My alp is climbing, when should i be worried?

Good Morning everyone,

This Monday I went in for my blood work and I got the results today.
My ALP went from 420 last month to 618. This is pretty scary for me considering that it should be around 116. When should I be worried about this?

My bilirubin went from 0.9 to 0.8
AST stayed at 88
ALT from 205 to 196

When my blood work was high, the only thing that got my doc’s attention was the bilirubin. Of what showed on the blood work, that was the best measure of liver trouble. I am glad your went down, if only by one notch.
Some where on this forum, I have posted a chart of that defines what usually gets tested for -liver function test…

hhmmm, I wonder why only the bilirubin worried him.

I did hop on Google {i know we should try and stay away for our sanity sake} but I did find out that the ALP enzymes are also produced by other parts of our body. Also said that people who workout rigorously tend to have high ALP because bone recovery or growth produces ALP.

I dont feel any worse so thats a plus {knock on wood}

Alkaline phosphatase (ALP) is an enzyme that’s released into the blood when damage occure to the bile ducts (and for multiple other reasons). If you simplify it, an elevated ALP suggests that your bile ducts are getting damaged at the moment. This is exactly what happens when you have PSC.

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Right, but whats the max it can reach before my liver stops functioning? my ALP is in the 600’s and that scares me.

ALP hasn’t to do with the liver, instead it has to with the bile ducts (and other stuff). An elevated ALP suggests that your bile ducts are being damaged right now, but it doesnt show if your liver is getting damaged. It might be hard to grasp, the liver gets damaged when bile cannot flow out of it, which eventually happens with this disease. ALT is a measurment of liver damage, and because you have an elevated ALT it suggests that there is damage going on in the liver.

You can refere to ALP, ALT and AST as speedometers, it show how much damage is going on right now but it doesn’t show how much damage there is. But keep in mind that there is no maximum value for these test. Also keep in mind that you’re fine right now, since yoru Bilirubin is low (Bilirubin is a measurment of liver function).

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hmmm, I understand what youre saying, so I guess thats why its more worrisome when the bilirubin is high?

Basically high ALP just means the disease is progressing.

Yeah exactly! You can have elevated ALP for decades, but when Bilirubin starts climbing things go much quicker.

ALP is really just a way of checking how you’re doing without doing an MRCP or ERCP. But remember that ALP, ALT and AST are just like speedometers. One day they can be super high, next day they can be normal.

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Well that does put me at ease a bit. Its weird that my ALP went up while my bilirubin went down.

Thank You
And I just saw that youre 21! Im 24, Nice to meet you

Nice to meet you too!

It takes a while to understand all the tests! But to summarize it, there are two kind of tests; one that show how much damage is going on right now (such as ALP, ALT and AST) and one that shows how well the liver functions (such as Bilirubin, Albumin and INR). So you can have damage going on right now (elevated ALP, ALT and AST) while the liver is still fully functioning (normal Bilirubin, Albumin, INR etc)

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HMMM, yes all those are normal for now.

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Great thread, thank you for asking the question and Andreas, you speak and write well, thank you!

My ALP likes to stay higher… it has come down by about 60% and is now in the 200’s over the past shy 5 months.

However, all my other liver functions are “normal”. Ultrasound, fibroscan and blood work. My experience thus far is that it varies a LOT from individual to individual… and the swings in readings can really swing without notice either direction. I’d say, all good if the billygoatrubin:) stays more chill!


Hello. I know that everyone is different with this disease. I have been diagnosed for 15 years now. My ALP was up there when I first was diagnosed above 600. My ALT and AST were over 200. Don’t remember exactly what the bilirubin was but it was probably close to 2.0. I was started on high dose Urso and this settled everything down pretty quickly. I know there is some controversy over this but for me it worked. Labs improved significantly. I have also experimented with diet over the years (one of the few things we can control). I have been able to make an eye brow raising impact on labs when I go gluten and dairy free.

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