Type ones on low carb diets experience less hypoglycaemia

Adapted from Why low carb diets for type one patients? Jun1 2019 by Emma Kammerer Pharmacy Doctorate Candidate Bradenton School of Pharmacy originally published in Diabetes in Control.

Both Dr Jorgen Neillsen and Dr Richard Bernstein have shown that insulin users have fewer attacks of hypoglycaemia and that the attacks are less severe.  A new randomised controlled study by Schmidt et al confirms this finding.

Studies have shown that when a high carb diet is consumed there 20% greater error in carbohydrate estimation compared to when a low carb diet is chosen. This then affects the insulin dose administered, and thus the resulting blood sugars.

Schmidt wanted to look at the long term effects on glycaemic control and cardiovascular risk in type one patients on a low carb diet compared to a high carb diet.

The study was a randomised open label crossover study involving 14 adults who had had diabetes for more than 3 years, to eliminate the honeymoon effect. The patients went on one diet for 12 weeks, had a washout period of another 12 weeks, and then took up the other diet.  This was done so that the glycated haemoglobin levels would not be carried over from one diet to the next.

A low carb diet was defined as less than 100g carb a day and a high carb diet as over 250g per day.

Patients were given individualised meal plans and education on how to eat healthy carbs, fats and proteins. They all were experienced insulin pump users. They were asked to record total carbohydrate eaten but not the food eaten. Measurements were taken on fasting days on the first and last day of the study periods.

Blood glucose levels were downloaded from continuous glucose monitoring devices.

Four patients dropped out of the study so ten completed the test which was considered satisfactory by the statistician involved.

Results showed that the time spent in normal blood sugar range 3.9 to 10 mmol/L ( USA 56-180) was not significantly different for each diet.

The time spent in hypoglycaemia, below 3.9 (USA 70) was 25 minutes less a day on the low carb diet, and six minutes less a day below 3.0 (USA 56).

On the low carb diet glycaemic variability was lower and  there were no reports of severe hypoglycaemia.

On the high carb diet, significantly more insulin was used, systolic blood pressure was higher and weight gain was more.

There was no relevant changes in factors for cardiac risk between the two study arms.

The study showed that a low carb diet can confer real advantages to type one patients but education on how to conduct a low carb diet and manage the lower doses of insulin is required.

Schmidt, Signe et al. Low versus high carbohydrate diet in type 1 diabetes: A 12 week randomised open label crossover study. Diabetes, Obesity and Metabolism. 2019 March 26.

 

 

Eating carbs last gives lower blood sugar spikes

From IDDT newsletter December 2018

A report in BMJ Open Diabetes Research and Care Sept 2017 shows that in type two diabetes, eating sugar and starch later in the meal halved the blood sugar spike after the meal compared with those who ate the sugar and starch first.

This study was done on 16 people who ate test meals of protein, vegetables, bread and orange juice. Those who were instructed to eat the bread and juice last also had 40% lower post meal glucose levels compared to those who ate all of the meal components in a mixed fashion.

My comment: This is a small study but easily reproducible with yourself and your blood glucose meter. If you do wish to eat sugar and starch best have these last, unless you are treating a hypo.

 

 

American Diabetes Association Endorses Low-Carb for Type 2s

eggs and asparagus

eggs and asparagusA landmark decision this week—the American Diabetes Association (ADA) has decided to back low-carb diets for type 2 diabetics.

Diabetes.co.uk reported the announcement this week. The charity has produced a report, ‘Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report (Consensus Report)‘, published in the journal Diabetes Care.

Last year, the ADA acknowledged the low-carb approached as beneficial for treating type 2 diabetes. The new report goes further, stating that diabetes-focused nutrition therapy is a crucial part of overall diabetes management.

Previous high-carb recommendations

Previous dietary guidelines have focused on high-carb diets for people with or without diabetes.

The report says: “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied In a variety of eating patterns that meet individual needs and requirements.

“For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic mediations is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.”

Non-starchy vegetables

The report also says it is important to eat non-starchy vegetables, minimise the intake of added sugars and refined grains, and choosing whole foods instead of highly-processed foods.

As one of the authors of the paper, Dr Laura Saslow from the University of Michigan was also the author of a research paper published last year which revealed that 26 percent of users of Diabetes Digital Media’s Low Carb Programme put their type 2 diabetes into remission after a year. Remission was defined as reducing HbA1c to normal levels while taking no glucose-lowering medications or just metformin.

