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Introduction Postprandial distress syndrome (PDS) affects 80% of individuals with functional dyspepsia, yet evidence-based dietary management strategies remain poorly defined.Aims This UK-based, single-centre, randomized trial compared traditional dietary advice (TDA) with a low fermentable oligo-, di-, mono-saccharides and polyols (low FODMAP) diet in PDS.Methods Participants with PDS received dietary education on TDA (i.e. small, frequent meals with reduction of caffeine, alcohol, carbonated beverages, and high-fat, processed, or spicy foods) or a low FODMAP diet. Questionnaires were completed at baseline and over 6 weeks, including the Leuven Postprandial Distress Scale (LPDS), which was used to determine the primary endpoint of clinically meaningful reductions in the PDS subscale of the LPDS (≥0.5 points and ≥0.7 points). Secondary endpoints included individual changes to the LPDS, changes in the overall Gastrointestinal Symptom Rating Scale and Nepean Dyspepsia Index for quality of life, and self-reported adequate relief of dyspeptic symptoms (≥50% of the time during weeks 4-6).Results A total of 60 patients with PDS underwent randomization; 31 were assigned to the low FODMAP diet and 29 to the TDA. Baseline characteristics were similar between groups, with mean age 39.6 years, 78% female, 78% white, and coexistent irritable bowel syndrome in 63%. For the primary endpoint, a ≥0.5-point reduction in PDS subscale was achieved by 61.3% with the low FODMAP diet vs. 37.9% with TDA (p=0.04), while a ≥0.7-point reduction was achieved by 61.3% with the low FODMAP diet vs. 20.7% with TDA (p<0.001). The low FODMAP diet group demonstrated significantly greater improvements in individual LPDS symptoms, overall quality of life, and overall gastrointestinal symptoms compared with TDA. Adequate relief of dyspepsia was self-reported by 71.0% with the low FODMAP diet vs. 34.5% with TDA (p=0.005).Conclusion A low FODMAP diet was superior to traditional dietary advice for achieving symptom relief and quality of life improvement in PDS.