At some point in our lives, most of us have gone to the doctor's office, had blood drawn for lab testing, and anxiously awaited the results. One of these common lab tests evaluates the levels of a compound known as alkaline phosphatase.
Today we’re going to explore exactly what role alkaline phosphatase plays in our bodies, what it means if your levels are too low, and most importantly – exactly what you can do to help restore your alkaline phosphatase levels back to normal. Let’s dive in.
What Is Alkaline Phosphatase?
Alkaline phosphatase is a type of molecule known as an enzyme – a type of protein that accelerates chemical reactions within your body.1 Alkaline phosphatase can be found scattered throughout your body but is primarily concentrated in your liver, kidneys, bones, digestive tract, and in the placenta in pregnant women.
Researchers are still working to fully understand the exact functions of alkaline phosphatase, but we do know that this enzyme plays an important role in things like:2,3
- Bone calcification and mineralization
- Cellular growth and movement
- Digestion and gut microbiome balance
- The breakdown and distribution of fats and certain vitamins
While we may not fully understand how alkaline phosphatase functions in the body, we do know that abnormal levels can indicate an underlying problem.
What Are Normal Alkaline Phosphatase Levels?
What’s classified as a normal range for alkaline phosphatase can vary slightly from lab to lab. Some labs set the normal range from 44 to 147 international units per liter (IU/L), while others use the range of 30 to 120 IU/L.4
Elevated alkaline phosphatase levels can indicate a number of underlying issues that range in severity from minimal to quite serious. High alkaline phosphatase has been linked to:5,6
- Liver issues like cirrhosis, hepatitis, or another underlying infection
- Blocked bile ducts
- Cancer
- Overactive thyroid or parathyroid
Elevated levels of alkaline phosphatase are much more common than low levels of this enzyme. But low levels can also be indicative of an underlying problem.
Should I Be Concerned If My Alkaline Phosphatase Is Low?
Having an alkaline phosphatase level that falls out of the normal range – either too high or too low – doesn’t always mean there is cause for concern. There are a number of factors that can impact your alkaline phosphatase levels such as:7
- Some medications (like birth control pills)
- Your dietary habits
- Whether or not you’re pregnant
- Your age – children and teenagers often have higher levels because their bones are still growing
- Issues with your immune system
So if your alkaline phosphatase levels are low or falling outside the normal range, it’s important to look at the bigger picture and determine if there are other factors that may be influencing your results. If you do have abnormal levels, your doctor will likely run other diagnostic tests and conduct a thorough assessment to get a better picture of your health.
With that being said, low alkaline phosphatase levels can be a clue that there’s some imbalance that may need to be addressed.
Causes of Low Alkaline Phosphatase
Low alkaline phosphatase levels typically indicate one or more of the following underlying issues:8,9
- Malnutrition – typically a protein deficiency
- Zinc deficiency
- Magnesium deficiency
- Anemia
- Vitamin B12 deficiency
- Hypothyroidism – or an underperforming thyroid
- Excessive supplementation of vitamin D
Occasionally, low alkaline phosphatase levels can indicate rare genetic conditions like:8,9
- Hypophosphatasia – a genetic disorder that impairs bone growth and mineralization
- Wilson disease – a genetic disorder that causes the accumulation of copper in the liver and other organs
The treatment for rare genetic conditions associated with low alkaline phosphatase levels requires a unique and in-depth treatment path. However, the good news is, addressing the more common causes of low alkaline phosphatase can be much more straightforward.
How to Increase Alkaline Phosphatase
If your alkaline phosphatase levels are below normal, there are several lifestyle factors you can tweak to help restore your levels back to a healthy baseline. Here’s what I recommend:
Evaluate for Underlying Digestive Issues
First and foremost, it’s crucial to find out if you have an underlying disruption in your ability to break down and absorb nutrients that may be causing malnutrition and vitamin deficiencies. Celiac disease and other inflammatory bowel conditions are notorious for hindering nutrient absorption and can be a major contributing factor to low alkaline phosphatase levels.
If you’re unfamiliar with exactly what Celiac disease and inflammatory bowel conditions are, I encourage you to head over and read my article Crohn’s vs. Ulcerative Colitis vs. Celiac: A Fascinating Look at Their Differences. And if you’re concerned that you may have an undiagnosed digestive problem, I encourage you to seek out the guidance of an experienced Functional Medicine Practitioner to help you pinpoint and treat the root of the problem.
