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The 2-hour food buffer matters because insulin and growth hormone work against each other at the receptor level

MOTS-c has no relationship to this axis at all

The study was modified after randomization and treatment of 117 patients to require that all patients receive folic acid 350 mcg to 1000 mcg daily beginning 1 to 3 weeks prior to the first dose of pemetrexed and continuing until 1 to 3 weeks after the last dose, vitamin B12 1000 mcg intramuscularly 1 to 3 weeks prior to first dose of pemetrexed and every 9 weeks thereafter, and dexamethasone 4 mg orally, twice daily, for 3 days starting the day prior to each pemetrexed dose

Easiest way to combat this deficiency is to enrich your daily diet with Vitamin B12, which is found in meat, fish and dairy foods