<?xml version="1.0" encoding="UTF-8"?><edgarSubmission xmlns="http://www.sec.gov/edgar/ownership" xmlns:ns2="http://www.sec.gov/edgar/common">
    <headerData>
        <submissionType>144</submissionType>
        <filerInfo>
            <filer>
                <filerCredentials>
                    <cik>0001419217</cik>
                    <ccc>XXXXXXXX</ccc>
                </filerCredentials>
            </filer>
            <liveTestFlag>LIVE</liveTestFlag>



        </filerInfo>
    </headerData>
    <formData>
        <issuerInfo>
            <issuerCik>0001572616</issuerCik>
            <issuerName>FRACTYL HEALTH INC</issuerName>
            <secFileNumber>001-41942</secFileNumber>
            <issuerAddress>
                <ns2:street1>3 Van de Graaff Drive Suite 200</ns2:street1>
                <ns2:city>Burlington</ns2:city>
                <ns2:stateOrCountry>MA</ns2:stateOrCountry>
                <ns2:zipCode>01803</ns2:zipCode>
            </issuerAddress>
            <issuerContactPhone>781-902-8800</issuerContactPhone>
            <nameOfPersonForWhoseAccountTheSecuritiesAreToBeSold>JAY CAPLAN</nameOfPersonForWhoseAccountTheSecuritiesAreToBeSold>
            <relationshipsToIssuer>
                <relationshipToIssuer>Officer</relationshipToIssuer>
            </relationshipsToIssuer>
        </issuerInfo>
        <securitiesInformation>
            <securitiesClassTitle>Common</securitiesClassTitle>
            <brokerOrMarketmakerDetails>
                <name>Morgan Stanley Smith Barney LLC Executive Financial Services</name>
                <address>
                    <ns2:street1>1 New York Plaza</ns2:street1>
                    <ns2:street2>8th Floor</ns2:street2>
                    <ns2:city>New York</ns2:city>
                    <ns2:stateOrCountry>NY</ns2:stateOrCountry>
                    <ns2:zipCode>10004</ns2:zipCode>
                </address>
            </brokerOrMarketmakerDetails>
            <noOfUnitsSold>43818</noOfUnitsSold>
            <aggregateMarketValue>88512.36</aggregateMarketValue>
            <noOfUnitsOutstanding>48098944</noOfUnitsOutstanding>
            <approxSaleDate>01/30/2025</approxSaleDate>
            <securitiesExchangeName>NASDAQ</securitiesExchangeName>
        </securitiesInformation>
        <securitiesToBeSold>
            <securitiesClassTitle>Common</securitiesClassTitle>
            <acquiredDate>01/30/2025</acquiredDate>
            <natureOfAcquisitionTransaction>Exercise of Stock Options</natureOfAcquisitionTransaction>
            <nameOfPersonfromWhomAcquired>Issuer</nameOfPersonfromWhomAcquired>
            <isGiftTransaction>N</isGiftTransaction>
            <amountOfSecuritiesAcquired>43818</amountOfSecuritiesAcquired>
            <paymentDate>01/30/2025</paymentDate>
            <natureOfPayment>Cash</natureOfPayment>
        </securitiesToBeSold>
        <nothingToReportFlagOnSecuritiesSoldInPast3Months>N</nothingToReportFlagOnSecuritiesSoldInPast3Months>
        <securitiesSoldInPast3Months>
            <sellerDetails>
                <name>JAY CAPLAN</name>
                <address>
                    <ns2:street1>3 Van de Graaff Drive Suite 200</ns2:street1>
                    <ns2:city>Burlington</ns2:city>
                    <ns2:stateOrCountry>MA</ns2:stateOrCountry>
                    <ns2:zipCode>01803</ns2:zipCode>
                </address>
            </sellerDetails>
            <securitiesClassTitle>Common</securitiesClassTitle>
            <saleDate>11/11/2024</saleDate>
            <amountOfSecuritiesSold>64197</amountOfSecuritiesSold>
            <grossProceeds>158540.91</grossProceeds>
        </securitiesSoldInPast3Months>
        <remarks>The shares covered by the Form 144 are sold pursuant to a Rule 10b5-1 trading plan dated as of 09/13/2024.
The securities to be sold were and will be received upon the exercise of stock options over the next three months. The dates of acquisition and payment were and will be the dates of exercise/sale.
</remarks>
        <noticeSignature>
            <noticeDate>01/30/2025</noticeDate>
            <planAdoptionDates>
                <planAdoptionDate>09/13/2024</planAdoptionDate>
            </planAdoptionDates>
            <signature>/s/ Jay Caplan</signature>
        </noticeSignature>
    </formData>
</edgarSubmission>
[{"type": "144", "sequence": "1", "filename": "primary_doc.xml", "secsgml_size_bytes": 4343}]
144
0001419217
XXXXXXXX
LIVE
0001572616
FRACTYL HEALTH INC
001-41942
3 Van de Graaff Drive Suite 200
Burlington
MA
01803
781-902-8800
JAY CAPLAN
Officer
Common
Morgan Stanley Smith Barney LLC Executive Financial Services
1 New York Plaza
8th Floor
New York
NY
10004
43818
88512.36
48098944
01/30/2025
NASDAQ
Common
01/30/2025
Exercise of Stock Options
Issuer
N
43818
01/30/2025
Cash
N
JAY CAPLAN
3 Van de Graaff Drive Suite 200
Burlington
MA
01803
Common
11/11/2024
64197
158540.91
The shares covered by the Form 144 are sold pursuant to a Rule 10b5-1 trading plan dated as of 09/13/2024.
The securities to be sold were and will be received upon the exercise of stock options over the next three months. The dates of acquisition and payment were and will be the dates of exercise/sale.
01/30/2025
09/13/2024
/s/ Jay Caplan