Keep Your Gut Happy and Healthy
Even if you don’t have an underlying inflammatory bowel condition, if your gut is inflamed and not running on all cylinders it can hinder your ability to properly absorb nutrients. So giving your tummy the support it needs to function properly is important. Here’s what I suggest:
- Incorporate a daily probiotic to regularly reinoculate your gut with friendly beneficial bacteria.
- Add in some gut-healing supplements like Collagen Boost and Gut Immune to bolster the integrity of your gut lining and enhance nutrient absorption.
- Get plenty of fiber (like that found in Bind Aid) to ensure you’re having regular bowel movements.
Equally as important as keeping your gut healthy, is ensuring you have plenty of nutrients to correct any imbalances.
Prioritize A Nutrient-Dense, Well-Rounded Diet
Getting plenty of nutrients – especially protein, zinc, magnesium, and vitamin B – is crucial when it comes to restoring healthy alkaline phosphatase levels. Focus on building the majority of your meals around:
- High-quality protein: When possible, opt for higher-quality animal products like grass-fed beef, wild-caught fish, pasture-raised pork or chicken, and/or wild-harvested game. Or if you don’t prefer animal-sourced protein, you can add in a tasty daily protein shake with my Plant Protein Complete formula that’s available in both chocolate and vanilla.
- Healthy fats: Like olive oil, avocado, fattier cuts of meat, nuts, and grass-fed butter or ghee.
- A wide variety of vegetables and fruits: Try to incorporate fresh fruits and veggies into every meal and aim to “eat the rainbow” by mixing in a variety of different and tasty foods. If you need help coming up with ways to incorporate more fruits and veggies, head over and check out my library of delicious and healthy recipes right here.
- Filtered water: Ensure that the water you drink is pure and free of harmful toxins and contaminants. Investing in a quality water-purification system like Clearly Filtered or Boroux Water Filters is an easy way to ensure you’re getting pure clean water.
Eating a nutrient-dense, well-rounded diet is the foundation of restoring any nutrient deficiencies you might have. But sometimes we can all use a little extra boost in the form of some strategic supplementation.
Incorporate Supplements
If you have low alkaline phosphatase levels, chances are you have some sort of nutrient deficiency. Supplements are a simple and powerful way to get a concentrated dose of nutrients to help your body “catch up” a little faster. With low alkaline phosphatase levels, you’ll likely want to incorporate:
- Magnesium
- Mineral Essentials (to restore a multitude of minerals)
- Thyroid Boost (to support your thyroid)
- Vitamin B Complex
- Zinc
Adding in a handful of supplements can significantly speed up your ability to bounce back and restore your alkaline phosphatase levels back to normal.
So, How Worried Should I Be About Low Alkaline Phosphatase?
It’s possible that we may begin seeing more and more cases of low alkaline phosphatase levels . Thanks to our modern agricultural practices, cultural dietary habits, and fast-paced lifestyles, we live in a world where it’s easy to find a surplus of calories while still having a deficiency in true nutrition.
So if you’ve gotten lab results that show you have low alkaline phosphatase levels, the first step is to work with an experienced doctor (ideally one who specializes in Functional Medicine) to help you rule out any serious underlying issues. From there, the good news is, some simple lifestyle tweaks can have a monumental impact on reversing any imbalances you may have.
When it comes to your health, you are in the driver’s seat and have the power to transform your well-being. If you enjoyed this article and are looking for more ways to step into your power and optimize your health, I’ve got hundreds of articles on my blog to help you do just that. And if you want to take it even deeper, you can sign up for my weekly newsletter by entering your name and email address in the form below.
Now it’s time to hear from you. Were you surprised to learn about some of the underlying causes of low alkaline phosphatase (AP)? Have you ever been diagnosed with low AP? And if so, how did you correct it? Leave your questions and thoughts in the comments below!
References:
- Enzyme (genome.gov)
- Alkaline Phosphatase: An Overview (nih.gov)
- Alkaline Phosphatase – StatPearls – NCBI Bookshelf (nih.gov)
- Alkaline Phosphatase (ALP): What It Is, Causes & Treatment (clevelandclinic.org)
- ALP – blood test: MedlinePlus Medical Encyclopedia
- Alkaline Phosphatase: MedlinePlus Medical Test
- Alkaline Phosphatase (ALP): What It Is, Causes & Treatment (clevelandclinic.org)
- Alkaline Phosphatase (ALP): What It Is, Causes & Treatment (clevelandclinic.org)
- Low Alkaline Phosphatase Symptoms, Causes & Meaning – SelfDecode Labs
* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease. The information in this article is not intended to replace any recommendations or relationship with your physician. Please review references sited at end of article for scientific support of any claims made.
