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Alkaline Phosphatase Blood Test: What Does Elevated Alkaline Phosphatase Mean?

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What is alkaline phosphatase (ALP)?

Alkaline phosphatase (ALP) is an important enzyme found throughout the body including the intestines, kidneys, liver, bones, and in the placenta of pregnant women. However, the bone and liver contain the highest concentrations of ALP in the body because they are the organs that greatly manufacture the enzyme. ALP is needed in liver physiology and bone development. (1)
The blood contains ALP, which amount is maintained at a particular range of values. Gradual increase or decrease in blood ALP can indicate problems in the liver or bones. However, there are people that have high blood ALP but don’t have any liver or bone problems. They are children, adolescents, and pregnant women. Blood ALP is high in children and adolescents because their bones are growing. High blood ALP is natural to pregnant women because ALP is needed by the developing fetus. (2)

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What is ALP blood test? When it is ordered?

ALP blood test measures blood alkaline phosphatase to detect liver and bone problems. It is ordered by the doctor if the patient has symptoms of liver or bone diseases.

The signs and symptoms of liver disease include itching, dark urine, light colored feces, jaundice, abdominal swelling and pain, nausea, vomiting, appetite loss, fatigue, and weakness. (2)

For bone disorders, signs and symptoms can include bone and/or joint pain, bone deformity, and increased frequency of fractures. (2)

ALP blood test is also ordered to monitor improvement in patients receiving medications for a particular liver or bone disease.

What is the normal range of blood alkaline phosphatase (ALP)?

The normal range of blood ALP in adults is 44 to 147 international units per liter (IU/L) according toMedline Plus Medical Encyclopedia. (3) However, according to WebMD the 30-126 IU/L is the normal range for adults and 30-300 IU/L for children. (4) The range can vary with gender and age, and from laboratory to laboratory. As discussed above, children, adolescents, and pregnant women have higher blood ALP. (3)

What does elevated alkaline phosphatase mean?

When the test results show that the patient has an elevated alkaline phosphatase, it means that either the liver is damaged or something is causing increased bone cell activity. ALP test does not tell which of the two (liver or bone) is causing increased ALP. To find out, the doctor orders more laboratory tests for the liver (e.g. bilirubin, aspartate aminotransferase (AST), GGT and alanine aminotransferase (ALT), 5-nucleotidase) and the bones (e.g. calcium and phosphate levels). (2)

If blood levels of bilirubin, AST, ALT, 5-nucleotidase, and GGT are high, ALP is coming from the liver. ALP is coming from the bone if calcium and phosphate levels in the blood are elevated. (2)

Liver problems that cause very high levels of blood ALP may include hepatitis, blockage of bile ducts, cirrhosis, gallstones, liver cancer, or cancer that has spread to the liver from another part of the body. (4)

Bone disorders that cause high levels of blood ALP can include Paget’s disease,  rickets, osteomalacia, bone cancer, or cancer that has spread to the bone from another part of the body. Overeactive parathyroid gland (hyperthyroidism) and healing bone fracture can also elevate blood ALP. (4)

What causes low ALP levels?

Low ALP levels can be caused by certain disorders including hypophosphatasia, anemia, leukemia, enteritis, hypothyroididsm, osteoporosis, malnutrition, magnesium deficiency, achondroplasia, cretinism, and protein deficiency.

What drugs can affect blood ALP levels?

Certain drugs can affect blood ALP levels. The doctor usually instructs the patient to stop taking the medications hours/days before the test. Drugs that can increase or decrease ALP levels include antibiotics, allopurinol, anti-inflammatory drugs, contraceptives, arthritis drugs, diabetes medications, chlorpromazine, cortisone, male hormones, narcotic pain relievers, methyldopa, tranquilizers, propanolol, and tricyclic antidepressants. The patient should not stop taking these medications without first talking to his doctor. (3)[ad#afterpost]

References and Further Reading

  1. ALP: Test Sample. Lab Test Online
  2. ALP: The Test. Lab Test Online
  3. ALP: MedlinePlus Medical Encyclopedia
  4. Alkaline Phosphatase. WebMD

Health Benefits of Pomegranate Juice

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Pomegranate, Image from Wikimedia CommonsPomegranate juice is becoming a very popular fruit juice because of its many health benefits. It is extracted from the fruit pulp of pomegranate plant (Punica granatum) which is also called Granada or Chinese apple. Pomegranate plant has been widely cultivated in the Iranian Plateau since ancient times. It was introduced to other parts of the world by settlers. (Ref.) Today, pomegranate is cultivated in various countries for its delicious and nutritious pulp.

