Bring a large pot of salted water to a boil. Add the pasta and cook according to package instructions until al dente. Reserve ½ cup of pasta water, then drain the pasta in a colander.
In a skillet or saucepan, heat the olive oil over medium heat. Add the minced garlic and sauté for about 1 minute, or until fragrant.
Add the spinach (or other vegetables) to the skillet and cook for 2-3 minutes until wilted.
In a large mixing bowl, combine the cottage cheese, milk, parmesan cheese, salt, black pepper, and red pepper flakes (if using). Mix well until smooth.
Add the drained pasta to the skillet with the cooked vegetables. Pour the cottage cheese mixture over the pasta and toss to combine. If the sauce is too thick, gradually add some reserved pasta water until the desired creaminess is achieved.
Serve warm, garnished with fresh basil or parsley if desired.