Alkaline phosphatase (ALP) is an enzyme found throughout the body, with the highest concentrations in the liver and bones. Smaller amounts are also present in the digestive system, kidneys, and the placenta during pregnancy. While the exact function of ALP is not fully understood, it is believed to play a crucial role in bone formation, the transport of phosphates, and other essential bodily processes. An alkaline phosphatase (ALP) test measures the amount of this enzyme in your blood to help diagnose certain health problems.
Understanding Alkaline Phosphatase (ALP)
Alkaline phosphatase (ALP) is an enzyme that lives on the outer layer of the cell membrane. Though experts don’t know the precise function of ALP, it’s believed to be an important catalyst for many bodily processes, including those that occur in the liver, kidneys, bones, and digestive system.
What Does an Alkaline Phosphatase Test Measure?
An alkaline phosphatase (ALP) test measures the amount of ALP in your blood. Although ALP exists throughout your body, the two main sources of ALP in your blood are your liver and bones. High levels of ALP may indicate liver disease or certain bone disorders, but an ALP test alone cannot diagnose a condition.
There are two main types of alkaline phosphatase (ALP) blood tests: a general ALP (the more common test) and an ALP isoenzyme test. A general ALP test is usually included in a blood test known as a comprehensive metabolic panel (CMP) and a liver panel (HFP or LFT).
Whereas an ALP test just measures the level of ALP in your blood, an ALP isoenzyme test can differentiate between types of alkaline phosphatase based on where they originated in your body. Your healthcare provider may have you undergo an ALP isoenzyme test as a follow-up if you had an abnormal ALP level on a previous test.
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The Significance of ALP Levels
An alkaline phosphatase test is a critical tool for identifying potential health concerns. An alkaline phosphatase test is commonly included in a comprehensive metabolic panel, with a normal range for adults being between 44 to 147 international units per liter. When the liver is inflamed or overburdened, alkaline phosphatase levels can spike, which might occur due to conditions like fatty liver, issues with bile ducts, or excessive alcohol consumption. This connection underscores why it’s crucial to avoid triggers such as processed foods and alcohol.
What is Considered a Normal Range?
Normal ranges for ALP levels can vary from laboratory to laboratory. Standard ranges also vary depending on your sex, age, and pregnancy status. One normal range of ALP levels for adults is 44-147 international units per liter (IU/L). Some organizations use a standard range of 30-120 IU/L.
Why is an ALP Blood Test Needed?
Your provider may order an alkaline phosphatase (ALP) blood test to help screen for, monitor or help diagnose liver and biliary diseases, bone disorders and other health conditions. Screening means checking for potential health issues before you experience symptoms. An ALP test is often included in a comprehensive metabolic panel (CMP) and liver panel. Healthcare providers often use these panels as part of a routine check-up to screen for a wide range of potential health problems.
If you have a liver or bone condition or another type of condition, your provider may order an ALP test, often as part of a panel, to monitor your condition to see if it’s improving, worsening or staying the same with or without treatment.
Your provider may use an ALP test for diagnostic purposes when you have signs of possible liver or bone problems. An ALP test can also help diagnose the cause of more general symptoms, such as fatigue, when it’s included in a liver panel or CMP. While providers can’t diagnose a condition based solely on ALP levels, it can be an important part of the diagnostic process. The degree to which the ALP level is elevated or lower than usual may indicate the type or severity of a condition.
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Symptoms Associated with High ALP
Elevated alkaline phosphatase can be a sign your liver isn’t working the right way.
Signs and symptoms of liver disease include:
- Jaundice - a condition that causes your skin and the whites of your eyes to turn yellow.
- Abdominal (belly) pain and/or swelling, especially on your right side.
- Bruising easily.
- Nausea and/or vomiting.
- Having dark-colored pee and/or light-colored poop.
- Unexplained weight loss.
- Tiredness (fatigue).
- Swelling in your arms or legs (edema).
Signs and symptoms of bone disorders include:
- Bone pain and/or joint pain.
- Enlarged and/or abnormally shaped bones.
- Increased frequency of bone fractures.
- If the ALP is elevated and it is reflecting liver and biliary disease, Assis says you may also have fatigue and itching. Many people don’t have symptoms of high ALP at all, Assis says.
- If you have high ALP, doctors will likely evaluate you whether or not you have symptoms, Assis adds.
Alkaline Phosphatase and Fatty Liver
Fatty liver, or fatty liver disease, refers to a buildup of fat in your liver. ALP is one of the markers that can be used to diagnose the disease, but it’s not the only one that guides a doctor to the diagnosis.
There are two kinds of fatty liver disease:
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- Metabolic-associated steatotic liver disease (MASLD) is when fat accumulates in your liver, and it is often caused by high cholesterol, type 2 diabetes, insulin resistance, or having a body mass index (BMI) over 30. It was formerly called nonalcoholic fatty liver disease (NAFLD).
