A unifying mechanism of ketogenic diet action: The multiple roles of nicotinamide adenine dinucleotide

•Ketogenic diets treat diverse seizure types and mobilize multiple mechanisms. A fundamental mechanism is of great therapeutic interest.•Glucose or ketone bodies can each produce ATP for cell energy.•Notably, ketone-based metabolism requires fewer molecules of nicotinamide adenine dinucleotide (NAD).•Altered levels of NAD + may be a unifying mechanism for ketogenic diet action and its beneficial effects.