Alkaline Phosphatase (ALP)

What Is ALP?

Alkaline phosphatase is an enzyme which is found in several tissues of the body but predominantly the liver and bone. Smaller amounts can be found in the kidney, intestines and the placenta in pregnant women. However, each tissue produces different types of alkaline phosphatase known as isoenzymes.

Which tests include this marker?

What Role Does It Play in The Body?

Elevated levels of ALP in the blood can indicate bone turnover and/or liver disease. It may also be a sign that the bile ducts are blocked, possibly due to gallstones. Increased ALP can occur when there is bone formation occurring, so children naturally have transiently increased ALP as they grow and develop. In adults, this may signify bone disease, hyperparathyroidism (a disease which can affect calcium levels in the blood), vitamin D deficiency or damage to liver cells. High levels may also be caused by the healing of bone fractures and pregnancy. [1]

Reduced levels of ALP, on the other hand, are less common. Diseases such as magnesium deficiency, hypothyroidism, some anaemias, osteoporosis, malnutrition and myelogenous leukaemia can all cause decreased levels of blood alkaline phosphatase levels. Oral contraceptives may also reduce ALP levels in females. [1]

How Does ALP Affect My Wellbeing?

Increased ALP levels can be a sign of liver injury which can produce flu-like symptoms in severe cases. It may also be bone in origin caused by conditions such as vitamin D deficiency, you may experience muscular weakness, be more susceptible to illness, depression and feel fatigued. [2] These symptoms may also be true if your ALP levels are reduced too. For example, if the reduction is due to malnutrition, anaemia or osteoporosis, symptoms may include pain, weakness, depression, fatigue, delirium or generally feeling unwell. You may also notice that your energy levels feel low and you have no desire to carry out your normal daily activities.

How Can I Improve My Result?

An ALP test is usually carried out alongside other liver function tests to give an indication of how well your liver is working.


Ensure you are getting a good range of food types in your diet. If you haven’t already, you should increase the amount of fruit, vegetables and wholegrains you consume. For a healthy liver, you should keep your alcohol intake within the recommended guidelines of 14 units per week.

If your ALP levels are increased due to vitamin D deficiency, you can get vitamin D from the sun or from supplements. So, you should spend some time outdoors to ensure you get enough, particularly in the summer months.

However, in the UK more than half of the adult population have insufficient levels of vitamin D. [3] This can be prevented through supplementation. Public Health England recommends that all adults and children over the age of one should consider taking a daily supplement of vitamin D. This may be solely a vitamin D supplement or a daily supplement but should contain at least 10mcg of vitamin D. [4]


There is evidence that there are significant benefits of regular exercise on overall fitness, the cardiovascular system, health-related quality of life and nutritional parameters, particularly in those with kidney disease.  [5]

However, exercise has major benefits for our wellbeing too. Exercise can help to reduce the symptoms of depression, self-esteem and anxiety. We should all aim for around 150 minutes of aerobic exercise per week. Activities may include jogging, walking, swimming, cycling, exercise classes, sports matches or tennis.

Tests that include this marker

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[1] Sharma, U., Pal, D and Prasad, R. (2014). Alkaline Phosphatase: An Overview. Indian Journal of Clinical Biochemistry: 29(3), pp 269-278.

[2] Holick, M, F and Chen, T, C. (2008). Vitamin D Deficiency: A Worldwide Problem with Health Consequences. American Journal of Clinical Nutrition: 87, pp 1080S-1086S.

[3] Pearce, S, H, S and Cheetham, T, D. (2010). Diagnosis and Management of Vitamin D Deficiency. BMJ: 340.

[4] National Health Service. (2016). The New Guidelines on Vitamin D – What You Need to Know. Available at:


[5] Heiwe, S and Jacobson, S, H (2011). Exercise Training for Adults with Chronic Kidney Disease (Review). Cochrane Database of Systematic Reviews: 10.

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