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Liver

Alkaline phosphatase (ALP): diet, deficiencies and the value

According to the Cleveland Clinic, what someone eats can affect alkaline phosphatase, an enzyme that in the blood comes mainly from the liver and the bones. An enzyme is a protein in a cell that allows certain bodily processes to happen.

According to the Cleveland Clinic, a low alkaline phosphatase may indicate malnutrition or a zinc or magnesium deficiency, and a high value may indicate, among other things, osteomalacia, a bone disease that according to that source develops most commonly due to a vitamin D deficiency. Only a blood test shows how high the value is.

Certe uses less than 98 U/l for women above 19 and less than 115 U/l for men above 19.

Doctor's Assessment Included

Alkaline phosphatase is an enzyme that in the blood comes mainly from the liver and the bones. According to the Cleveland Clinic, a high value may indicate liver disease or a bone disorder, a low value malnutrition, among other things.

  • For alkaline phosphatase, Star-SHL and Unilabs use 45 to 128 U/l for men aged 19 to 50 inclusive and 38 to 123 U/l for women of that age.
  • For alkaline phosphatase, Certe uses less than 115 U/l in men and less than 98 U/l in women above 19; Diagnostiek voor U 40 to 120 U/l above 18.
  • According to the Cleveland Clinic, an isoenzyme test can show whether alkaline phosphatase comes from the liver or the bones.

Reference Ranges

See the value that applies to you:

Choose male or female — this range differs by sex.

Enter your age — this range changes with age.

This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Your reference range
u/l
38 209 u/l
Reference ranges by group, in u/l
Male · 13–18 years 63–190 u/l
63 190
Male · 19–50 years 45–128 u/l
45 128
Male · 51–65 years 46–126 u/l
46 126
Male · 66–80 years 44–134 u/l
44 134
Male · 81 years and older 45–145 u/l
45 145
Female · 6–12 years 107–209 u/l
107 209
Female · 13–18 years 44–149 u/l
44 149
Female · 19–50 years 38–123 u/l
38 123
Female · 51–65 years 48–142 u/l
48 142
Female · 66–80 years 47–138 u/l
47 138
Female · 81 years and older 45–146 u/l
45 146
38 209 u/l

Source: NVKC Reference population: Dutch general-practice population (NUMBER, n = 7,574,327)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

ALP (Alkaline Phosphatase): what Dutch laboratories use

Reference ranges by group, in u/l
Star-shl · Male · 19–50 years 45–128 U/l
45 128
Star-shl · Female · 19–50 years 38–123 U/l
38 123
Star-shl · Male · 51–65 years 46–126 U/l
46 126
Star-shl · Female · 51–65 years 48–142 U/l
48 142
Star-shl · Male · 66–80 years 44–134 U/l
44 134
Star-shl · Female · 66–80 years 47–138 U/l
47 138
Star-shl · Male · 81 years and older 45–145 U/l
45 145
Star-shl · Female · 81 years and older 45–146 U/l
45 146
Unilabs · Female · 19–50 years 38–123 U/l
38 123
Unilabs · Female · 51–65 years 48–142 U/l
48 142
Unilabs · Female · 66–80 years 47–138 U/l
47 138
Unilabs · Female · 81 years and older 45–146 U/l
45 146
Unilabs · Male · 19–50 years 45–128 U/l
45 128
Unilabs · Male · 51–65 years 46–126 U/l
46 126
Unilabs · Male · 66–80 years 44–134 U/l
44 134
Unilabs · Male · 81 years and older 45–145 U/l
45 145
Certe · Female · 19 years and older · a limit, not a range < 98 U/L
98
Certe · Male · 19 years and older · a limit, not a range < 115 U/L
115
Diagnostiek voor U · Everyone · 19 years and older 40–120 U/L
40 120
0 160.6 u/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

ALP (Alkaline Phosphatase): what this test measures

The amount of alkaline phosphatase in the blood is expressed in units per litre (U/L), and at Diagnostiek voor U the range above 18, for both sexes, runs from 40 to 120 U/L.

ALP (Alkaline Phosphatase): why this value matters

Alkaline phosphatase matters with a restricted diet, because according to the Cleveland Clinic malnutrition and a zinc or magnesium deficiency are among the possible causes of a low value.

ALP (Alkaline Phosphatase): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

ALP (Alkaline Phosphatase): when is testing worthwhile?

According to the Cleveland Clinic, an ALP test can also help explain a general symptom such as fatigue, when it is part of a liver panel or a comprehensive metabolic panel.