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Nutritional Value of Pomegranate Juice

According to the USDA Nutrient Database, pomegranate juice contains carbohydrates (sugars), dietary fibers, fats, proteins, thiamine (Vit. B1), riboflavin (Vit. B2), niacin (Vit. B3), pantothenic acid (Vit. B5), vitamin B6, folate, vitamin C, calcium, iron, magnesium, phosphorus, potassium, and zinc. A 100 gram of pomegranate can give 285 kJ of energy.

Pomegranate juice is one of nature’s best sources of antioxidants. Antioxidants are substances that scavenge free radicals – unstable and highly reactive atom or group of atoms that can damage cells and speeds up the progression of cancer, cardiovascular diseases, and age-related diseases (Ref). Antioxidants in pomegranate juice are in the form of polyphenols which include ellagitannins, punicalagins, catechins, gallocatechins, and anthocyanins. The amount of antioxidants in pomegranate juice is claimed to be three times higher than red wine or green tea (Ref.).

 

Health Benefits of Pomegranate Juice

There are published researches suggesting that pomegranate juice may be effective in fighting different types of cancer such as breast, skin, and prostate cancers. Pomegranate juice helps slow down the progression of cancer. It contains powerful antioxidants that neutralize cancer-causing free radicals. (Ref)

Drinking pomegranate juice help prevent heart attacks and strokes caused by atherosclerosis or the deposit of cholesterol in the inner linings of the arteries. The antioxidants found in pomegranate juice inhibits the formation of cholesterol plaques in the arteries. Without cholesterol plaques, blood circulation will surely improve. (Ref)

Pomegranate juice also contains compounds that act as blood thinners which enhance blood flow to all parts of the body.

Another health benefit of pomegranate juice is preventing the onset of osteoarthritis; although, more researches are needed to prove this. A group of scientists have found that pomegranate extract inhibits the production of a particular enzyme responsible in causing human cartilage damage in osteoarthritis. (Ref)

A group of Israeli researchers published an article in Clinical Nutrition (June 2004 issue) suggesting that drinking a glass of pomegranate juice a day for one year reduces systolic blood pressure and slows down the oxidation of bad cholesterol (LDL cholesterol). (Ref)

The ascorbic acid or Vitamin C found in pomegranate juice acts as anti-inflammatory agent which reduces inflammation or swelling. (Ref.)

Drinking pomegranate juice might prevent and slow down the progression of Alzheimer’s disease according to studies.
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Tuberculin Skin Test: Positive and Negative Results of Tuberculin Skin Test

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Definition of Tuberculin Skin Test

Tuberculin skin test is a diagnostic procedure for tuberculosis – the disease caused by rod-shaped gram-positive aerobic bacterium called Mycobacterium tuberculosis. Its other names are tuberculin sensitivity test, Mantoux screening test, Purified Protein Derivative (PPD) test, and Latent tuberculosis infection test.

Tuberculin skin test is used to identify persons who may have been infected by Mycobacterium tuberculosis. This test, however, cannot tell how long an individual has been infected with tuberculosis. It cannot also tell if the infection is inactive (latent) or is active and can be transmitted to others.
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People Who Needs Tuberculin Skin Test

  • People showing TB symptoms including night sweats, continuing cough, and weight loss for no apparent reason
  • People with weak immune system because of having diseases (e.g. AIDS) that make them more susceptible to TB infection
  • People who are confined in schools, homeless shelters, correctional facilities, and nursing homes
  • People who have been exposed to tuberculosis bacteria by close contact with people who have active and contagious TB infection
  • Healthcare professionals and workers who are at high-risk for M. tuberculosis exposure
  • People who migrated from countries with high prevalence of tuberculosis
  • People who are required to take a routine examination (where TB skin test is a part) before starting a new job or attending school

 

Tuberculin Skin Test Procedure

Tuberculin skin test is done by injecting a small amount (standard: 0.1 ml) of purified protein derivative (PPD) tuberculin intracutaneously or just under the top layer of the skin. Tuberculin is a combination of bacterial antigens obtained in a culture of Mycobacterium tuberculosis. Antigens are foreign substances that trigger the immune system to produce antibodies (e.g. immunoglobulin E). The usual location of the injection is on the inside of the forearm, halfway between the elbow and the wrist.

