Have you recently had a blood test? When you see the ALP value among the letters and numbers, you may have thought, 'What is this?' Don't worry, many people feel the same way. It's normal. Today, let's talk about what this ALP test is, why doctors check it, and what changes in its values really say about our health.
First, let's see, what is alkaline phosphatase (ALP)?
Simply put, alkaline phosphatase, or ALP as we're talking about, is an enzyme in our body. It's like a little worker inside our bodies. This worker is mainly found in our liver and bones . In addition, small amounts are found in our digestive system, kidneys, and even the placenta during pregnancy.
Although scientists are still not 100% sure, it is believed that this ALP enzyme performs many important functions in our bodies. For example, ALP helps build strong tissues like bones and teeth, and helps move things like phosphate around in the intestines.
The relationship between fatty liver and ALP
ALP is one marker used to diagnose fatty liver disease. However, it is not the only marker that can diagnose the condition. There are two main types of fatty liver disease:
- Metabolic-associated steatotic liver disease (MASLD): This is caused by a buildup of fat in the liver due to factors such as high cholesterol, type 2 diabetes, insulin resistance, or a body mass index (BMI) greater than 30.
- Alcoholic fatty liver disease: As the name suggests, this is caused by drinking too much alcohol over a long period of time.
Doctor, why are you asking me to do an ALP test?
There are several reasons why your doctor may order an ALP test. Most often, this is done to confirm whether you have liver damage or a bone disease.
Sometimes, this ALP test is included as part of the ``comprehensive metabolic panel (CMP)`` that we usually do during an ``annual health checkup``, or as part of the ``liver panel`` that checks liver function.
But keep this in mind. You can't make a final decision about a serious illness just by looking at the ALP test result. It's like the first clue on the journey to find the disease. To know exactly what's going on, more tests and medical examinations are needed.
If you are constantly taking medications that can affect the liver (e.g. paracetamol, cholesterol-lowering statins), your doctor may also regularly perform an ALP test to check if those medications are affecting your liver.
When the report comes in... How do you understand the ALP values?
The report is usually received within a day or two. The normal range for ALP can vary slightly from one lab to another. Typically, this value is between 44-147 IU/L (international units per liter). Your report will also state what their normal range is.
If the ALP value is elevated...
A slightly higher ALP level than normal is not a sign of a serious illness. ALP levels can also be elevated due to some common and natural causes .
- Growing children and young adults: Because their bones are growing rapidly, ALP levels are naturally high.
- Pregnancy: During pregnancy, ALP can increase up to three times the normal value because the placenta produces it.
- Aging: ALP levels may also increase slightly as you age.
- When a bone fracture heals: When a bone is broken, ALP temporarily increases as it heals.
- Eating a high-fat meal before the test: For some people, eating a high-fat meal before the test can increase ALP levels.
- Smoking.
However, some medical conditions can also cause ALP levels to rise significantly.
| Affected organ | Diseases that can cause ALP to rise |
|---|---|
| Liver |
|
| Bones |
If the ALP value is low...
It is very rare to see ALP levels decrease rather than increase. Possible causes include:
- Deficiency of minerals such as zinc or magnesium.
- Decreased function of the thyroid gland (Hypothyroidism).
- Hypophosphatasia (HPP) is a rare genetic disease.
- Wilson's disease.
- Some medications (e.g. birth control pills).
What are the symptoms of a change in ALP levels and what to do next?
In most cases, there are no specific symptoms of an altered ALP level. However, symptoms may occur depending on the underlying medical condition causing it.
| Liver-related symptoms | Bone-related symptoms |
| :--- | :--- |
| Yellowing of the eyes and skin (jaundice) | Pain in the bones and joints |
| Dark urine and light stools | Easy bone breakage |
| Itching | Joint swelling and inflammation |
| Nausea and vomiting | Bone deformity |
| Loss of appetite and extreme fatigue | |
| Stomach pain or bloating | |
What to do next?
If your ALP level is abnormal, your doctor will order several more tests to determine the exact cause.
1. Repeating the test: You may be asked to fast for 10-12 hours and then take the test again.
2. ALP isoenzyme test: This can accurately distinguish whether the increased ALP is from the liver or from the bones.
3. GGT test: `Gamma-glutamyl transpeptidase (GGT)` is an enzyme that is more specific to the liver. If GGT is also elevated along with ALP, it is more likely that the problem lies in the liver.
4. Other tests: In addition, imaging studies or, if necessary, a biopsy may be performed to remove a small piece of tissue from the liver.
Preparing for the test and its process
This is very simple and can be completed in a few minutes.
- Preparation: Your doctor will probably advise you not to eat or drink anything except water for 10-12 hours before the test. It is important to tell your doctor about all medications, vitamins, and supplements you are taking. It is also important to tell your doctor if you are pregnant.
- Procedure: At the lab, they find a vein in your arm, clean the area, make a small puncture and take just a little blood. It feels like a small prick, but it's not too painful. Then they put a small plaster on the area. That's it.
Take-Home Message
- ALP is an enzyme found mainly in your liver and bones.
- An abnormal ALP value in a blood report is not a final diagnosis, it is just a clue on the way to finding a disease.
- It is common for ALP levels to be elevated in growing children, pregnant mothers, and those who are healing from a fracture.
- If your ALP level is abnormal, don't be afraid to see your doctor. He or she will refer you for additional tests to find the exact cause.
- If you have symptoms like yellowing of the eyes or bone pain, don't ignore them. Seek medical advice immediately.
- Discuss any questions or concerns you have about your blood report openly with your doctor.
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