What Is ALP Normalization?

How to Prepare for an ALP Test

Your doctor will let you know how to get ready for an ALP test. If it’s part of a CMP, you’ll probably need to stop eating or drinking (fast) for 10 to 12 hours before the test. You can still drink water during this period.

You may also need to stop taking certain medicines, as they can skew the test results. But talk to your doctor before you stop or change medicines.

What to Expect During an ALP Test

During an ALP test, you’ll sit in a chair while a medical professional trained in drawing blood (a phlebotomist) looks for a vein, usually in the inner part of your arm near your elbow or the back of your hand. Once they find a good spot, they’ll clean the area and insert a small needle to draw your blood. You might feel a quick pinch, but it’s usually not too painful. 

The blood will collect in a small test tube. Once there’s enough, the phlebotomist will remove the needle, press a cotton ball or gauze on the spot to stop any bleeding, and then cover the area with a bandage. The whole process takes less than five minutes.

Your blood sample will go to a lab for testing, and your doctor will share the results with you once they’re ready. Blood tests are routine and safe, with very little risk. Some people may have slight tenderness or bruising where the needle went in, but this usually goes away quickly. Most results are available within a couple of days, but in some cases, they may take a little longer.

What Do My ALP Numbers Mean?

Your ALP blood test report will include details such as the name of the test, your ALP level, the normal range for comparison, and whether your result is high, low, or within the normal range.

What’s a Normal ALP Level?

Normal ALP levels vary depending on the lab, but a standard reference range is 44 to 147 IU/L, while some labs use 30 to 120 IU/L. These levels also change based on age, sex, and certain conditions and may be higher in:

• Children and teenagers (due to bone growth)
• Boys and men ages 15 to 50 
• Older adults 
• Pregnant people (the placenta produces ALP)
• People healing from a broken bone

What Does a High ALP Level Mean?

High ALP levels can suggest liver damage, but not always. A mild increase may not need treatment, and your doctor will track any changes over time. If your ALP level is very high, your doctor may order other tests, like an ALP isoenzyme test, to figure out where the extra ALP is coming from. If your high ALP is liver-related, it may be linked to PBC or another condition.

What Is ALP Normalization?

ALP normalization means taking steps to lower your ALP levels to within a standard range. Normal ALP levels are a sign that treatment for PBC is helping to control the disease, and you’re less likely to need a liver transplant.

How Do I Normalize My ALP Levels?

Medications

Medication for PBC may lower and even normalize your ALP levels. Here’s a look at some of the medications your doctor might consider:

Ursodeoxycholic acid (Actigall, Urso). Your doctor will likely prescribe this drug first. Also called UDCA or ursodiol, it works by circulating bile through your liver. While ursodiol isn’t a cure for PBC, it can help your liver to work better and lessen liver scarring. One study found that people with PBC who achieve normal ALP levels after two years of UDCA treatment have better survival rates and fewer serious liver problems. But researchers need to do more studies to confirm these results.

Obeticholic acid (Ocaliva). You may take this medication alone or with ursodiol. Your doctor may prescribe it if ursodiol doesn’t improve your symptoms. The FDA announced in late 2024 that some patients treated with obeticholic acid had serious liver injury, so it should be prescribed only if you don’t have cirrhosis. Your doctor should test your liver frequently if you take it to be sure its function isn't worsening.

Seladelpar (Livdelzi). Clinical trials have shown that seladelpar can improve your liver function if you’re diagnosed with PBC. It can reduce liver enzymes and lower the amount of bile acids in your blood. It also is one of the first medications approved by the FDA to help you achieve ALP normalization, as well as reduce itching that comes with PBC. 

Elafibranor (Iqirvo). Elafibranor can help reduce the amount of bile your liver makes, and help it move out bile acid. You can take it with ursodeoxycholic acid if you didn’t get results from ursodeoxycholic alone, or take it on its own if you don’t tolerate ursodeoxycholic. It helps curb liver inflammation and can help reduce alkaline phosphatase.

Off-label medications

Fibrates. Fibrates are a class of drugs that, when combined with ursodiol, can ease liver inflammation and itching. They must be prescribed off-label, which means for something they’re not been approved to treat, and scientists are still studying how the medicines help with PBC symptoms and its long-term effects. 

Lifestyle changes

Certain lifestyle changes can also help normalize your ALP and improve your PBC symptoms:

• Make changes to your diet. Eat more whole foods and healthy fats, and cut back on sodium, processed and packaged foods, and saturated fats. Also, avoid oysters and other raw shellfish as they carry bacteria that can harm people who have liver disease.
• Exercise more. Walk every day and lift weights to lower your chances of bone loss. Weak or thinning bones (osteoporosis) is another PBC-related health problem.
• Stop smoking. Talk to your doctor about how to quit smoking.
• Don’t drink alcohol. Your liver is responsible for processing alcohol, and the extra stress of doing so can damage your liver.

How Does ALP Normalization Determine Survival Rates and Whether to Have a Liver Transplant?

While medication may help to lower your ALP levels, it may not be enough. Experts have found, for example, that ursodiol works well in more than half of people with PBC. But up to 40% of people with the condition don’t see enough of a drop in ALP. And around 5% to  10% can’t take the drug. 

If medication doesn’t make you feel better and your liver health gets worse, you may need a liver transplant. Studies closely link ALP normalization with a lower chance of needing a liver transplant and a higher survival rate.

People with PBC who have a liver transplant usually have a good outcome and have a normal life span, but it’s still possible for PBC to come back after surgery. The disease usually advances more slowly after a liver transplant.