 

Tuberculin Skin Test Result

The result of tuberculin skin test cannot be obtained just after the injection. The patient will be asked to go home and return after 48-72 hours for the test result. The patient is prevented in scratching the injected skin area so as not to affect the result. The formation of greater than 5 mm of wheal or bump in the injected area indicates a positive result; mere redness without a bump indicates a negative result. The bump is measured by a trained professional in millimeters. The erythema or redness is excluded in the measurement. A person who didn’t return within 48-72 hours will be rescheduled for another skin test.

Since a positive tuberculin skin test cannot tell if tuberculosis infection is active or inactive (latent), other procedures like blood test, x-ray, and sputum culture should be done. People who are positive to the skin test but do not show the symptoms of tuberculosis may have latent or inactive TB infection. Active tuberculosis disease is confirmed by positive skin test, M. tuberculosis in sputum culture, abnormal chest x-ray, and mycobacterial antigens in the blood.

 

Interpretation of Results

A bump measuring 5 or more millimeters is considered positive in

  • People with diseases or conditions that weaken their immune system (e.g. AIDS)
  • People who are taking drugs (e.g. prednisone, TNF-a antagonists) that suppress their immune system
  • People with close contact to a person with active TB disease
  • Organ transplant recipients
  • People with abnormal chest X-ray result (e.g. lung fibrosis or scarring)

A bump measuring 10 or more millimeters is considered positive in

  • Recent immigrants (less than 5 years) from countries where TB diseases is prevalent
  • People who are living and working in high-risk confined places such as correctional facilities, nursing homes, homeless shelters, etc.
  • People working in mycobacteriology laboratory
  • Children who are less than 4 years old
  • Healthcare professionals with clinical conditions that place them at high risk
  • Injection drug users

A bump measuring 15 or more millimeters is considered positive in any person, including persons with no risk factors (e.g. abnormal chest X-ray, injection drug users, organ transplant, close contact with TB patients, etc.).

 

False-Positive Results of Tuberculin Skin Test

The reasons for false-positive result of tuberculin skin test may include, but are not limited, to the following:

  • Incorrect method of administering the test
  • Incorrect antigen used
  • Incorrect interpretation of reaction
  • Previous Bacillus Calmette-Guerin (BCG) vaccination
  • Infection with nontuberculosis mycobacteria

 

False-Negative Results of Tuberculin Skin Test

The reasons for false-positive result of tuberculin skin test may include, but are not limited, to the following:

  • Incorrect interpretation of reaction
  • Incorrect method of administering the test
  • Cutaneous anergy or the inability to react to the antigen because of weak immune system
  • Viral illnesses like chicken pox and measles
  • Recent live-virus vaccination for chicken pox, measles, and other viral infections; the vaccination may interfere with tuberculin skin test reaction
  • Very young persons (< 6 months old) who have underdeveloped immune system
  • Recent TB infection; sensitivity to antigen develops after 8-10 weeks

Pictures of Tuberculin Skin Test

mantoux test, Image from Wikimedia Commons
Intradermal injection of PPD tuberculin (Image from Wikimedia Commons)
Mantoux-2, Image from Wikimedia Commons
The size of the bump is measured after 48-72 hours (Image from Wikimedia Commons)
mantoux-3, Image from Wikimedia Commons
PPD Skin test injection site after 50 hours.; the picture shows negative result (Image from Wikimedia Commons)


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References & Further Reading

Lactobacillus Acidophilus Side Effects and Health Benefits

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Good vs. Bad Bacteria

Our digestive tract is a jungle, as it houses more than 400 species of living bacteria. Other areas in the body like the mouth, urinary tract, ear canal, and vagina are home to a diverse population of bacteria.

The hundreds of species of bacteria are classified into two groups: friends and enemies. There is a balance between the two groups. Our bacterial friends suppress the growth of harmful bacteria to keep as healthy. Besides from controlling the number of harmful bacteria, good bacteria helps improve immune function, enhance protective barrier of digestive tract, and produce Vitamin K.

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Meet Lactobacillus acidophilus

Lactobacillus acidophilus is an example of friendly bacteria found in our digestive tract. The word “acidophilus” in its scientific name gives us an idea that it is an acid-producing bacterium. It specifically produces lactic acid in the process of fermentation. By contributing acidity to the intestinal environment, the growth of harmful bacteria is suppressed. To keep us healthy, L. acidophilus and its friends have a continuous civil war to harmful bacteria. In exchange to their service, we provide them nourishment.

