This Is What May Be Causing Your Fruity Breath

Your breath smell can indicate a lot more than when you last brushed your teeth. For example, breath that has a fruity or acetone-like scent may be a sign of ketosis from your diet, excessive alcohol intake, or liver disease.

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—including when your fruity breath should cause you to seek out medical attention. 

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. Along with fruity breath, other symptoms you may experience on a ketogenic diet include:

• "Keto flu": upset stomach, dizziness, decreased energy, and mood swings when first starting the diet
• Low blood pressure
• Kidney stones
• Constipation
• Nutrient deficiencies and increased risk of heart disease if the diet is continued long-term

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 of 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 untreated, more severe symptoms can appear quickly along with fruity-smelling breath:

• Fast, deep breathing
• Dry skin and mouth
• Flushed face
• Headache
• Muscle stiffness or aches
• Being very tired
• Nausea and vomiting
• Stomach pain

Sometimes DKA is the first sign of diabetes in children or adults who haven’t yet been diagnosed.

DKA can progress quite quickly once it begins. If you begin vomiting or have other symptoms of DKA, contact your healthcare provider immediately or go to the emergency room. 

Risk Factors

Risk factors for developing DKA include:

• Illness: When you're not able to eat or drink as much as usual, blood sugar levels can be hard to manage.
• Missing insulin shots, a clogged insulin pump, or the wrong insulin dose
• Heart attack or stroke
• Physical injury
• Alcohol or drug use
• Certain medications: Corticosteroids and some diuretics
  

Alcoholic Ketoacidosis

In some cases, excessive alcohol use can cause ketoacidosis. However, the condition is more rare than DKA.

Along with fruity breath, other symptoms of this condition may include:

• Nausea and vomiting
• Abdominal pain
• Agitation, confusion
• Changed level of alertness, which may lead to coma
• Fatigue, slow movements
• Deep, labored, rapid breathing
• Loss of appetite
• Symptoms of dehydration, such as dizziness, lightheadedness, and thirst

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 who don't have their diabetes under control. 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. Other symptoms may include:

• Extremely high blood glucose level
• Dehydration
• Decreased alertness or consciousness

If you believe you are experiencing HHS, contact 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.

Bad breath related to liver disease is known as fetor hepaticus. Other symptoms of liver disease include:

• Ascites (fluid buildup in the belly)
• Vomiting blood, often from bleeding in the esophagus
• Gallstones
• Itching
• Jaundice (yellowing of the skin and eyes)
• Kidney failure
• Muscle loss
• Loss of appetite
• Easy bruising
• Spider-like veins in the skin
• Fatigue
• Weight loss
  
• Confusion as toxins build up in the blood
  

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. 

If you have diabetes and have glucose testing supplies on hand, check your blood sugar. If it is 240 mg/dL (milligrams/deciliter) or higher, use an over-the-counter ketone test kit to check your urine for ketones every four to six hours. You should also test for ketones if you have any of the symptoms of DKA. Call your doctor if your ketones are moderate or high.

If you are unable to test your blood sugar and ketones, go to the emergency room.

Preventing Fruity Breath

If you have diabetes, 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 registered dietitian.

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. 

Summary

Breath that has a fruity or acetone-like scent may be a sign of ketosis from your diet, DKA, HHS, excessive alcohol use, or liver disease.

If you’re intentionally fasting or following a ketogenic diet, you should expect fruity breath. You can drink plenty of water, brush your teeth more often, or use mints or gum to try to mask it.

If you have fruity breath along with more serious symptoms like excessive thirst, vomiting, or change in alertness, seek immediate medical attention, especially if you have diabetes. This can be a sign of DKA or HHS, both of which can lead to serious complications (including death) if left untreated.