Cook the pasta according to the package instructions until al dente. Before draining, reserve 1/3 cup of pasta water and set it aside.
Heat a drizzle of olive oil in a large pan over medium heat. Add the diced onion and cook for about 7–8 minutes, stirring occasionally, until softened and lightly golden.
Add the sliced shiitake mushrooms and continue cooking until the mushrooms are softened and lightly browned.
Stir in the miso paste and chili flakes or cayenne pepper. Add a small splash of the reserved pasta water and stir until the miso is evenly incorporated and coats the mushrooms and onions.
Reduce the heat to low. Add the heavy cream and the remaining reserved pasta water. Stir well to create a smooth, creamy sauce.
Stir in the Parmesan cheese and let it melt into the sauce.
Add the cooked pasta to the pan and toss until everything is well coated in the creamy miso mushroom sauce.
Serve immediately with extra Parmesan and chili flakes, if desired.
Enjoy this creamy, savory Miso Mushroom Pasta!