Lactobacillus acidophilus Decline

Sometimes, we perform actions that cause population decline of friendly bacteria like L. acidophilus in our digestive tract. These actions include oral antibiotic therapy, inadequate dietary fiber, chemotherapy, and ingestion of environmental toxins. An inadequate number of bacteria and an overgrowth of harmful bacteria can result to diarrhea, infection, and abnormal digestion.

Lactobacillus acidophilus in Probiotics

To restore the balance of good and bad bacteria in our system, we need to take probiotics. Probiotics are substances that contain beneficial bacteria like L. acidophilus. L. acidophilus can be found in capsule, liquid, powder, tablets, and suppositories. It can also be found in cultured dairy products like yogurt or kefir. Once these probiotic products are consumed, L. acidophilus begins to colonize the digestive tract.

Lactobacillus acidophilus Side Effects

Lactobacillus acidophilus side effects are uncommon. Most people take L. acidophilus without any problem. However, some people experience side effects including gas, flatulence, bloating, stomach discomfort, dizziness, flu-like symptoms (nausea & fever), and diarrhea. These side effects usually occur at the 1st or 2nd day of use of L. acidophilus but they will disappear in following days. Women who use L. acidophilus vaginally may experience itching in their vaginal lining. If the these side effects persist, seek medical help.

L. acidophilus can also trigger allergic reactions. Symptoms include skin rashes, itching, swelling (edema), diarrhea, vomiting, nausea, breathing difficulty, and anaphylactic shock. Seek medical help if you experience these allergy symptoms.

Take note that side effects can also be caused by other ingredients/contaminants of probiotics beside from live microorganisms. Always purchase probiotics from trusted and reliable producers.

Precautions on Using Lactobacillus acidophilus

L. acidophilus medications haven’t yet received FDA approval so ask your doctor first before using them.

People who have suppressed immune system due to disease or chemotherapy may not take L. acidophilus medications because they may not tolerate the bacteria leading to serious infection.

People with artificial heart valves are prevented in using L. acidophilus medications.

The safety of L. acidophilus supplements in pregnant women is not yet known. Thus, pregnant women should avoid L. acidophilus supplements.[ad#afterpost]

Ginkgo Biloba Side Effects

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Ginkgo biloba, Image from Wikimedia CommonsAlthough Ginkgo biloba offers a lot of health benefits, there are also possible side effects. There are reports of Ginkgo biloba side effects but their number is small to cause alarm. To prevent possible side effects, the usage of Ginkgo biloba products should be under the guidance and supervision of a qualified physician. Even if Ginkgo is a herbal medicine, it should be treated like any other drug because it contains bioactive compounds that can cause harm to the body.

Common Side Effects

The common side effects of ginkgo include dizziness, diarrhea, nausea, headache, gastrointestinal upset, palpitations, restlessness, and allergic reactions. If you experience these symptoms, stop using any ginkgo product and visit your doctor for medical advice. The doctor will tell you whether you need to stop using ginkgo or you need to lower the dosage.
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Allergic Reactions Symptoms

Many organic compounds have been isolated in ginkgo. Some of these compounds can trigger allergic reactions. Symptoms of ginkgo allergy include skin rashes, hives, swelling, itching, breathing difficulty, sneezing, breathing difficulty, and anaphylactic shock. Seek medical help if you experience these allergic reactions after using any ginkgo product. Special medical attention should be given to people with anaphylactic shock because of the fatality of this condition.

Allergens found in ginkgo are long-chain alkyphenols and urushiols. Urushiol, a potent allergen, is an oily poisonous irritant found in the resin and on the leaves and stems of poison ivy, lacquer tree, mango, and related plants. If you have a history of allergy to any of the mentioned plants, you are likely to experience adverse reactions when taking ginkgo products. In ginkgo seed, urushiol is found in the outer fleshy coating. When the coating is removed, the seed is safe to handle.

Sadly, the only solution for ginkgo allergy is avoidance of ginkgo products.

Ginkgo Toxicity

Eating raw seed of ginkgo in large quantities (over 5 seeds a day) can cause poisoning due to the presence of 4-methoxypyridoxine (MPN) in the seed’s gametophyte (meat). MPN, also called ginkgotoxin, can cause seizure and convulsion. Ginkgo leaf and leaf extract contain little MPN.

Ginkgo for Children and Pregnant Women

Ginkgo products should not be taken by children, pregnant women, and breastfeeding mothers.

Interaction with Other Medications

Ginkgo can interact with other prescriptions and non-prescription medications by altering their effectiveness and metabolism within the body. Medications known to interact with ginkgo include anticonvulsants, antidepressants (SSRIs and MAOIs), antihypertensive medications, blood-thinning medications, cyclosporine, blood sugar-lowering medications, trazodone, and thiazide diuretics.

