In addition to intestinal tumors, what other diseases may cause a persistently elevated alkaline phosphatase? In an asymptomatic person with an alkaline phosphatase intestinal fraction of > x3 normal, is there evidence that herbal preparations or special diet could cause this problem?
Edith Konesi, PA-C
from
Charlene M. Morris, PA-C, 01/16/01Without a complete isoenzyme fractionation, a finding of 3-fold elevated alkaline phosphatase is probably a rare familial benign persistent increase in total ALP. This abnormality occurs in the absence of other systemic disease and is believed to be an autosomal recessive disorder. The increase in ALP is of the intestinal fraction in origin. Increase in the intestinal fraction of ALP has been shown to be related to the concentration of lymph triglycerides and in response to a fatty meal.[2]
In a study of both fast- and slow-moving electrophoretic patterns of this enzyme, variations were found to be under genetic control and linked to the blood groups in the ABO system. These areas are determined by electrophoresis pattern predominance or "zones," and are relatively common in secretors of enzyme but are infrequently seen in nonsecretors of any group. In secretor populations, O exhibits the zone more than B and significantly much more frequently than group A with AB as an intermediary. In other words, O>B>AB>A. This physiologic variant of ALP appears to be correlate AB0-related associations of hypercholesterolemia and ischemic heart disease.[3]
Increased serum ALP is seen in states of increased osteoblastic activity (hyperparathyroidism, osteomalacia, primary and metastatic neoplasms such as Paget's or lymphomas), hepatobiliary diseases characterized by some degree of intra- or extrahepatic cholestasis, and in sepsis, chronic inflammatory bowel disease, and thyrotoxicosis. Although a total ALP measurement may be an efficient screen for a disease or metabolic abnormality, isoenzyme determination identifies the organ or tissue responsible for the ALP elevation.[1]
Interactions of various herbal medicines have been studied. Echinacea, used to increase immune function, can cause hepatotoxicity. Feverfew, garlic, ginkgo, ginger, and ginseng may interfere with bleeding times. Borage and evening primrose may lower seizure threshold and should not be used with anticonvulsants that may also interfere with ALP. St. John's wort (Hypericum perforatum) increases ALP and other blood values. Since ALP is a hepatocompetitive enzyme, it would be wise to monitor changes of laboratory values with respect to herbal preparations a patient may be ingesting.[4]
Consistent balanced nutrition is necessary for ALP production. Levels are reduced in starvation yet correctable with resumption of feeding. Of interest, increased fiber consumption encourages in vivo ALP manufacture, even with otherwise suboptimal nutrition. Although short-term use (less than 20 days) of ethanol has been found to have no ill effect on ALP, more than 3 consecutive weeks of alcohol consumption inhibits its usual production. Therefore, with abnormal laboratory studies, it is imperative to gather a complete history -- including nutritional and complementary alternative medication (CAM) modalities -- and correct these with serial retesting as necessary.
Bansal D, Sodhi CP, Mahmood S. Effect of chronic ethanol feeding on intestinal alkaline phosphatase activity in rats. Indian J Med Res. 1998;107:118-122.
Kako MD, al-Sultan II. Vet Hum Toxicol. 1993;35:298-300.
Martins MJ, Dias PO, Hipolito-Reis C. Rat serum alkaline phosphatase electrophoretic fractions: variations with feeding, starvation and cellulose fibre ingestion. Clin Nutr. 1998;17:279-285.
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