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High Alkaline Phosphatase Symptoms & How to Reduce It

Written by Puya Yazdi, MD | Last updated:
Ana Aleksic
Evguenia Alechine
Medically reviewed by
Ana Aleksic, MSc (Pharmacy), Evguenia Alechine, PhD (Biochemistry) | Written by Puya Yazdi, MD | Last updated:

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Intestinal Alkaline Phosphatase is Found on the Cells that Line the Gut as Well as Inside the Gut and the Gut Immune Cells, source: https://www.ncbi.nlm.nih.gov/pubmed/25400448
Image source: https://www.ncbi.nlm.nih.gov/pubmed/25400448

Alkaline phosphatase is an enzyme found in all tissues in the human body. In balance, it protects your gut against harmful bacteria and aids digestion. However, high blood levels usually point to liver or bone problems. Read on to understand the symptoms and causes of high alkaline phosphatase and how to reduce it naturally.

What Does High Alkaline Phosphatase Mean?

The normal range of alkaline phosphatase in the blood is 20 to 140U/L, although this can vary from lab to lab. Children and pregnant women can have significantly higher levels of the enzyme in their blood [1].

Values above 130 U/L are usually considered to be high.

Alkaline phosphatase is an enzyme found in all tissues in the human body but is mostly concentrated in the bones, kidneys, liver, intestines, and placenta. It exists in different forms, depending on where it originates [1].

Its major function is to protect your intestinal tract against bacteria, aid in digestion, breakdown fats and some B vitamins, and promote bone formation [1].

High levels of ALP in the blood may indicate bone, liver, or bile duct disease.

ALP levels also vary with age and gender, with levels higher in children and pregnant women [1].

Higher ALP levels can occur in people with blood group B or blood group O [2].

In balance, ALP supports good health. In excess or deficiency, this enzyme can lead to a broad range of diseases [3].

When the liver is not functioning properly, ALP is released into the bloodstream. Additionally, any condition that affects bone growth or causes the increased activity of bone cells can increase ALP levels in the blood. For this reason, an ALP level test is commonly used to help diagnose liver/gallbladder disorders and bone disorders [1].

Note: Lab results are commonly shown as a set of values known as a “reference range”, which is sometimes referred to as a “normal range”. A reference range includes the upper and lower limits of a lab test based on a group of otherwise healthy people.

Your healthcare provider will compare your lab test results with reference values to see if your chloride results fall outside the range of expected values. By doing so, you and your healthcare provider can gain clues to help identify possible conditions or diseases.

Remember that some lab-to-lab variability occurs due to differences in equipment, techniques, and chemicals used. Don’t panic if your result is slightly out of range – as long as it’s in the normal range based on the laboratory that did the testing, your value is normal.

However, it’s important to remember that a normal test doesn’t mean a particular medical condition is absent. Your doctor will interpret your results in conjunction with your medical history and other test results.

And remember that a single test isn’t enough to make a diagnosis. Your doctor will interpret this test, taking into account your medical history and other tests. A result that is slightly low/high may not be of medical significance, as this test often varies from day to day and from person to person.

High alkaline phosphatase (above 130 U/L) may point to liver, gallbladder, or bone disorders.

Symptoms of High Alkaline Phosphatase

The symptoms we discuss here are commonly associated with high alkaline phosphatase levels, but are not enough for a diagnosis. Work with your doctor to discover what underlying condition might be causing high alkaline phosphatase levels and to develop an appropriate plan to improve your health.

When caused by liver disease, symptoms of high ALP include [4, 5]:

  • Itching
  • Nausea and vomiting
  • Weight loss
  • Fatigue
  • Weakness
  • Jaundice
  • Swelling and pain in your stomach
  • Dark-colored urine and/or light-colored stool

Symptoms caused by bone disorders include [6]:

  • Bone or joint pain
  • Enlarged or abnormally shaped bones
  • Higher frequency of bone fractures
Symptoms of high alkaline phosphatase depend on your underlying health condition — such as liver disease or bone disorders.

Causes of High Alkaline Phosphatase

While alkaline phosphatase may not necessarily cause harm to the body itself, elevated levels are associated with cancer, bone, liver, and kidney diseases [7].

Additionally, lifestyle factors, medication, and certain supplements can raise alkaline phosphatase levels. Work with your doctor to find out what causes your high alkaline phosphatase levels.

1) Birth control pills

Birth control pills can increase alkaline phosphatase to many times the level of a normal range [8].

2) Exercise

Exercise increases bone alkaline phosphatase levels after thirty and fifty minutes of moderate to intensive exercise in male cyclists, but it quickly returns to normal [9].

