In a skillet, cook and stir the ground beef over medium-high heat, breaking the meat up as it cooks, until the meat is no longer pink and has started to brown (about 10 minutes). If necessary, skim off excess fat, and stir in the onions and garlic. Cook and stir the meat mixture until the onions are translucent, about 10 more minutes.

While meat mixture is cooking, place frozen okra in a colander and rinse with hot water to thaw. (I pick out the stems that sometimes sneak into the package. They don't have an appealing texture, and may be why some people don't like okra.)

To the meat mixture, add the can of undrained petite diced tomatoes, Italian seasoning, salt, balsamic vinegar, and okra. Stir to mix, and reduce heat to medium.

Prepare the elbow macaroni according to the directions on the box in a dutch oven, or large pot. Drain cooked macaroni and return to the dutch oven/pot. Add the can of crushed tomatoes, and stir gently.

Pour the meat mixture into the macaroni mixture and stir to combine. Heat thoroughly, and serve with choices of kosher salt in a bowl, a black pepper grinder, Parmesan cheese, and capers.