Enzyme related to liver and bone health
20 of 22 providers
Liver Function
44-147 U/L
ALP (Alkaline Phosphatase) is an enzyme found primarily in your liver and bones, with smaller amounts in intestines, kidneys, and placenta (during pregnancy). ALP plays a role in breaking down proteins and is particularly concentrated in the bile ducts of the liver and in bone-forming cells (osteoblasts).
The challenge with ALP is determining the source:liver or bone. Elevated ALP from liver typically indicates cholestasis (bile duct obstruction or impaired bile flow), while bone-source ALP indicates increased bone turnover from growth, fracture healing, or bone disease. GGT is the key differentiator—if both ALP and GGT are elevated, the source is likely liver;if only ALP is elevated, consider bone disorders.
ALP can be mildly elevated in healthy growing children and adolescents due to bone growth, and during pregnancy due to placental ALP. In adults, persistently elevated ALP warrants investigation. Low ALP, though less common, can indicate nutritional deficiencies (zinc, magnesium, vitamin B6) or rare genetic conditions like hypophosphatasia.
| Range Type | Level | Significance |
|---|---|---|
| Optimal (Adult) | 35-100 U/L | Optimal range for adults indicating healthy bile flow and normal bone turnover. Values in this range suggest good liver and bone health, adequate nutrition, and low inflammation. Note:Children and adolescents normally have higher ALP due to bone growth (can be 2-3x adult values). |
| Borderline High | 100-150 U/L | Upper normal range;may warrant investigation depending on age and context. Check GGT to determine if liver-related. Consider bone source if isolated. Retest in 3-6 months and investigate if rising trend. Rule out benign causes (post-meal elevation in blood type O/B secretors, recent bone healing). |
| Moderately Elevated | 150-300 U/L | Requires investigation. If GGT also elevated:Evaluate for cholestatic liver disease, bile duct obstruction, primary biliary cholangitis, drug-induced liver injury. Order liver ultrasound or MRCP. If GGT normal:Consider bone disorders (Paget's disease, healing fracture, osteomalacia, vitamin D deficiency). Order bone-specific ALP isoenzyme, calcium, phosphate, PTH, vitamin D. |
| Severely Elevated | >300 U/L | Indicates significant pathology requiring urgent workup. Liver causes (with elevated GGT):Bile duct obstruction, primary sclerosing cholangitis, liver metastases, severe cholestatic drug reaction. Order urgent imaging (ultrasound/MRCP). Bone causes (normal GGT):Paget's disease, bone metastases, osteomalacia, hyperparathyroidism. Order bone scan, PTH, calcium, vitamin D. Levels >1000 U/L suggest severe disease. |
Identify and remove offending medications:Common culprits include antibiotics (amoxicillin-clavulanate, fluoroquinolones), antifungals, anabolic steroids, birth control pills, NSAIDs
Ursodeoxycholic acid (UDCA):13-15 mg/kg daily for primary biliary cholangitis or other cholestatic conditions (prescription)
Treat underlying conditions:Address biliary obstruction (may require ERCP or surgery), manage inflammatory bowel disease if primary sclerosing cholangitis
Support bile flow:Artichoke extract, milk thistle, and phosphatidylcholine may support bile health
Weight loss if obese:Non-alcoholic fatty liver disease can cause cholestatic pattern with ALP elevation
Vitamin D optimization:Target 40-60 ng/mL (100-150 nmol/L). Supplement 2000-5000 IU daily if deficient. Vitamin D deficiency causes osteomalacia with high ALP
Calcium and phosphate:Ensure adequate intake (1000-1200 mg calcium daily, 700 mg phosphate). Check serum levels
Magnesium:400-500 mg daily (glycinate or threonate forms). Essential for bone health and ALP regulation
Vitamin K2 (MK-7):90-180 mcg daily directs calcium to bones rather than soft tissues
Treat Paget's disease:Bisphosphonates (alendronate, risedronate) if Paget's confirmed. Normalizes ALP in 80% of patients
Zinc supplementation:15-30 mg daily (zinc picolinate or glycinate). Zinc deficiency is most common cause of low ALP
