Alkaline Phosphatase

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ALKALINE PHOSPHATASE

Alkaline Phosphatases are a group of enzymes found primarily the

liver (isoenzyme ALP-1) and bone (isoenzyme ALP-2). There are also

small amounts produced by cells lining the intestines (isoenzyme ALP-

3), the placenta, and the kidney (in the proximal convoluted

tubules). What is measured in the blood is the total amount of

alkaline phosphatases released from these tissues into the blood. As

the name implies, this enzyme works best at an alkaline pH (a pH of

10), and thus the enzyme itself is inactive in the blood. Alkaline

phosphatases act by splitting off phosphorus (an acidic mineral)

creating an alkaline pH.

The primary importance of measuring alkaline phosphatase is to check

the possibility of bone disease or liver disease. Since the mucosal

cells that line the bile system of the liver are the source of

alkaline phosphatase, the free flow of bile through the liver and

down into the biliary tract and gallbladder are responsible for

maintaining the proper level of this enzyme in the blood. When the

liver, bile ducts or gallbladder system are not functioning properly

or are blocked, this enzyme is not excreted through the bile and

alkaline phosphatase is released into the blood stream. Thus the

serum alkaline phosphatase is a measure of the integrity of the

hepatobiliary system and the flow of bile into the small intestine.

In addition to liver, bile duct, or gallbladder dysfunction, an

elevated serum alkaline phosphatase can be due to rapid growth of

bone since it is produced by bone-forming cells called osteoblasts.

One would expect that growing children have higher levels than full-

grown adults. The relationship of alkalinity to bone development

warrants further discussion because it plays a major role in the

prevention and reversal of osteoporosis. Just as calcium builds up

around faucets, so is calcium laid down into bone. The reason the

calcium deposits on your faucet is because the water is alkaline and

calcium comes out of solution and crystallizes in an alkaline

environment. The reverse is also true, " Lime -Away " , vinegar, or any

other acidic solution dissolve the calcium deposits because they are

acidic. It makes sense that osteoblasts by creating a local

environment of alkalinity via alkaline phosphatase helps build bone.

It also implies that in order to slow bone loss, one can not be in an

acidic state. Studies have shown that giving bicarbonate of potassium

is just as effective as calcium in correcting osteoporosis! One would

expect then that in an acidic state, the body will compensate for

this by increasing the bone alkaline phosphatase levels…

Because acid-alkaline is influenced by many other glands, the

implications of serum alkaline phosphatase levels must consider more

than just bone and liver function. Associated organs/glands include

adrenals, uterus, prostate, and intestine.

The consequences of impaired bile flow are pervasive since bile is

critical to your body's ability to process fats. As a result, fats

remain undigested in the digestive tract and can cause bloating,

cramps, light colored stools, gaseousness, etc. especially after a

rich food. Many patients report pressure or pain in the right upper

area of their abdomen where the liver and gallbladder are located.

You may have discomfort in the right shoulder or between your

shoulder blades anywhere from your mid-back to the base of your neck.

Many people say they " carry my stress in the upper back and neck. "

This may due to gallbladder dysfunction. Unfortunately, a normal

alkaline phosphatase does not exclude hepatobiliary dysfunction. In

many cases, even the ultrasound shows no gallstones, etc. Rather the

problem is that the bile does not flow freely throughout the system,

which may result in insufficient bile action.

The consequences of impaired bile function involves the endocrine

system in a major way because all of the steroid hormones are

metabolized in part by the liver. These include the sex hormones

(androgens and estrogens). As a result the menstrual cycle, sexual

functions and sex characteristics can be affected.

The optimal range for alkaline phosphatase depends on your age. A

growing adolescent will have a much higher alkaline phosphatase than

a full grown adult because his/her osteoblasts are laying down bone

very rapidly. For an adult, 50-80 mg/dl I consider a reasonable

range.

An increased serum Alkaline Phosphatase may be due to:

Congestion or obstruction of the biliary tract, which may occur

within the liver, the ducts leading from the liver to the

gallbladder, or the duct leading from the gallbladder through the

pancreas that empty into the duodenum (small intestine). Any of these

organs (liver, gallbladder, pancreas, or duodenum) may be involved.

See serum liver enzyme tests for more about causes of liver

dysfunction.

Rapid bone growth such as after a fracture, bone cancers like

osteogenic sarcoma, Osteomalacia, and Paget's Disease.

Over-activity of the Parathyroid glands.

Vitamin D deficiency (rickets).

Sarcoidosis.

Rheumatoid arthritis.

As a normal part of late pregnancy since the placenta produces

alkaline phosphatase.

Certain cancers such as Hodgkin's Lymphoma.

Ulcerative colitis.

Acute tissue damage in the heart or lungs (myocardial or pulmonary

infarctions).

An elevated alkaline phosphatase almost always requires other tests

to determine the origin of the condition. For example, liver enzyme

tests to check the integrity of the liver, x-rays or other bone

images if a bone abnormality is evident. Although not used often, the

isoenzyme profile of alkaline phosphatases can be determined to see

if the elevation of alkaline phosphatase came primarily from liver

(ALP-1), bone (ALP-2), or elsewhere. Most often, however there is a

modest elevation from ideal but the actual value is within the

laboratories reference range and the origin is inferred from the

symptoms, exam, or existing lab results.

A decreased serum alkaline phosphatase may be due to:

Zinc deficiency.

Hypothyroidism.

Vitamin C deficiency/Scurvy.

Folic acid deficiency.

Excess Vitamin D intake.

Low phosphorus levels (hypophosphatasia)

Celiac disease.

Malnutrition with low protein assimilation.

Insufficient Parathyroid gland function.