If you’re a low-carb enthusiast (type 2 diabetes or not), you’ll find lots of recipe ideas on this website and you can also buy our book, The Diabetes Diet as a paperback or e-book on Amazon. The book has recipes, meal plans and suggestions for how to adjust insulin when starting on a low-carb eating plan.

Nancyelle’s low carb pizza

JIM NEDVED’S TAKE ON NANCYELLE’S LOW-CARB PIZZA
WITH EGG, CHEESE & HERB CRUST.   This is a Neved family favourite which is
delicious, and avoids the excess moisture of cauliflower crusts.  You will need parchment or silicone liner and a pizza pie dish with perforations to allow steam to escape.                          

THIN AND CRISPY PIZZA CRUST

8 ounces mozzarella cheese, shredded
8 ounces cheddar cheese, shredded
(reserve a bit of cheese for sprinkling top, for final 4-5 minute broil)
4 eggs
1 teaspoon garlic powder
1 teaspoon basil, optional

OTHER INGREDIENTS

 Store-bought spaghetti sauce (lowest sugar content you can find) or use tomato paste.

A bit of olive oil

Toppings of your choice such as:

 Mushrooms
Onions (sliced)
Peppers (all colors, chopped fairly large)
Italian sweet sausage (raw)
Pepperoni (sliced at store for pizza)

pic of pizza tin used for cheese-egg crust pizza (use w parchment paper)


First, p
re-bake crust:  Mix the cheeses, eggs, garlic powder & basil well. Line 16-inch perforated pizza pan with parchment paper. Evenly spread cheese mixture on parchment, almost to edge of pan, making it as thin as possible. Bake with oven rack in center position at 450 for 15-20 minutes until golden brown. I suggest checking it after about 10 minutes. If it’s getting very dark on the edges and top, turn the oven down to 400 and continue baking until brown all over and no longer pale on the bottom. Pat off any excess grease.  Let cool a few minutes.  Spread on a 1/2 cup spaghetti sauce with spatula.

pic of cheese-egg pizza crust

Cook toppings – while they’re hot, you’ll top the pre-baked crust with them: Using 2 separate fry pans (1) cook Italian sausage, add pepperoni & warm, then put onto pre-baked crust which has sauce already on it; (2) in other fry pan, sauté in olive oil your mushrooms, peppers & onions till as done as you want when you eat them; then put onto pizza, on top of meat.  NOW INTO THE OVEN FOR A SHORT BROIL:  Sprinkle cheese you’ve reserved on top.  Keeping oven rack in center position, put in pizza (which already has all the hot ingredients on it) under the broiler until topping cheese & pre-cooked ingredients are bubbly, about 4-5 minutes.

Enjoy!

Makes 8 servings
Can be frozen

Nancyelle’s recipe was posted at LowCarbFriends®, a registered mark of Netrition, Inc.
On April 5, 2018, Low Carb Friends’ management announced that LCF’s forums would be permanently shut down.

pic - close up of finished pizza on cheese-egg crust                               

 

 

 

 

 

 

 

 

 

 

                               

 

 

 

      

Making Sundays Special

roast pork on the Diabetes Diet
Roast pork – eat this to make your Sunday special… (recipe Ministry of Food, Jamie Oliver).

New Year’s resolutions? Pah! One, you can makes changes any time you want, and two, most of us see them as miserable—the lose weight, take up punitive exercise regimes kind. In this part of the world, January is a challenging month. The weather’s dreich, the nights are long and the pennies few and far between. Who wants to add starvation and exhaustion to the mix?

One resolution I do intend to stick to is my campaign to Make Sundays Special again. Years ago, my husband and I used to make a point of doing something on Sundays. He works most Saturdays, so the Sundays were the one day a week we could visit castles, go to Edinburgh, take the motorbike out for a spin, bike to Balloch, drink too much and cycle back via the main road while piddled*. Last year, we fell into the habit of doing nothing. He’d be downstairs catching up on Colombo (why, why, why?), and I’d hide away upstairs working or writing. We added doing the supermarket shopping to a Sunday. As I love food, I don’t mind the supermarket shop but does it belong on a precious day off? I think not.