- Alcoholic fatty liver disease, which is also known as alcoholic steatohepatitis, is due to drinking too much alcohol over time.
Causes of High Alkaline Phosphatase
There are several possible causes of high ALP levels, including cirrhosis, hepatitis, and mononucleosis. If your ALP levels are high, your doctor will likely recommend additional testing to identify the root cause.
Elevated alkaline phosphatase levels can be caused by conditions such as:
- Blocked bile ducts
- Liver cancer
- Cirrhosis
- Hepatitis
- Narrowing of the bile ducts
- Mononucleosis
- Cholestasis of pregnancy (a liver condition that occurs late in pregnancy)
- Untreated celiac disease
- Certain drugs or toxins
- Inflammatory conditions such as primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC)
An elevated ALP isoenzyme test can indicate issues like:
- Cancers that have spread to your bones
- Paget’s disease, which affects how bones grow
- Vitamin D deficiency
- Some thyroid conditions
Liver Problems
High ALP in your liver can be a sign of:
- Blockages or narrowing in your bile ducts
- Cirrhosis, which is when scarring affects how your liver works
- Liver inflammation, or hepatitis
- Mononucleosis, which can sometimes cause swelling in the liver
- Cholestasis of pregnancy
Bone Disorders
High ALP in your bones may be a sign of:
- Bone metastasis, when cancer spreads to bones
- Paget’s disease of the bone, or osteitis deformans
- Osteogenic sarcoma, a cancer that starts in your bones
- Fracture healing
- Untreated celiac disease
- Hyperparathyroidism, which occurs when your calcium levels go up
- Hyperthyroidism, when your body makes too much thyroid hormone
- Osteomalacia, which weakens bones
What Level of Alkaline Phosphatase is Dangerous?
The high end of the normal ALP range is 147 IU/L, but laboratories can differ slightly in terms of what they consider a normal range. Other organizations say that 30 to 120 IU/L is considered normal. Generally, anything over 147 IU/L can be considered high. There’s no known research that a certain level is dangerous, per say. Sepsis, which can be dangerous or life-threatening, can cause some cases of high ALP (over 1,000 IU/L).
Elevated Alkaline Phosphatase in Pregnancy
During pregnancy, the placenta produces alkaline phosphatase. Levels of ALP can get up to three times the normal limit. Experts say that an abnormal elevated level, or rising levels, can indicate problems with the placenta. High ALP may also be a sign that you may experience preterm delivery or have an infant born large for gestational age, some research indicates. During the third trimester of pregnancy, levels may be from 38-229 IU/L. Your doctor may monitor your ALP levels during your pregnancy if they are elevated. ALP levels generally go back to normal after birth, notes David N. Assis, MD, an associate professor of medicine in digestive diseases at the Yale School of Medicine.
Low ALP
Having lower-than-normal ALP levels is less common than having high levels. You may have low levels of ALP if you have:
- An underactive thyroid gland (hypothyroidism)
- Low red blood cells due to a vitamin B12 deficiency (pernicious anemia)
- Zinc or magnesium deficiency
- Hypophosphatasia (HPP)
- Wilson’s disease, a rare genetic disorder that causes the body to make too much copper
Some medications, including hormonal birth control, can sometimes lower your levels of ALP.
What Foods to Avoid if Alkaline Phosphatase is High
There’s not much research published on foods to steer clear of if you have high ALP levels. If elevated ALP levels are from your liver, you may want to avoid foods known to be bad for your liver. Consult your doctor.
Some foods that aren’t good for optimal liver health include:
- Fatty foods
- Sugar
- Alcohol
- Processed foods
If you have high ALP in your bones, ask your doctor if there are foods to avoid. These tips about foods that can negatively impact bone health may help:
- Limit meat, salty foods, caffeine, coffee, tea, soft drinks, and alcohol.
- Time when you take wheat bran, which may lower absorption of calcium in other foods you eat with it.
- Don’t skip spinach, but don’t rely on it for calcium, as the green is high in oxalates that can block calcium absorption.
- Soak beans in water first to lower phytates, which interrupt your ability to absorb calcium.
Dietary Recommendations
While there is no standard diet specifically recommended for people with high ALP levels, certain dietary changes can help manage the underlying conditions that may be causing the elevation.
Foods to Avoid
- Alcohol: High ALP levels can be a sign of liver damage. People with liver damage should avoid drinking alcohol, which can place more stress on the liver.
- Fatty Foods: If you’re a meat lover, this might be tough. But fatty meats make digestion harder and can inflame the liver. Stick to lean proteins like chicken or fish instead. Excess fat from full-cream milk, cheese, or butter increases the liver’s workload. Try switching to low-fat or plant-based dairy substitutes.
- Sugar: Consuming excessive sugar isn’t just bad for your waistline. It directly impacts your liver.
