With rugby players testing positive for the use of banned substances in the news lately, Dr Phatho Zondi, new managing director of the Sport Science Institute (Ssisa) touched on a topical issue when she presented a talk on supplement use in school sport at the Schools Sport Summit. The passionate doctor, who is also the president of the South African Sports Medicine Association (Sasma) and on the appeals board of the South African Institute for Drug Free Sports (Saids), referred to aggressive marketing campaigns aimed at school children specifically. One example of this was a supplement company who launched a points based competition where the school that earns the most points (by buying products or allowing exhibitions or branding at events), will win a concert at their school by a popular singer. This should be questioned, Zondi said. “Is there an issue? If yes, how serious? What are we going to do about it?’’According to two studies (2013 and 2015), an estimated 37 to 55% of rugby-playing school boys in South Africa use some form of sport supplement. These include dietary supplements and sport supplements, which claim to enhance performance, build muscle or assist in recovery. The use of these “performance enhancing” supplements is prevalent in sports where weight and size matters, such as rugby. They are more used by boys than girls and from as early as the age of 10. Zondi’s issue is that the supplement industry remains poorly regulated globally and companies do not have to prove their product’s efficacy or safety and often lack scientific evidence. “Health considerations include body changes, liver and kidney failure, a change in blood lipid profile (cardiovascular disease), heart attacks, stroke and even psychiatric issues with prolonged use. These risks might be magnified in children under 18 with developing bodies,” says Zondi. “We simply don’t know the scope, as it would be unethical (because of the potential health risks) to test on minors.” She added possible interaction with medication that children might take, such as Ritalin or Roaccutane, are largely unknown. Products are sometimes mislabelled or might be contaminated by a banned substance, which could lead to inadvertent doping. According to a Saids position statement (2011, currently being updated) there is an increase in the number of reports of damaging health effects and positive doping tests related to supplement use in SA and globally. Examples include reported deaths and medical problems from the use of tryptophan and products containing ephedra. Products only get pulled from the market after adverse effects have been reported.Zondi believes the main reasons for teenagers using supplements are image related. Firstly to “bulk up”, and secondly because a toned, muscular body is the ideal and then, to a lesser extent, perform better at sport. Supplements commonly used by the youth are vitamins and minerals, protein shakes, creatine, pro-hormones, stimulants, sports/caffeine energy drinks and herbal preparations. “If some of these pose health risks for adults, what is the ethical considerations of aggressive marketing aimed at school children with developing bodies, and who are mentally more vulnerable to advertising?” asks Zondi.According to Sasma only a small percentage of supplement ingredients have been shown to have performance enhancing potential. “The gains are typically very small. Maybe for the Olympic athlete looking for that 0.001 second difference to get a medal, but not for the average competitor,” says Zondi. Using these supplements can foster an unnecessary dependency, says Zondi. Zondi says 13 of the 18 rugby players testing positive recently were minors and concluded with a plead to the delegates to be pro-active in their schools. She adds a survey among teachers indicates that 90% think “anti-doping” should be included in the Life Orientation curriculum.