Cut the screen time

In 2019, I’ve vowed to spend less time in front of a screen. I’m there for work and as a hobby, and I dread to think how many hours I spend hunched over my laptop. On the plus side, I use a standing desk so it’s not as sedentary as it could be. On the other hand, it’s still not healthy. Time to reinstate the Sunday activities, such as:

Ben Lomond

I have Ben Lomond in my sights. Hill climbing is one of the best activities you can do in Scotland. The Munro is right on my doorstep, and the shame is I’ve yet to climb it.

Three Lochs Walk

I’d also like to walk from Balloch to Helensburgh with Sandy. I’ve done it a couple of times with my friends, and it’s a fabulous walk because of the views you get of Loch Lomond.

Linlithgow Palace

We’re members of Historic Scotland and we’ve yet to visit Linlithgow Palace so a train trip there and a pub lunch is in order.

Uni tour

The University of Glasgow offers walking tours. As I work there, it will be fascinating to find out more about this iconic Glasgow building. Another tour that has always piqued my interest is the one you can do of Glasgow Central station. If I book now, we might get there in the summer. (It’s terrifically popular.)

Sunday roast

Roast pork, the before version.

Finally, it’s nice to include special meals in your Sunday plans. As a child, I didn’t like the Sunday roast—probably because it meant sitting at the table waiting for adults to finish so we children could be excused, and I have memories of thick slabs of meat and nasty bits of under-cooked fat. These days, I’m a fully paid up member of the Sunday roast forever club. While the meat is nice, the best bits are the accompaniments – home-made gravy with a decent amount of wine thrown in, roasted parsnips and carrots, crackling if you’re making pork (or just make it as a side dish anyway) and one roast potato as a treat.

Bring on the special Sundays!

What’s your idea of a treat on a Sunday? Is cutting back your time online part of your plans for 2019, and if so what do you intend to do instead?

*Don’t do this at home, folks!

Vitamin B12 and Diabetes

vitamin B12 bottle on the Diabetes Diet
Vitamin B12 Gummies by icethim on flickr. Reproduced thanks to Creative Commons 2.0

In the news this week was an article about Vitamin B12 and its deficiency in those with type 2 diabetes*.

A new study by Nottingham researchers has shown that most people (64 percent of those assessed) people taking metformin (for type 2) were not being routinely tested for levels of vitamin B12 in their bodies. The assessment is needed to check for signs of nerve damage, a painful side effect of diabetes. Vitamin B12 is an essential vitamin the body requires to work properly.

The study’s author, Dr Kaenat Mulla from Hucknall Road Medical Centre said: “Current British Society of Haematology guidelines recommend that vitamin B12 levels are checked only when there is clinical suspicion of deficiency. However, peripheral neuropathy is irreversible and it may be too late once symptoms have developed.”

In an article on diabetes.co.uk, she stressed her warning wasn’t intended to discourage people from taking metformin, but she wanted to encourage doctors to monitor vitamin B12 routinely so deficiencies are picked up quickly and can be treated.

Before you all rush to Holland & Barrett to stock up, there are plenty of food sources that are rich in Vitamin B12. And funnily enough, we have a few recipes that feature them… Here’s what you might want to consider.

Liver and kidneys

Animal organ meats are a good source of the vitamin. A lot of people find the taste too strong—and I for one am never going to eat kidneys as their function puts me off—but chicken liver is more delicate than lamb’s for example, and might be more palatable.

Sardines

Sardines are another source and they are one of the few fish where Omega 3 levels survive the canning process. They are also cheap as chips and packed full of calcium as again the canning process softens the bones enough for you to eat them (and not notice you’re doing so).

Tuna, trout and salmon

More fish products that are super high in vitamin B12. You can find recipes on our site for salmon here and here, and trout here. I prefer trout to salmon as I find the flavour more delicate and it’s a heck of a lot cheaper too.

Dairy products

Milk, plain yoghurt and cheese have decent levels of the vitamin. Make a delicious sweet treat using Greek yoghurt, two teaspoons of good cocoa powder and a tablespoon of granulated sweetener and you’ve got a calcium, protein and magnesium packed pudding. And as for cheese, is there anyone out there who doesn’t love, adore like it? Hard, soft, strong, mild blue or from the cow, goat or sheep, there’s one that suits all. Want to make the most of it? Try our cauliflower cheese, broccoli and Stilton soup or our aubergine and pepper parmigiana.

For more information on vitamin B12 levels in food, check out healthline.com

*Please note—this article doesn’t constitute medical advice.