ALP (Alkaline Phosphatase): symptoms of a high or low value

Low Levels

According to the Cleveland Clinic, a low alkaline phosphatase may indicate malnutrition or a zinc or magnesium deficiency, and also an underactive thyroid.

High Levels

According to the Cleveland Clinic, osteomalacia, a disease that weakens the bones and develops most commonly due to a vitamin D deficiency, can raise alkaline phosphatase, as can untreated coeliac disease and liver disease.

ALP (Alkaline Phosphatase): causes of a low or high value

What lowers the value

  • Malnutrition

    Malnutrition may lie behind a low alkaline phosphatase, which is less common than a high one.

  • Zinc or magnesium deficiency

    A zinc deficiency or a magnesium deficiency may cause a low alkaline phosphatase.

  • Underactive thyroid (hypothyroidism)

    An underactive thyroid may cause a low alkaline phosphatase.

  • Rare genetic conditions, such as hypophosphatasia

    Rare genetic conditions, including hypophosphatasia and Wilson disease, may cause a low alkaline phosphatase.

What raises the value

  • Narrowed or blocked bile ducts

    A narrowed bile duct, or a bile duct blocked by cancer, may cause a high alkaline phosphatase from the liver.

  • Hepatitis or cirrhosis of the liver

    Hepatitis, an inflammation of the liver, and cirrhosis may cause a high alkaline phosphatase.

  • Cholestasis of pregnancy

    Cholestasis of pregnancy is a liver disease that can develop late in pregnancy and may cause a high alkaline phosphatase.

  • Healing fracture

    A fracture that is healing may cause a high bone alkaline phosphatase.

  • Bone disorders such as Paget's disease or osteomalacia

    Paget's disease, a rare chronic bone disorder, and osteomalacia, which weakens the bones, may cause a high bone alkaline phosphatase.

ALP (Alkaline Phosphatase): lifestyle and this value

According to the Cleveland Clinic, diet is one of the factors that can affect alkaline phosphatase, and an abnormal value is one to discuss with your GP.

ALP (Alkaline Phosphatase): frequently asked questions

Can a zinc or magnesium deficiency lower alkaline phosphatase?

According to the Cleveland Clinic, a zinc or magnesium deficiency can go with a low alkaline phosphatase.

ALP (Alkaline Phosphatase): sources

  1. den Elzen WPJ, Brouwer N, Thelen MH, Le Cessie S, Haagen I-A, Cobbaert CM. NUMBER: standardized reference intervals in the Netherlands using a 'big data' approach. Clin Chem Lab Med 2018;57(1):42-56. (retrieved 2026) doi.org
  2. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  3. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  4. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  5. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  6. Cleveland Clinic Health Library, Alkaline Phosphatase (ALP), my.clevelandclinic.org, geraadpleegd 2026-10-18 (retrieved 2026) my.clevelandclinic.org

Tests with related values

These panels measure values from the same category as this marker.

GLP-1

GLP-1 Baseline Panel

Your starting point before the first injection: blood sugar, cholesterol, pancreas, liver, kidneys, thyroid and nutrients in one measurement.

Insulin (Fasting) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) Bilirubin (Total) ApoB (Apolipoprotein B) Vitamin B12 Ferritin Potassium Sodium Glucose (Fasting) Total Cholesterol Albumin Lipase Creatinine Vitamin D (25-OH) Triglycerides Bilirubin (Direct) Bilirubin (Indirect) HOMA-IR eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€214,-
GLP-1

GLP-1 Extended Panel

The 6-month measurement: everything from the check-in plus insulin, ApoB and your nutrients — especially relevant if you have been eating much less for a while.

Insulin (Fasting) ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) ApoB (Apolipoprotein B) Vitamin B12 Ferritin Potassium Sodium Glucose (Fasting) Total Cholesterol Albumin Lipase Creatinine Vitamin D (25-OH) Triglycerides HOMA-IR eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€196,-
GLP-1

GLP-1 Check-in Panel

The 3-month safety and progress check clinics do: pancreas, liver, kidneys, salts and your metabolic progress on GLP-1 medication.

ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) Potassium Sodium Glucose (Fasting) Total Cholesterol Lipase Creatinine Triglycerides eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€109,-

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Medical standards

Dr. Naimi oversees the medical standards behind our content and assessments.

Medical policy
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ALP (Alkaline Phosphatase)

€8,-