Magnesium:400-500 mg daily. Required for ALP enzyme function
Vitamin B6:25-50 mg daily if deficient. ALP requires pyridoxal phosphate (B6) as cofactor
Copper:Ensure adequate intake (1-2 mg daily) but avoid excess. Both deficiency and excess can affect ALP
Protein intake:Ensure 0.8-1.2 g/kg body weight daily. Severe protein malnutrition lowers ALP
Fiber and bile acid binding:Adequate fiber intake (25-35g daily) supports healthy bile acid metabolism
Omega-3 fatty acids:2-4g EPA+DHA daily reduces liver inflammation
Taurine:500-1000 mg daily. Amino acid that conjugates bile acids and supports liver function
Avoid alcohol:Even moderate drinking can impair bile flow and elevate ALP
Bitter foods:Arugula, dandelion greens, artichoke stimulate bile production and flow
Regular weight-bearing exercise:Builds bone density and normalizes bone turnover markers including ALP
Sunlight exposure:15-30 minutes daily (arms/legs) for vitamin D production
Avoid smoking:Increases bone turnover and ALP, accelerates bone loss
Monitor trend over time:ALP should be stable in healthy adults. Rising trend requires investigation even if still "normal"
Timing:Blood type O and B secretors can have transient ALP elevation after fatty meals. Test fasting for accuracy
Concurrent elevation of ALP and GGT has 94% specificity for hepatobiliary disease. If ALP is elevated with normal GGT, bone is the likely source. This simple combination effectively distinguishes liver from bone pathology without requiring expensive ALP isoenzyme fractionation in most cases.
Source:Dufour DR, et al. Diagnosis and monitoring of hepatic injury. I. Performance characteristics of laboratory tests. Clin Chem. 2000;46(12):2027-2049.
In primary biliary cholangitis (PBC), ALP is often the first and most persistently elevated liver enzyme. Failure to normalize ALP with ursodeoxycholic acid treatment predicts worse prognosis. ALP >1.5x upper limit after 1 year of UDCA treatment is associated with increased risk of liver transplant or death.
Source:Lammers WJ, et al. Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis. Gastroenterology. 2014;147(6):1338-1349.
Severe vitamin D deficiency causes osteomalacia (soft bones) with characteristic elevation of ALP, often 2-5x upper limit. Supplementation with adequate vitamin D (2000-4000 IU daily) normalizes ALP within 3-6 months. ALP can be used to monitor response to vitamin D therapy in deficient patients.
Source:Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly. Endocrinol Metab Clin North Am. 2001;30(4):833-843.
Low ALP (<40 U/L) is associated with increased mortality risk in multiple populations, including heart failure patients and elderly individuals. Proposed mechanisms include nutritional deficiencies (zinc, magnesium), frailty, and impaired bone remodeling. Low ALP warrants nutritional assessment and supplementation.
Source:Beddhu S, et al. Associations of serum alkaline phosphatase with coronary artery calcification in CKD. Kidney Int Rep. 2018;3(6):1273-1281.
Paget's disease of bone causes dramatically elevated ALP, often 500-3000 U/L, reflecting increased bone turnover. Treatment with bisphosphonates reduces ALP by 50-80% and reduces bone pain and complications. ALP level correlates with disease activity and can be used to monitor treatment response.
Source:Singer FR, et al. Paget's disease of bone. J Bone Miner Res. 2014;29(10):2091-2098.
| Provider | Includes | Annual Cost | Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ (150 with ratios) |
 WHOOP Advanced Labs | ✓ | $349 | 65 |
 Labcorp OnDemand | ✓ | $398 | 30+ |
| ✓ | $486 | 40+ | |
| ✓ | $468 | 83 | |
| ✓ | $349 | 100+ | |
 InsideTracker | — | $680 | 54 |
 Function Health | ✓ | $365 | 100+ |
| ✓ | $250 | 65 | |
| ✓ | $495 | 70+ | |
| ✓ | $895 | 100+ | |
| ✓ | $1950 | 150+ | |
| — | $399 | 100+ | |
| — | $Varies | 75+ | |
| ✓ | $190 | 100+ | |
| ✓ | $99 | 50 | |
| ✓ | $125 | 60 | |
| ✓ | $199 | 50 | |
| ✓ | $499 | 120+ | |
| ✓ | $4188 | 80+ | |
| ✓ | $375 | 85 | |
| ✓ | $700 | 129 |
20 providers include this biomarker in their panels
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.