- Processed Foods: When the liver is inflamed or overburdened, alkaline phosphatase levels can spike, which might occur due to conditions like fatty liver, issues with bile ducts, or excessive alcohol consumption. This connection underscores why it’s crucial to avoid triggers such as processed foods and alcohol.
- Processed Meat: Processed meat is a prime culprit. For example, sausages and salamis are high in saturated fats, which can overload your liver. In addition, these foods can slow down digestion, making symptoms worse.
- Carbonated Drinks: They don’t just add empty calories. They’re also loaded with sugar, which harms liver cells.
- Energy Drinks: They may seem harmless, but they often contain artificial additives. These additives can cause inflammation, which harms the liver.
- Deep-Fried Snacks: Deep-fried snacks like chips or fried chicken are another common trigger. They are loaded with unhealthy fats, which increase inflammation.
- Sugary Drinks: Similarly, avoid sugary drinks like soda, which can stress the liver.
Foods to Include
- High-Fiber Foods: High-fiber foods are excellent for reducing alkaline phosphatase alp test levels. They improve digestion and support liver health. Fiber helps the body remove toxins naturally. Adding high-fiber foods like oats, beans, and lentils to your meals makes a big difference. For instance, starting your day with a bowl of oatmeal topped with fruit boosts digestion. It also supports better liver function. Lentil soup is another delicious way to add fiber to your diet.
- Vitamin D Rich Foods: Foods like mushrooms and fortified cereals provide a good source of Vitamin D.
- Magnesium Rich Foods: Nuts like almonds and seeds like pumpkin seeds are rich in magnesium.
- Superfoods:
- Turmeric, known for its anti-inflammatory properties, can be added to various dishes to support liver health and reduce inflammation, potentially lowering levels of ALP in your blood.
- Ginger, another superfood, aids digestion and can be consumed as tea.
- Incorporating berries such as blueberries and strawberries into your diet boosts vitamin intake and supports liver detoxification.
- Avocados, with their healthy fats, can help reduce inflammation.
Research on Foods That May Lower ALP Levels
- Omega-3 Fatty Acids: One small study of 52 participants found that supplementation of omega-3 fatty acids (like those found in fatty fish and some nuts) for 12 weeks helped to lower ALP levels in people with type 2 diabetes. Another double-blind randomized controlled clinical trial from 2020 found that omega-3 supplementation also helped to lower ALP levels in people with non-alcoholic fatty liver disease.
- Coffee: One review from 2017 suggests that people who drink more than three cups of coffee per day have significantly lower levels of ALP. A survey from 2016 similarly reports that drinking 2-3 cups of coffee per day is associated with lower ALP levels. Another cross-sectional study from 2012 shows that current coffee drinks have lower levels of ALP when compared with never or past coffee drinkers.
Other Ways to Lower Alkaline Phosphatase Levels
Depending on the cause of your elevated ALP levels, there are some strategies your doctor may recommend to help lower your levels, including:
- Medication, including cinacalet, a medication prescribed for some people with chronic kidney disease.
- Vitamin D supplementation may help to lower ALP levels in the blood.
- Resistance exercise may help to lower ALP levels in the bone.
Lifestyle Changes
Managing an alkaline phosphatase ALP levels requires more than just dietary adjustments. Simple lifestyle changes can significantly impact your overall liver health. For example, ensuring you drink enough water daily helps flush out toxins and supports liver function.
How is an Alkaline Phosphatase (ALP) test different from a liver panel or comprehensive metabolic panel (CMP)?
A panel blood test involves more than one measurement from a blood sample. Because of this, a liver panel or comprehensive metabolic panel (CMP) provides more information than a test for just alkaline phosphatase.
How to Prepare for an ALP Test
You may have to limit food and liquids (other than water) for 10-12 hours before the test. Some medicines interfere with the results, so make sure your doctor knows about all drugs you take, including over-the-counter medicines, vitamins, and supplements.
Tell your doctor if you're pregnant because ALP in the placenta can increase the amount of the enzyme in your blood.
Risks of High Alkaline Phosphatase
The risks of high alkaline phosphatase will vary depending on the cause of your elevated levels. If your ALP test shows high or moderately high levels, your doctor will work with you to determine the underlying cause and its associated risks.
Regular Monitoring
Regular blood tests, such as an ALP test, are crucial. They help monitor the levels of ALP in your blood, showing progress or detecting issues. Regular monitoring through an ALP isoenzyme test, and understanding the results of an ALP test, are integral to managing your health.
When to Worry About Alkaline Phosphatase
Your doctor will let you know what high or low alkaline phosphatase levels mean. But you should seek medical help if you have symptoms like yellowing skin or pain in your bones or joints. Those could be a sign of liver or bone disease.
What Causes Alkaline Phosphatase Levels to Change?
Medical conditions that affect the liver and bones can change your ALP levels. Factors such as recent bone fractures, pregnancy, dietary choices, certain medications, and hormonal birth control can also cause your ALP levels to go up or down.