The effectiveness of anticonvulsant medications such as carbamazepine and valproic acid can be lessen when taken with ginkgo.

Ginkgo should not be taken with serotonin reuptake inhibitors (SSRIs) such as Celexa, Lexapro, Zoloft, Paxil, Luvox, and Prozac. Interaction of ginkgo and SSRIs can lead to potentially fatal serotonin syndrome.

Ginkgo can improve both the good and bad effects of monoamine oxidase inhibitors (MAOIs) like Nardil. Hence, the two medications should not be taken together.

If you are taking antihypertensive medications, consult your doctor before using ginkgo. Ginkgo can lower blood pressure by dilating the blood vessels and physical characteristics of blood. It may reinforce the effects of antihypertensive medications resulting to dangerous drop in blood pressure. Ginkgo has been reported to interact with Procardia (nifedipine), a calcium blocker used for arrhythmias and high blood pressure.

Ginkgo reinforces the effects of anticoagulants or blood-thinners such as aspirin, clopidogrel, heparin, and warfarin. This can result to internal bleeding. People with bleeding disorder like hemophilia should not take ginkgo. You should discontinue taking ginkgo at least 36 hours before your scheduled surgery (including dental) to prevent bleeding complications.

Ginkgo can affect insulin secretion in people with diabetes. If you have diabetes, don’t take ginkgo without first consulting your doctor.

Ginkgo can interact with cyclosporine, thiazide, and trazodone medications. Talk to your doctor before using ginkgo with any of the three medications mentioned.

Additional Note

You may experience other ginkgo side effects other than those mentioned here. If it happens, discontinue using ginkgo and visit your doctor for advice.[ad#afterpost]

References and Further Reading


Does Drinking Coffee Before Blood Tests Affect the Results?

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Coffee (Image from WIkimedia)Blood tests are among the most important laboratory tests to help diagnose many human diseases. Physical, chemical, and biological properties of the blood give a big picture on the condition of the body. Blood tests can tell if there is a problem on your kidney, heart, liver, glands, brain, muscles, bone marrow, etc. Without blood tests, it would be really hard for doctors to know what’s wrong inside your body. Blood tests are also important in monitoring the effectiveness of the medications you are taking. Blood tests can determine whether the drugs for your hypertension/diabetes/cancer/infection/etc. are working effectively. Examples of blood tests are BUN, LDH, ANA, ESR, GGT, and MPV.

An accurate blood test result will give an accurate diagnosis. It is therefore important to eliminate possible sources of error for blood test results. Eating and drinking can affect the result of certain blood tests. Doctors require their patients to fast before undergoing blood tests such as cholesterol and glucose blood tests. Patients who habitually drink coffee have one important concern: how does drinking coffee before blood tests affect the results.

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Drinking Coffee Before Blood Test Affect the Results

Drinking coffee before blood test can affect the results of tests that measure blood sugar and cholesterol levels.

Coffee contains caffeine that is easily absorbed into the system at a fast rate. Caffeine can temporarily raise blood sugar levels resulting to an inaccurate fasting blood sugar (FBS) result. This happens as a result of caffeine’s stimulation of the pancreas to release insulin – hormone that regulates blood sugar level. Fasting blood sugar, commonly known as blood sugar level test, is used to diagnose diabetes and monitor hyperglycemia (too much blood sugar) or hypoglycemia (not enough blood sugar). Besides from caffeine, coffee (especially the roasted one) contains sugar in the form of polysaccharides.

Drinking coffee before blood cholesterol test should also be avoided. Coffee can alter the level of cholesterol in blood resulting to inaccurate result. Blood cholesterol test measures the level of bad cholesterol (low-density lipoprotein, HDL) and good cholesterol (high-density lipoprotein, LDL) in the blood. Higher level of LDL than HDL is considered unhealthy. Bad cholesterol plaques are deposited on the inner surfaces of the arteries obstructing blood flow. Many cases of heart attack and stroke are due to the obstruction of blood flow in arteries.

Other drinks that contain caffeine should be avoided before blood sugar and cholesterol tests. There are also other blood tests that will require you not to take coffee or other drinks. Normally, your doctor will tell all the do’s and don’ts before any test. Water is the recommended fluid to take before blood test.

There are also blood tests in which the results are not affected by drinking coffee. Examples are tests for bacterial, fungal, & viral infections, ANA, CBC, HIV and others.[ad#afterpost]