This Is What May Be Causing Your Fruity Breath

Fruity breath can signal dangerous health conditions

Your breath smell indicates a lot more than when you last brushed your teeth. For example, your breath can give clues into how your body is metabolizing the food you eat. Eating lots of protein or operating in a state of ketosis—common goals on modern diets like keto—can give your breath a fruity or acetone-like scent.

If you have diabetes, this scent can be a sign of diabetic ketoacidosis (DKA), a condition that can be fatal if not treated. In other cases, it can be a sign of liver disease.

Learn more about fruity breath below—including when your fruity breath should cause you to seek out medical attention. 

Toothbrushes near a mouthwash bottle (Potential Causes of Fruity Smelling Breath)

Verywell / Laura Porter

Causes of Fruity Breath

Fruity breath is caused by your metabolism. As your body breaks down food and fat in different ways, it releases chemicals that are then expelled when you breathe out. In some cases, these chemicals can cause a fruity or acetone smell. 

Ketosis From Your Diet

Modern fad diets like ketogenic diets are designed to help your body enter a state of ketosis, where it begins burning fat rather than glucose (blood sugar) for fuel. This process releases chemicals known as ketones, including acetone, which can cause a fruity smell. In fact, having fruity or acetone-smelling breath is a reliable sign that your body has entered ketosis.

Ketones are also released when you’re fasting. That’s because your body is burning fat for fuel, rather than blood sugar, just as it is during ketosis. 

Is Fruity Breath From Dieting Dangerous?

If you have been intentionally fasting or eating a ketogenic diet, fruity breath is not a cause for concern—it’s just a sign that your body has entered ketosis.

If you experience fruity breath that’s not caused by intentional changes to your diet, the scent of your breath may have more dire causes. 

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis, or DKA, is a complication from diabetes, especially type 1 diabetes.

If a person does not have enough insulin, their body is unable to convert blood sugar to glucose, which the body uses as fuel. Without glucose to burn, the body enters a severe form of ketosis, releasing enough ketones into the blood that the ketones begin poisoning the person.

Fruity breath is a common sign of DKA. Other signs include:

  • Dry mouth and increased thirst
  • Frequent urination
  • High blood sugar levels
  • Confusion

If you are experiencing symptoms of DKA, you should contact your healthcare provider immediately or go to the emergency room. 

Alcoholic Ketoacidosis

In some cases, excessive alcohol use can cause ketoacidosis. The symptoms of this condition are similar to those of DKA, including fruity breath. However, the condition is rarer than DKA.

In order to experience alcoholic ketoacidosis, a person often has to drink large quantities of alcohol, while also being malnourished.

Hyperglycemic Hyperosmolar Syndrome (HHS)

Hyperglycemic hyperosmolar syndrome (HHS) is extremely high blood sugar that occurs in people with type 2 diabetes. It’s similar to DKA in that it can cause a diabetic coma or death if left untreated.

In most cases, people with HHS do not experience the same buildup of ketones in their blood that people with DKA experience. However, some buildup of ketones in the blood can occur with HHS, leading to fruity-smelling breath.

If you believe you are experiencing HHS, reach out to a healthcare provider or go to the emergency room immediately. 

Liver Disease

In some cases, fruity breath has causes that are not related to ketones. People with liver disease can experience fruity breath, but it’s a bit different.

Difference of Fruity Breath Related to Liver Disease

While fruity breath related to ketones has an acetone-like scent, the fruity breath associated with liver disease is mustier.

Bad breath related to liver disease is known as fetor hepaticus.

People with liver disease have higher levels of certain chemical compounds, including acetone. The link between liver disease and fruity, musty breath is so strong that healthcare providers use breath smell as an indication of liver disease.

What to Do If You Have Fruity Breath

If you experience fruity breath after intentionally fasting or following a ketogenic diet, you don’t have cause for concern. Drinking more water may help control the fruity scent, but there’s no way to prevent it while following these types of diets. Gum and mints may help mask the scent. 

Seek Medical Attention

If you are experiencing unexplained fruity breath, especially if you have diabetes, it’s important to seek medical care. Other symptoms to watch out for include:

  • Confusion
  • Excessive thirst
  • Very high blood sugar

Preventing Fruity Breath

If you are diabetic, managing your blood sugars and taking your medications as prescribed can help reduce your risk of fruity breath.

Remember to eat well-balanced meals spaced throughout the day. If you need help creating a nutritional plan to help control your blood sugar levels, ask your healthcare provider for a referral to a nutritionist. 

If you have fruity breath because you are fasting or following a ketogenic diet, there’s not a lot that you can do to prevent fruity breath. Staying hydrated and brushing your teeth thoroughly can help make the smell less noticeable. 

A Word From Verywell

Having an unusual breath odor can be embarrassing. Because of that, you might not want to talk with your healthcare provider about your fruity, acetone, or musty-scented breath. However, opening up an honest conversation can help you ensure that your fruity breath isn’t the sign of a serious health concern, like uncontrolled blood sugar or liver disease. 

If you have fruity breath along with more serious symptoms like excessive thirst, seek immediate medical attention, especially if you’re diabetic. This can be a sign of DKA or HHS, both of which can lead to high blood pressure or death if left untreated. 

On the other hand, if you’re intentionally fasting or following a keto diet, know that you should expect fruity breath. This can be a good sign that your body has reached ketosis, and your hard work is paying off. Do your best to prevent fruity breath by drinking plenty of water, brushing your teeth more frequently, or using mints or gum. 

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Diabetes Association. DKA (ketoacidosis) & ketones

  2. Ruzsányi V, Péter Kalapos M. Breath acetone as a potential marker in clinical practiceJ Breath Res. 2017;11(2):024002. doi:10.1088/1752-7163/aa66d3

  3. MedlinePlus. Alcoholic ketoacidosis.

  4. MedlinePlus. Diabetic hyperglycemic hyperosmolar syndrome.

By Kelly Burch
Kelly Burch is has written about health topics for more than a decade. Her writing has appeared in The Washington Post, The Chicago Tribune, and more.