Alkaline Phosphatase High & Low Causes, Tests and Treatments

Your liver produces proteins known as liver enzymes, which perform essential bodily functions. However, excessively high or low levels of these enzymes can signal underlying health issues. One such enzyme is Alkaline Phosphatase (ALP). These levels provide insights into bone and liver health. When ALP levels are high, it could mean problems with the liver, bones, or bile ducts.

On the other hand, low alkaline phosphatase levels might signal issues like not getting enough nutrition, a slow thyroid, or a lack of vitamins. This blog has researched backed insights about high and low levels of ALP. Also, learn more about ALP diagnosis and treatment in this blog to get help at the right time and stay healthy. 

What is Alkaline Phosphatase?

ALP is an enzyme found primarily in your liver, bones, intestines, and kidneys. These enzymes are a form of protein biomolecule that speeds up chemical processes that take place in the human body. Different parts of your body produce different types of ALP.

ALP present in your body contributes to several processes, such as:

• breaking down fats in the intestines

• metabolising alcohol

• transporting calcium, phosphates, and fatty acids in the intestines

• improve digestion by transporting nutrients to the liver

• fighting against harmful bacteria present in your gut. 

• keeping your bones strong 

• helping you keep your brain sharp and focused; and

• Promoting cell growth.

These processes collectively ensure the proper functioning of your mind and body.

Nevertheless, a downward or elevated alkaline phosphatase level generally suggests that certain parts of your body are not functioning normally. It may also be an indication of underlying diseases such as liver cirrhosis, hepatitis, liver inflammation, bile duct blockage/damage, heart failure, and bacterial infections. 

What is the alkaline phosphatase normal range by age?

The normal range of alkaline phosphatase is 44-147 International units per liter (IU/L). However, other organizations prefer between 20 and 130 IU/L. These ranges are different for different laboratories; therefore, check with your laboratory for the normal range of results. ALP levels in the blood are usually high in growing children since their bones are still developing. Ideally, men between the ages of 15-45 years have a higher ALP than women of the same age. An ALP level of 140 IU/L is considered high and is a matter of concern. If you receive a result that shows a high level of ALP, the doctor may recommend that you undergo another test for ALP isoenzymes. This test specifies where the high levels of ALP originate, i.e., whether the ALP enzymes are high in the liver or if the ALP enzymes are high in the bones. This will help your doctor pin down the location of dysfunction and prescribe treatment accordingly.

What Causes Alkaline Phosphatase Levels to be High? 

Since ALP is highly concentrated in the bones and liver, high levels of ALP often indicate liver or bone disorders. Blood ALP levels may rise due to the following factors: 

• Liver disorders or any obstruction to the liver can elevate ALP levels.

• Increased bone cell activity can increase ALP levels in your blood. Diseases such as Osteomyelitis, Paget’s disease, osteogenic sarcoma, and bone metastasis can also cause alkaline phosphatase high.

• Studies show that rigorous workout sessions can raise your body’s ALP levels. However, the elevated levels generally revert to normal after one hour of rest.

• People with colorectal cancer may also have high levels of ALP, especially if the cancer has spread to the liver. 

• Elevated levels of ALP have been noticed in numerous AIDS patients.,k5

• Menopause can also raise ALP levels in women. However, menopause doesn't directly increase ALP levels. The decrease in oestrogen and progesterone levels in women’s bodies during this phase can indirectly raise their ALP levels. For example, oestrogen plays a crucial role in maintaining bone health, and its decline increases the risk of osteoporosis in menopausal women. Osteoporosis can lead to brittle bones, besides elevating ALP levels. Therefore, hormonal changes during menopause may affect ALP levels through their impact on bone health.

• Women with breast cancer generally have high ALP levels compared to healthy women. Moreover, increased enzyme activity indicates that the cancer may have spread to the bones or liver. Monitoring ALP levels can help assess the extent of cancer progression in such cases.

• Paget’s Disease characterised by fragile bones and partial bone development can also raise ALP levels in some people.

• Vitamin D deficiency often leads to higher levels of ALP.  Vitamin D helps absorb calcium and phosphorus from food besides maintaining normal levels of these minerals in the bloodstream. When vitamin D is low, the body may produce more ALP and increase parathyroid hormone production to release stored calcium and phosphorus from bones into the blood. This ends up raising ALP levels in the blood.

Also, Read 10 Foods to Avoid for High Blood Pressure

What Causes Low Alkaline Phosphatase Levels?

Cases of low API levels are very rare. Nevertheless, the following factors can reduce API levels in your blood:

• Low ALP levels may indicate malnutrition caused by Celiac disease. or a deficiency in vitamins and minerals. 

• Research suggests that zinc deficiency can also reduce ALP levels, which can cause impaired bone growth,

• An underactive thyroid, also known as Hypothyroidism, can also reduce your ALP levels.

• Hypophosphatasia, is a rare genetic disorder that affects bones and teeth; and 

• Wilson's disease is a rare condition leading to an accumulation of copper in body tissues.

It is equally important to note that an individual might have low or elevated ALP levels without any associated health issues. For instance, pregnant women, children, teenagers, and aging people generally have high levels of ALP in their blood. On the other hand, certain medications can also increase or decrease your ALP levels. 

Also Read: 12 Causes of High Liver Enzymes

How is the ALP Test Done?

The ALP test is a painless procedure and involves no side effects. Here is a step-by-step explanation that will help you prepare for the test: 

• Blood collection typically requires a minimum 8-hour fasting period; thus, you might be advised to fast for 10 to 12 hours before the test.

• Inform your doctor about any medications you are taking, as they can affect your ALP levels.

• The laboratory takes a small blood sample to conduct the test. 

