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                              October 3, 2023

       Harith Rajagopalan, M.D., Ph.D.
       Chief Executive Officer
       Fractyl Health, Inc.
       17 Hartwell Avenue
       Lexington, MA 02421

                                                        Re: Fractyl Health,
Inc.
                                                            Amendment No. 6 to
Draft Registration Statement on Form S-1
                                                            Submitted September
21, 2023
                                                            CIK 0001572616

       Dear Harith Rajagopalan:

            We have reviewed your amended draft registration statement and have
the following
       comment.

              Please respond to this letter by providing the requested
information and either submitting
       an amended draft registration statement or publicly filing your
registration statement on
       EDGAR. If you do not believe our comment applies to your facts and
circumstances or do not
       believe an amendment is appropriate, please tell us why in your
response.

               After reviewing the information you provide in response to this
letter and your amended
       draft registration statement or filed registration statement, we may
have additional comments.

       Amendment No. 6 to Draft Registration Statement on Form S-1

       Prospectus Summary
       Our Development Pipeline, page 2

   1.                                                   We note your response
to prior comment 2 and reissue in part. Please further clarify if
                                                        both the "CE Mark"
approval arrow and "Insulin-Treated T2D" arrow are for separate
                                                        indications. To the
extent both both of these arrows are targeting the same
                                                        indication, revise the
Revita section of your pipeline table so that the same indication does
                                                        not appear twice.
              Please contact Michael Fay at 202-551-3812 or Brian Cascio at
202-551-3676 if you
       have questions regarding comments on the financial statements and
related matters. Please
       contact Tyler Howes at 202-551-3370 or Alan Campbell at 202-551-4224
with any other
       questions.
 Harith Rajagopalan, M.D., Ph.D.
Fractyl Health, Inc.
October 3, 2023
Page 2




                                                    Sincerely,

FirstName LastNameHarith Rajagopalan, M.D., Ph.D.   Division of Corporation
Finance
                                                    Office of Industrial
Applications and
Comapany NameFractyl Health, Inc.
                                                    Services
October 3, 2023 Page 2
cc:       Nathan Ajiashvili, Esq.
FirstName LastName