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Like many other regions in Appalachia, the area was initially affected by the over-prescription of painkillers in the 1990s
Long-term PPI use impairs intestinal magnesium absorption, likely through inhibition of TRPM6/7 magnesium transport channels
Importantly, patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN2) should not use semaglutide, as noted in the boxed warning
This article reflects the state of published evidence as of June 2026 and should not be interpreted as clinical guidance
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