• Before inserting a needle into your vein, the person drawing your blood will place a tight elastic band around your upper arm to enhance blood flow in the veins. 

• Once they collect your blood sample, it is sent to a laboratory for analysis.

• Results generally take one to two days.

• Depending on the results of the initial test, your doctor may request a follow-up test or suggest the next steps of diagnosis. For instance, patients with liver disease or gallbladder blockage may need to undergo surgery or medications. Additionally, patients diagnosed with cancer may require a combination of surgical procedures and chemotherapy as part of their treatment plan. Likewise, patients suffering from bone density issues may have to undergo bone density scans or X-rays.

An Important Factor to Keep in Mind

ALP tests may not always be sufficient to detect the source of ALP in your blood. Therefore, patients are often advised to undergo an ALP isoenzyme test to measure various types of ALP. This test helps healthcare providers identify the specific part of the body affected by the underlying illness.

When to Consider an alkaline phosphatase blood test?

• Health practitioners often recommend ALP blood test to patients who have symptoms like jaundice, light stools, dark urine, nausea, vomiting, weakness, or excessive weight loss, which indicate underlying liver problems. 

• This test is also advisable for individuals using medicines, such as acetaminophen (Tylenol) that can harm the liver. Measuring ALP levels can help detect liver damage, and it is commonly conducted along with other liver function tests. 

• Likewise, ALP tests are also recommended for patients showing bone disorder symptoms, such as joint pain, bone pain, abnormally shaped bones, enlarged bones, or frequent bone fractures. It can also help identify bone disorders such as Paget’s Disease, rickets and osteomalacia caused by Vitamin D deficiency.

What are the treatments for alkaline phosphatase Low levels?

You need to seek medical attention if you observe alkaline phosphatase low level in the body. Here are some measures to take:

• Correct nutritional deficiencies

• Check your medications

• Measure thyroid hormone

• Change lifestyle

• Keep up with supplements
  

What are the treatments for high alkaline phosphatase levels?

The treatment of the high level of ALP may vary depending on its causes, which include: 

1. Liver condition 

• For hepatitis, antiviral drugs will be prescribed.

• In cirrhosis, changes in lifestyle and some medications will be recommended to manage high levels of ALP.

2. Bone condition

• For Paget's disease, medication is prescribed to regulate bone density.

• Osteomalacia will require vitamin D and calcium supplements.

3. Other conditions

• Adjustment through medications and discontinuation will be considered if certain drugs elevate the alkaline phosphatase level.

How to Balance Alkaline Phosphatase Levels?

A healthy diet and a few lifestyle changes can help you balance your ALP levels. 

• Additionally, you must incorporate liver-supportive foods into your diet to balance ALP levels. These foods include Omega-3 fatty acids, vegetables like broccoli, cabbage, and cauliflower, Taurine, Milk thistle, and Vitamin C.

• Simultaneously, it is advisable to avoid consuming lamb, pork, beef, cheese, lentils, corn oil, shellfish, coconut oil, and carbonated beverages. 

Jumpstart Healthy Changes in Your Life 

• Engaging in a leisurely morning walk under the nourishing sunlight is crucial for well-being. To trigger vitamin D synthesis, a minimum of 20 minutes of sunlight exposure is necessary

• Try incorporating doctor-approved vitamin D supplements

• Consult with a healthcare professional and adhere to their guidance for a wholesome lifestyle
  

What do high alkaline phosphatase levels indicate?

High levels of ALP in the blood generally indicate that the normal functioning of certain areas of the body is impaired, which can lead to the following conditions:

1. Cholestasis during pregnancy
2. Hepatitis
3. Liver cirrhosis
4. Mononucleosis
5. Paget's disease
6. Hyperthyroidism
7. Osteomalacia
8. Bone metastasis

How to lower alkaline phosphatase levels?

Lowering ALP levels in the blood can be done effectively by making a few lifestyle changes and changing the foods you consume. Here are some treatment options available to safely bring the levels of ALP back to normal. 

Eat foods that support your liver- certain foods have proven results that lower ALP levels, such as:

• Omega-3 fatty acids
• Vegetables such as broccoli, cabbage, cauliflower
• Taurine
• Milk thistle
• Vitamin C

These foods clean the toxins out of the liver, which helps eliminate any reasons that increase ALP levels in the blood. 

Quit smoking- there's no debate on this; smoking increases ALP levels in the liver. Stop smoking; you'll see the difference. 

Limit caffeine intake- Caffeine intake, especially in the form of coffee, is known to lower ALP levels. However, avoid overconsuming coffee to fasten the process. 

Resistance training- lifting weights can significantly reduce ALP levels in the bones in just three days of working out.  Vitamin supplements- since vitamin D deficiency raises levels of ALP, expose yourself to the sun or take vitamin D supplements to bring back the balance of the enzymes.

Prescription medication- Cinacalcet is a drug for chronic kidney disease and is known to lower the levels of ALp in the blood by 20%.

Removal of medication- medications such as birth control pills and thyroid supplements can interfere with the production of ALP enzymes and raise their levels. Hence, the doctor may advise you to stop taking these medications to get the ALP levels back to normal.

Also, Read Top 9 Vitamin D-Rich Foods in India For Immunity, Nutrition, and Bone Health

Conclusion

Elevated alkaline phosphatase levels in the bloodstream could signal underlying disorders that require prompt attention. Effectively reducing these levels involves a strategic blend of suitable medications, dietary changes, and consistent medical supervision. Before incorporating these changes into your lifestyle, it is imperative to consult with a healthcare provider to develop a tailored plan for maintaining optimal health. Regular check-ins and adherence to prescribed measures are essential for managing ALP levels and managing an overall healthier and more balanced life.