30 Comments
I have off and on elevated ALT. Also MTHFR homozygous. I live and eat a very healthy lifestyle and no alcohol. I have researched this issue without much information. My doctor basically ignored the results. Do you have resources that I can use to find out more?
You may want to discuss getting ultrasound imaging of liver and gallbladder and/or MRCP
Thank you for your informative articles. But Is there any info on high alkaline phosphatase? And dysautonomia?
Yes, causes of high all phos are also addressed in the article
I have osteoporosis and my liver enzymes (AST-22/ALT-18) are “normal” but my alkaline phosphatase is either too low or just within range at 43-46. I take magnesium religiously and supplement liver for its choline, vitamin A, copper, b12, folate, b2. I also eat meat, legumes, nuts and seeds for zinc. I have corrected my deficiencies and actively work on making sure I test every six months to stay on top of it. Osteoporosis is tied to inflammation which I had a massive, undetected parasitic infection for years along with mold. Those are treated and now seeing if lyme is a factor. I know all my ‘viruses’ are active. any suggestions other than more minerals to make help increase alp? thank you!
Thank you. I live in medical desert. Wish you could clone yourself. ❤️
My deceased mother, brothers, and I all have low (18 mg) alkaline phosphatase. I am testing for the levels of B 12, copper, magnesium, and Vitamin D. I eat plenty of seeds, have protein consistently, veggies, and fruits. I take a zinc , Dand B supplement. Doctors are not concerned about the low number and tell me that high numbers are to be concerned about. Your thoughts would be most welcome.
Hi Charlene,
This is why I wrote about low levels because there is not a lot of information out there about it. I think it could indicate malabsorption of nutrients like minerals. You might do a micronutrient test to assess through Spectracell or Vibrant labs
warmly
Dr Jill
Thank you so very much for your quick response, I so appreciate it! I will look into getting this test done. What will I be looking for in my results? If I do have malabsorption of nutrients, what is the next step?
Thank you again!!
Charlene
So pleased to find this article. It’s the most informative article I’ve found yet on low alkaline phosphatase! Thank you for taking the time to share your knowledge and give suggestions!
thank you, Gerri!
Dr. Jill,
Excellent article on Alkaline Phosphatase.
I noted two people posted about having a family history of low alkaline phosphatase. This is a strong indicator for hypophosphatasia. A simple vitamin B6 blood test would be the next screen.
I have mild hypophosphatasia. My question is would taking magnesium and zinc help increase my alkaline phosphatase level. Thank you.
Dr. Jill,
Excellent article on Alkaline Phosphatase.
I noted two people posted about having a family history of low alkaline phosphatase. This is a strong indicator for hypophosphatasia. A simple vitamin B6 blood test would be the next screen.
I have mild hypophosphatasia. My question is would taking magnesium and zinc help increase my alkaline phosphatase level. My average ALP is 23 but one year it was 33 and I’m wondering what I did to get it up to that level. Thank you.
Thank you for sharing this, Paul!
I am very thankful for this article, I too have low alk phos and I keep bringing it up to my doc and he doesn’t seem concerned because it’s not high. I think I have malabsorption since I gave up pastas and rice, and sugar and eat lots of veggies and possibly they don’t get absorbed, since I am very gassy.
Thank you for this information. My husband’s levels are only in the 20s and I just found out both of my sons’ levels are in the teens and low 20s. I asked if we should be concerned and my PCP said, “we aren’t concerned when levels are low”. She told me that my sons just have the same liver issues that my husband has. He has high triglycerides and so does one son. My sons also have autism. I am going to begin adding the supplements you suggest. I’d appreciate any advice other than you’ve already suggested if there’s something more I should be doing to help them.
Mine just came back tagged as slightly low. 50 in a range of 53 – 128 IU/L.
I know some labs have varying degrees of “low” which I think I remember you addressed here, so I may not really be an issue, but I have seen other markers that may be attributed to a B12 deficiency and hypothyroid. So may talk to my Doc about those as well.
Thanks for this info!