3) Thyroid Hormones 

Thyroid hormones stimulate alkaline phosphatase [10, 11]. Increased alkaline phosphatase levels are also correlated with hyperthyroidism [12].

Taking birth control pills, having high thyroid hormones, and exercising shortly before doing a blood test can increase your alkaline phosphatase levels.

4-5) Efavirenz and Cissus quadrangularis

Efavirenz, an anti-HIV drug, is associated with increased alkaline phosphatase levels in HIV patients. The high enzyme levels also associated with increased bone turnover and Vitamin D deficiency [13].

Cissus quadrangularis, a type of plant from the grape family, significantly increases alkaline phosphatase activity in cell culture. It also increases bone mineralization, which is likely due to the increased enzyme function [14].

An anti-HIV drug (efavirenz) and the herb Cissus quandrangularis both increase alkaline phosphatase.

6) Estrogen and Testosterone Metabolites

Estrogen, 5 alpha-DHT, and dehydroepiandrosterone (different types of hormones) can increase the enzyme’s activity (not the level in the blood) in human endometrial cancer cell lines [15].

Estrogen is also able to regulate the growth and expression of this enzyme in human bone marrow cell culture [16].

High levels of estrogen and testosterone breakdown products may increase the activity of alkaline phosphatase without affecting its blood levels.

7) Biliary Obstruction and Liver Cancer

High liver alkaline phosphatase levels are associated with bile duct obstruction and liver cancer. The presence of liver alkaline phosphatase in patients may indicate the presence of a tumor in the bile duct [17].

8) Colon Cancer

Alkaline phosphatase levels are frequently high in patients with metastatic colon cancer. Increasing alkaline phosphatase levels are correlated with an increased cancer stage and may indicate that cancer has spread to the liver [18].

9) Breast Cancer

Women with breast cancer had elevated levels of alkaline phosphatase compared to normal healthy women. The increase of enzyme activities also indicates that the cancer is metastatic and spread to either the bone or liver [19, 20].

10) Leukemia

Leukemia patients, especially untreated ones, have high alkaline phosphatase levels. The placenta alkaline phosphatase level is a useful biomarker to help diagnose and treat leukemia [21].

People with blocked bile flow and various types of cancers are more likely to have high alkaline phosphatase levels.

11) Alzheimer’s

Alzheimer’s patients have higher tissue-nonspecific alkaline phosphatase levels compared to healthy patients. The higher the alkaline phosphatase activity, the lower the brain function [22].

12) Paget’s Disease

Paget’s disease is a common disorder that affects bone strength and formation. Abnormally high levels of bone alkaline phosphatase can be an indicator of bone turnover, so while the enzyme does not cause the disease, it can be a helpful indicator [23].

13) Vitamin D Deficiency

Vitamin D deficiency is usually accompanied by elevated levels of total alkaline phosphatase in the blood. However, it is not the best indicator of vitamin D deficiency [24].

Alzheimer’s disease, Paget’s disease, and vitamin D deficiency may all underlie high alkaline phosphatase levels.

14) Heart Disease

Elevated alkaline phosphatase levels are associated with a higher risk of heart disease.

In a prospective study of more than 3,000 elderly men, the higher alkaline phosphatase levels predict higher risks of heart attacks, strokes, and increase mortality [25].

15) Liver Problems Associated with Celiac Disease

Celiac disease is an autoimmune condition where the immune system attacks the gut lining upon gluten consumption. In cases of uncontrolled celiac disease where the patients continue to consume gluten, other liver and biliary tract disorders can occur. Elevated alkaline phosphatase levels are associated with these two disorders [26].

Heart disease and liver damage from celiac disease have been linked with high alkaline phosphatase levels.

16) Sickle Cell Anemia

Sickle cell anemia is associated with high levels of alkaline phosphatase. The higher alkaline phosphatase levels correlate with worsened bone and other tissue damage in sickle cell anemia patients [27, 28].

In patients with sickle cell disease, higher levels of alkaline phosphatase are associated with vaso-occlusive crises involving the bones [28].

17) Epilepsy

Epileptic children have higher alkaline phosphatase levels compared to children without the disorder [29].

People with sickle cell anemia and children with epilepsy are more likely to have high alkaline phosphatase levels.

18) Genetic Factors

Different genes encode human alkaline phosphatases, i.e. [1]:

  • ALPP for the alkaline phosphatase in the placenta
  • ALPL (also called TNAP for Tissue Non-Specific Alkaline Phosphatase) for the alkaline phosphatase in the liver, bone, and kidney

Go to SelfDecode to learn how your genes can influence your alkaline phosphatase levels.

