1. Mac 'n' cheese

2. Ketchup with pasta

3. Pasta with seafood and cheese

4. Spaghetti and meatballs

5. And Fettuccine Alfredo

No, you're not eating "real Italian food" when you eat fettuccine Alfredo.
We all love a good macaroni and cheese, but it’s not actually a part of Italian cuisine! Instead, they prefer fresh-made pasta with cheese like gorgonzola, fontina, or toma, which are different kinds of seasoned cheese (and really tasty as well).
We know it might sound okay, but ketchup with pasta in Italy would be considered a culinary crime! In Italy, ketchup is considered as a sauce to eat with french fries and meat only. For that reason, pouring ketchup on a delicious dish of spaghetti would be rejected without even being served!
Another combo that is not really accepted by the Italians is any kind of pasta with seafood with a sprinkle of parmesan on top! The main reason for this is Italians have a clear rule in their recipes: meat has a strong flavor and goes with cheese, and seafood has a lighter flavor, so it has to be plain or not highly seasoned.
Did you know this rule is also valid for wines? Italians drink red wine (which has a stronger taste) with meat and white wine with seafood!
Really any pasta with meatballs is considered to be unknown in Italy! In the Italian culture, pasta is considered a dish on its own, as well as meatballs. For this precise reason, they will never serve it to you together; it's considered a huge culinary mistake! On the contrary, Italians would serve a pasta with a sauce called ragù, which is a sauce with minced meat cooked for hours and hours!
Even though this dish is really "Italian-sounding," this is not an Italian dish. Fettuccine Alfredo is a really common in the US, but an Italian would not accept it as an authentic Italian dish! This is because cream should be used in moderation in pasta dishes.
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