Alkaline phosphatase (ALP) level test: High and low levels

Slightly irregular ALP levels are usually no cause for concern. However, severely abnormal levels can signify a severe underlying medical condition, typically one relating to the liver, bones, or gallbladder.

In this article, we look at the ALP test in more detail and explain what it involves, how to prepare for it, and what the results may mean.

What is an ALP test?

An ALP test is a simple procedure that measures the amount of ALP in the blood. ALP is an enzyme that is present in most parts of the body but is most abundant in the bones, liver, kidneys, gallbladder, and intestines.

Researchers still do not understand the full range of ALP’s functions, but it seems to contribute to a wide range of processes, such as:

  • transporting nutrients and other enzymes in the liver
  • aiding the formation and growth of bones
  • transporting fatty acids, phosphates, and calcium in the intestines
  • digesting fat in the intestines
  • regulating cell growth, death, and migration during fetal development

Doctors will often request that a routine blood test includes an ALP test. They will also specifically order an ALP test if they think a person has a condition affecting any of the following:

  • bones
  • liver
  • gallbladder
  • kidney
  • intestines

What is a normal ALP level?

The ALP level in healthy adults should be 20–140 units per liter (U/L).

Children tend to have significantly higher levels of ALP than adults because their bones are still growing. A person recovering from a bone injury may also have a raised ALP level in the 3 months after the injury while their bone heals.

It is also common to have higher ALP levels than usual during the second and third trimesters of pregnancy.

However, everyone’s natural ALP level will be a bit different. After an ALP test, a doctor will be able to explain what it means if the ALP level is higher or lower than they would expect.

As ALP is most abundant in the bones and liver, elevated ALP levels are generally a sign of a liver or bone condition. An obstruction of the liver or damage to it will cause ALP levels to rise. This will also occur if there is an increase in bone cell activity.

Abnormal ALP levels usually indicate one of the following conditions:

  • gallstones
  • cholecystitis — inflammation of the gallbladder
  • liver cancer
  • abnormal, non-cancerous growths on the liver
  • cirrhosis — scarring of the liver
  • hepatitis — inflammation of the liver, often due to infection
  • bile cancers
  • overuse of medications harmful to the liver
  • excessive consumption of alcohol
  • malnutrition, especially deficiencies in vitamin D, calcium, protein, magnesium, and zinc
  • bone cancers

Conditions that abnormal ALP levels may indicate less regularly include:

  • rickets — a weakening of the bones in children, usually as a result of a vitamin D or calcium deficiency
  • osteomalacia — a weakening of the bones in adults, usually relating to a vitamin deficiency
  • Paget’s disease — a condition that causes significant bone deformity and problems with bone regeneration

Unusual ALP levels may also signify one of the following conditions, although this is rare:

  • congestive heart failure
  • anemia
  • untreated celiac disease
  • hyperparathyroidism
  • Hodgkin’s lymphoma
  • some bacterial infections
  • ulcerative colitis
  • Wilson’s disease
  • breast cancer
  • prostate cancer

The treatment for abnormal ALP levels depends entirely on the cause of the condition.

Slightly abnormal ALP levels are generally no cause for concern as ALP levels naturally fluctuate during the day and vary from person to person.

People with malnutrition should adjust their diet accordingly or take supplements. They should take care to include the following foods in their diet:

  • whole fruits and vegetables, especially citrus fruits, berries, and dark, leafy greens
  • whole-grain cereals, bread, rice, and pasta
  • red meats and fatty fish
  • probiotic food products, such as yogurt, kefir, kimchi, and sauerkraut

For infections, a doctor may prescribe a course of antibiotics or other antimicrobial medications.

People with significant liver, gallbladder, or bone obstructions may need to undergo surgery or laser-therapy sessions or take medications that break down the obstructions.

For chronic conditions that cause bone malformations or density issues, a person may need to have an X-ray.

People with cancer may need to undergo a combination of surgery, chemotherapy, and radiotherapy.

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