Gym and tonic - the sordid side of school sport

The unchecked use of supplements by pupils is eroding the values of rugby, writes Dr Jon Patricios

As thousands of pupils stream back to school, many will be focusing not only on their studies but on the exciting sporting opportunities that are an integral part of South African school culture.

It is a perceived strength of many of our institutions of learning that our sons and daughters receive a rounded education - what I remember my headmaster regularly referring to as developing "body, mind and character".

It is summer, so one would think cricket, swimming and water polo would be occupying most schoolboys' time of an afternoon. Increasingly, however, there is a single sport that overshadows all in terms of prestige, status and marketing value: rugby. In many schools, rugby season preparation has become a 12-month commitment.

I am a fan of the game, in particular what I had perceived to be school rugby's ability to accommodate all body types: the nippy halfback, the deft kicker, the lithe three-quarter, the gutsy loosey and the fatty in the front row. But I can detect through the window that my sports medicine practice affords me that the situation has changed quite dramatically. The emphasis is now above all else size, strength and power.

In order to achieve target weights ("the coach says that to make the front row I need to be 95kg"), schoolboys are resorting to extreme measures, using supplements both legal and banned.

Supplements used as aids to mental or physical performance have been in existence since the ancient Greeks were urged by the physician Galen to consume "the rear hooves of an Abyssinian ass". By definition a supplement is described as "any product intended for ingestion as a supplement to the diet" - about as broad a definition as one could imagine, encompassing vitamins, amino acids (protein building blocks), protein formulas, meal replacements, creatine and a host of other things.

The underlying belief is that, by taking these products, you are building more muscle and this makes you a better player. The truth may be quite different.

The core issue is that the supplement industry is unregulated. A prescription drug such as an antibiotic is put through several years of testing in laboratories and in humans to establish its efficacy and side effects, and continues to be monitored after release.

Supplements are not required to undergo such testing. The result is that we do not truly know what is in the bottle, whether it is effective and what the potential negative properties and interactions are. In a nutshell, a pharmaceutical drug has to be proven effective and safe before being released onto the market. A supplement has to be proven to be harmful before being withdrawn.

Often the public's only exposure to these products is in sports and lifestyle magazine adverts where the chiselled (airbrushed?) body of a rugby player is shown holding a bucket of a powdered concoction. Schoolboys receive information from their peers and the Internet and parents often act on hearsay.

Studies have found that up to 25% of supplements are tainted with banned substances.

Before using supplements, one should be aware of the following:

• Their long-term safety has not been established;
• Interactions with other supplements and drugs are unknown;
• You may not have quality assurance (even the quality between batches of the same supplement may vary) and labelling may not be accurate;
• There may be contamination with banned substances; and
• The claimed benefits may not be scientifically proven.

There may well be a place for supplement use if we acknowledge that they are indeed supplementary to a structured eating plan and appropriate training. But I would rather a doctor or dietician decided this than a coach, gym instructor or pharmacy sales assistant.

There are many players in this hazardous and expensive game. They include the ectomorphic (long-limbed, less muscular) pupil seeking muscle gain, the parental "sponsor", the profit-seeking producers and distributors and the often ill-informed coach.

All may succumb to peer influence rather than being guided by science. The boy is doing it because his mates are and he feels he is being left behind. The parents are aware of other parents subsidising this venture so they follow suit. The coach sees opposition schoolboys increasing in size (although this may not be due to supplements) and feels pressured to implore his charges to seek similar means to this end.

Clearly, supplement use is not restricted to amateur athletes. Many professionals - as part of a structured diet and in consultation with nutrition experts - may make use of dietary supplementation. But if these products are so successful, why did Ben Johnson, Marion Jones and Dwain Chambers resort to more potent agents? Perhaps, when they recognised the limited rewards of their supplement programme, they turned to something that they knew really worked. Many schoolboys are doing the same.

Of the banned substances, anabolic androgens ("steroids") are the most widely publicised and relevant to muscle gain. My schoolboy patients inform me they are also the most easily accessible - from gym trainers, under the counter at supplement shops and from school mates. Last week a schoolboy from a prominent rugby-playing school conceded to me that "well over half" of the first-team squad of 30 take anabolic steroids. Steroid use at school has quickly evolved from being surreptitious to ubiquitous. Ironically, these pupils may be tested for recreational drugs but fall through the steroid-detection net because sports dope testing is not routinely performed at schools.

The side-effects of anabolics, both physiological and psychological, are well-described and although the acne, aggression and depressed mood states may be confused with adolescent development, the heart enlargement, high blood pressure, raised cholesterol, liver damage and low sperm count may be more clandestine and enduring.

My young patients tell me that most of the products are obtained via a ballooning black market in gyms. Some of the ampoules they have shown me are intended for veterinary use and are imported from Asia and Central America. But, in the now tainted world of school sport, apparently anything justifies a first team jersey, the coach's approval, glowing parental pride and the school's adulation.

An unregulated supplement industry has resulted in anecdote prevailing over science. In our increasingly competitive world we have, encouraged by nutritional charlatans, forsaken the simple yet important principles of sports nutrition and with it "the spirit of the game". Increasing school sporting pressures and the acknowledged superiority of steroids as muscle builders have led to schoolboys following professionals' lead into the drug underworld. Many of our children, contrary to the perceived noble tenets of school sport, are drug-taking cheats. Suspicious coaches and parents who turn a blind eye are complicit in this sordid process.

To address this issue, we should all be a little more introspective:

• As a player do you really know what you are taking? Perhaps you should seek to more ardently explore the benefits of an appropriate training programme and eating plan rather than seeking success in a bottle.
• As a parent, are you subsidising the use of supplements of unproven efficacy and unknown side effects? I would encourage you to spend the R500 on a consultation with a sports dietician rather than a concoction of supplements.
• As a coach, are you pressurising the pursuit of size at the expense of your players' wellbeing? Engage a sports doctor or dietician to help formulate correct eating principles and a supplement policy (see www.boksmart.com/eating & drinking right for rugby).

As a public health initiative, the South African Sports Medicine Association is planning to draft a position statement on supplements in sport. More immediately, I feel inclined to contact the heads of some of our more prominent rugby-playing nurseries whose players I know are using steroids. They should be made aware that, should these inappropriate practices not be addressed, we are eroding the "body, mind and character" that our teachers once sought to nurture.

• Patricios is a sports physician in private practice in Johannesburg, president of the South African Sports Medicine Association and a consultant to the BokSmart rugby safety programme