I do have ulcerative colitis and have done every imaginable diet for the last 11 years. Fiber really helps. I’ve been chronically low in alp for maybe 8+ years, looking back at labs. Also low in other liver/kidney tests and I’ve always thought my liver was struggling, so I just pushed for an ultrasound. “heterogeneous and coarsened
echo features and texture” was a what the tech put and my doctor said “abdominal ultrasound looks fine”, when I messaged her in the portal. She also didn’t understand why I or anyone would check their blood sugar without being diabetic. I told her I run high while fasting but she said my meter must be off. I eat pretty darn well, avoid toxins, take high quality supplements that I’m not sure I’m absorbing…When I went and saw a functional do. 4-5 years ago he thought my liver was having issues bc of ebv and suggested medical medium cleanse/diet.
It’s been so difficult to find answers but I feel like I shouldn’t have fatty liver when I eat good. Last two months I’m back to grain-free vegan…not really sure what diet is best for me but I did seem to get sicker and heavier after being paleo for a couple of years. Hoping my doctor will be open to helping me figure this out and stop brushing it off. 🤞🏻 Appreciate all your info!
Non-alcoholic fatty liver is not driven by poor diet but by intestinal permeability and elevated LPS (lipopolysaccharide) coating of bacteria that leaks into the blood stream and increases risk of fatty liver. If you have inflammatory bowel disease, there is increase hyperpermability of the gut lining which makes sense to increase risks, even if you are eating healthy. You can read more HERE. Recommend treating any dsybiosis and normalizing the gut microbiome to support you fatty liver.
Best in healing
Dr Jill
I have low thyroid & have blood tests and ultra sound every 6 months for last 8 years. All my blood tests come back with extremely low Alk Phos ranging from 8 to the highest 24. It’s 22 atm, my Endo has always said it’s nothing to worry about. My sister has just been tested for thyroid and her reading was 18. I’m now being sent to a specialist to get tested for Hypophosphesia. Appointment is in July.
Be aware that low zinc and low B6 can both contribute to low alkaline phosphatase
Hi, what is considered low ALP? I know in AUSTRALIA its Below 30 U/L ?, but is there a more functional range? should it be higher
US lab ranges optimal above 44IU/L but I prefer 50-120 as optimal
60 male. Male breast cancer survivor but my ALP has consistently has bee low – Date Result Reference Range
9/27/23
40 [iU]/L L
46 – 160 [iU]/L
3/29/23
42 [iU]/L Low
46 – 160 [iU]/L
9/21/22
44 [iU]/L Low
46 – 160 [iU]/L
1/18/22
44 [iU]/L Low
46 – 160 [iU]/L
6/29/21
42 [iU]/L Low
46 – 160 [iU]/L
10/22/20
47 [iU]/L
46 – 160 [iU]/L
6/18/20
48 [iU]/L
46 – 160 [iU]/L
2/20/20
35 [iU]/L
32 – 160 [iU]/L
10/15/19
31 [iU]/L Low
32 – 160 [iU]/L
6/7/19
33 [iU]/L
32 – 160 [iU]/L
2/26/19
36 [iU]/L
32 – 160 [iU]/L
Also Sodium was 146 (H) and chloride was 108.
Consider taking zinc 30-50mg and B6/P5P 50mg for 30-60 days and check to see if alkaline phosphatase improves.
Do you a pattern of low alk phos in your patients with mold toxicity? I have tried to figure out if there is a relationship.
Hi Kristen
It may be associated with low B6 levels but not specifically with mold-related illness
Warmly
Dr. Jill
I’ve had low alkaline phosphate in the 20-30 range for at least a decade. My doctor recently tested the levels in my liver, bones, and I am at 0 in my intestines. I have had gastrointestinal discomfort for a long time and while I’ve had every test, the gastroenterologist has been unable to determine the cause. I am guessing I must be malnourished and have gut issues, which is causing my AP to be at 0 in the intestines, but I can’t seem to figure out what to do to resolve the problems. I eat healthy, exercise regularly and take magnesium, and meds for under active thyroid. I have not been told to take zinc and will try that. What else can I do?
Yes, Kim, this could indicate a deficiency of zinc or vitamin B6. You amy want to test these first or try supplementation for 30-60 days to see if Alkaline phosphatase improves.
Thanks for the article.
I just had a blood test and my levels came as 20.
I recently stopped eating wheat on a regular basis.
My mom used to have osteoporosis though and so her sisters so I am not sure if that’s an indicator.
I am very skin and eat very healthy but maybe not enough so I can see malnutrition to be a reason for this number
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