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As a recent scientific review explains, 4 Owing to its size and charged nature, NAD+ cannot passively pass through cellular membranes, including the plasma membrane. ...this probably occurs indirectly through the generation of NAD+ degradation products, such as NMN, NR or NAM, which act as precursors. In other words, NAD+ taken orally must first be broken down into these smaller molecules before it can re-enter cells and contribute to NAD+ synthesis

This makes it much more suitable than sterile water, which is free from living organisms but does not contain any preservatives like 0.9 percent benzyl alcohol that can limit microbial growth in the long run

Only laboratories with specialized LC-MS/MS protocols could detect it, and no regulatory body currently mandates wide-scale testing for BPC-157

To assume that all delays reflect poor care is overly simplistic