Your genes may have an effect on your alkaline phosphatase levels, though more research is needed to determine their impact.

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How to Reduce Alkaline Phosphatase

If your phosphatase alkaline levels are too high, discuss with your doctor what underlying health conditions are causing them and what strategies may help you lower them. Never implement them in place of what your doctor recommends or prescribes.

1) Support Your Liver

If your alkaline phosphatase levels are high because you have liver damage, you may look into natural ways to support the health of your liver. Your liver has the capacity to regenerate. Talk to your doctor about how to improve your liver health and read our 6-step protocol for liver regeneration. In a nutshell, you should take targeted liver-protective herbs and nutrients while adapting your diet and reducing alcohol intake.

Consider liver-protective supplements like:

Vegetables like broccoli [30], onions [31], dandelion greens, cabbage, cauliflower and Brussels sprouts [32] also have a cleansing effect on the liver.

Here is a list of all foods and supplements that are good for your liver.

If your alkaline phosphatase is high due to a liver disorder, the number one step you should take is to protect and support your liver with nutrients and healthy lifestyle changes such as reducing your alcohol intake

2) Omega-3 Fatty Acids

Omega-3 fatty acids reduce the levels of intestinal alkaline phosphatase, whereas omega-6 fatty acid increases the level of intestinal alkaline phosphatase in the gut [33].

3) Stop Smoking

Stop smoking, as it can increase ALP levels [34].

To lower your alkaline phosphatase levels, you may stop smoking and get more omega-3s in your diet.

4) Coffee

Coffee intake is linked to lower ALP levels. Remember to stick to a moderate consumption to avoid unwanted effects such as high blood pressure and sleep disturbances [35].

5) Cinacalcet

Cinacalcet, a drug for chronic kidney disease, can reduce blood alkaline phosphatase levels by more than twenty percent in patients after 26 weeks of administration. This drug should be prescribed by a doctor and taken as recommended [36].

6) Resistance Exercise

In untrained male subjects, one single bout of resistance exercise can cause bone ALP activity to significantly decrease two and three days after the exercise [37].

7) Sun Exposure/Vitamin D

Since vitamin D deficiency has been linked with high alkaline phosphatase, be sure to check your levels. If you are deficient, get more sun and/or take vitamin D supplements. Reasonable sun exposure is a better way to increase your vitamin D levels than supplements.

Get more sun, exercise, and consider upping your coffee intake to lower your alkaline phosphatase.


Alkaline phosphatase is an enzyme that helps you digest food and maintain strong bones. It’s concentrated in the liver, kidneys, gut, and bones. High levels may point to problems with these organs. Alkaline phosphatase is high if the blood levels surpass 130 U/L. High alkaline phosphatase doesn’t cause any symptoms directly. The symptoms will depend on your underlying health issue–such as liver or bone disorders. If your levels are high due to liver disease, you may want to take supplements and nutrients that will help your liver regenerate. Some good options include milk thistle, NAC, taurine, B vitamins, and vitamin C. Additionally, get enough sun, exercise, omega-3 fatty acids, and coffee. Reduce alcohol and stop smoking — they both lower alkaline phosphatase levels and support good health. Always talk to your doctor about any lifestyle and dietary interventions that you plan to implement.

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About the Author

Puya Yazdi

Puya Yazdi

Dr. Puya Yazdi is a physician-scientist with 14+ years of experience in clinical medicine, life sciences, biotechnology, and nutraceuticals.
As a physician-scientist with expertise in genomics, biotechnology, and nutraceuticals, he has made it his mission to bring precision medicine to the bedside and help transform healthcare in the 21st century. He received his undergraduate education at the University of California at Irvine, a Medical Doctorate from the University of Southern California, and was a Resident Physician at Stanford University. He then proceeded to serve as a Clinical Fellow of The California Institute of Regenerative Medicine at The University of California at Irvine, where he conducted research of stem cells, epigenetics, and genomics. He was also a Medical Director for Cyvex Nutrition before serving as president of Systomic Health, a biotechnology consulting agency, where he served as an expert on genomics and other high-throughput technologies. His previous clients include Allergan, Caladrius Biosciences, and Omega Protein. He has a history of peer-reviewed publications, intellectual property discoveries (patents, etc.), clinical trial design, and a thorough knowledge of the regulatory landscape in biotechnology. He is leading our entire scientific and medical team in order to ensure accuracy and scientific validity of our content and products.

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