Most people with abnormal ALP levels have high, rather than low, levels.
Causes of high ALP levels
The ALP level reference range for adults aged 18 years and older is 30-130 IU/l, according to the NHS. Therefore, some healthcare professionals may consider ALP levels over 130 IU/l as high.
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However, reference ranges vary between labs and can depend on individual factors, so a person should speak with a doctor before interpreting their results. A doctor may not consider ALP levels to be high unless they are significantly more than the upper limit of the reference range.
Elevated ALP levels are generally a sign of a liver or bone condition. An obstruction of the liver or damage to it causes ALP levels to rise. Elevated levels can also result from an increase in bone cell activity.
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High ALP levels may stem from:
- cirrhosis, which is scarring of the liver
- hepatitis
- mononucleosis, or mono, which can cause swelling of the liver
- a blockage in the bile duct
Elevated ALP levels can also occur in people with:
- a bacterial infection
- osteomyelitis, an infection that causes bone pain
- bile duct damage
- a decrease in bile flow
- overactive parathyroid or thyroid glands
- osteomalacia, which is softening of the bones
- Paget’s disease, which can cause bones to become unusually large, weak, or prone to fracture
- myeloid metaplasia, which can cause bone marrow to be replaced by fibrous tissue and blood to be made in the organs
- heart failure
- AIDS
- Hodgkin lymphoma, a cancer of the lymphatic system
- osteogenic sarcoma, a bone cancer
- certain other cancers
- bone metastasis, which involves cancer cells spreading to bone
Malnutrition can also lead to high ALP levels.
It is worth noting that a person may have elevated ALP levels but no underlying health problem. ALP levels may be naturally higher in:
- pregnant people
- growing children and adolescents
- older adults
- people with healing fractures
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Intestinal ALP levels may also increase in people with blood types O and B after they have eaten a fatty meal. In addition, certain drugs can cause ALP levels to vary.
Causes of low ALP levels
According to the NHS, the ALP level reference range for adults aged 18 years and older is 30-130 IU/l. Therefore, healthcare professionals may consider ALP levels under 30 IU/l to be low. However, these ranges vary between labs and can depend on individual factors, so a person should discuss their results with a doctor.
There are various causes of low ALP levels, including:
- zinc deficiency
- an underactive thyroid, or hypothyroidism
- pernicious anemia — an autoimmune condition
- hypophosphatasia — a rare genetic disorder that affects the bones and teeth
- Wilson’s disease — a rare condition that causes a buildup of copper inside body tissues
- malnutrition
In addition, some medications, such as birth control pills, can lower ALP levels.
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