta to the skillet and toss until evenly coated in the sauce.
If the sauce becomes too thick, stir in a little reserved pasta water or extra milk until it reaches your desired consistency.
Season to taste and serve topped with red pepper flakes or fresh parsley, if desired.