The Ethics of Eating Meat

Diabetes Diet

Diabetes DietHow do you love animals, hate waste and environmental damage, and yet eat meat, fish, dairy and eggs at the same time?

I ask myself this a lot. I was a vegetarian for years because I called myself an animal lover and meat-consumption didn’t seem to fit. As a long-term lover of vegetables and pulses, I found the food delicious—certainly the stuff I made for myself in the house. I suffered my way through plenty of bad pasta dishes in restaurants staffed by unimaginative chefs.

In 2010, I embraced low-carb living. At first, I only added fish to my diet. You can do a low-carb version of vegetarianism, but it’s limited. Fish added variety and health benefits even if my ethical self shuddered at the thought of being one of ‘those’ vegetarians.

Bacon temptation

I started eating meat in 2013. The stance didn’t feel as big as a jump as going from vegetarian to eating fish, so it wasn’t such a dramatic shake-up of my internal moral compass. And blimey, bacon… it’s a cliché that many a former vegetarian stumbled at the bacon hurdle and it’s well founded.

Diabetes Diet's picture of the cover of Louise Gray's bookThe reason for all this pondering is a book I’ve just bought—The Ethical Carnivore: My Year of Killing to Eat by Louise Gray. The premise is that the Daily Telegraph’s onetime environmental journalist decided she would only eat meat she’d killed herself, and the book begins with her first experience of shooting a rabbit.

I’m 75 percent certain I couldn’t kill an animal deliberately. I’m of the generation that’s become completely detached from the animals we put in our mouths. My father shot rabbits and gutted and skinned them, and he could do the same with birds. I have a razor-sharp memory of him standing at the back door, one back foot of a dead rabbit in each hand, and ripping it apart to allow the cats to dig in

Chickens coming to life

Meat’s almost always appeared in front of me packaged, its origins neatly obscured. Handling chickens makes me flinch as I visualise a head sprouting from that gaping cavity or feathers poking through the skin.

Veganism’s argument for greater health benefits doesn’t convince me. An omnivorous diet of unprocessed foods and plenty of fruit and vegetables will provide the same health gains. But I’m still left with the conundrum—how to eat meat that minimises animal suffering and doesn’t cost the planet dearly?

The ethics thing trips me up all the time. Buy free-range eggs—yes, but they clip the birds’ breaks and kill the male chicks at birth in a horrible way, anyway. Buy Red Tractor meat—not according to this article about what it means for animal welfare standards. Eat meat from the Farmers Market—but it’s so expensive. Eat organic dairy—what about the forced separation of cows from calves and what the industry does to male calves?

I’ve only started the book and I’m hoping it will end with a neat set of guidelines. Follow these and you too can be an ethical carnivore kind of thing. I doubt reading The Ethical Carnivore will turn me into a hunter, but if I emerge with a better understanding of what I can do, I’ll be delighted.

How do you deal with the ethics of eating meat? Any tips or advice gratefully received…

Ethics picture – Madhamathi SV and licenced under a Creative Commons Attribution-Share Alike 4.0 International Licence. 

 

Baba Ghanoush – Low Carb Recipes

a picture of aubergines on the Diabetes DietAubergines are fan-flippin-tastic done in a pizza oven. Cut the tops off, half them, score the skin and rub with olive or rapeseed oil, sprinkle with sea salt, wrap in foil and place in the heated oven for fifteen minutes.

Done! The best accompaniment to…well, anything if you love aubergines as much as I do. Traditional matches might be lamb steaks. Or you could wrap up some peppers too and make yourself a big bowl of garlic dip to go with them. Ooh, veggie heaven…

Alternatively, why not try some Baba Ghanoush? Ever heard this aubergine dip referred to as poor man’s caviar? If you’ve tasted the real thing, you’re within your rights to argue the supposed paupers’ option is the much better deal. What would you rather eat—a super silky, lemony-garlicky scented paste you can dip things in? (Fingers if you really must; we won’t judge.) Or fish eggs?

Here’s my version, with an alternative method if you don’t have a pizza oven.

Baba Ghanoush

  • Servings: 4-6
  • Difficulty: easy
  • Print

  • 2 medium-sized aubergines
  • 2tbsp tahini paste
  • 4tbsp rapeseed or olive oil
  • 4tbsp fresh lemon juice
  • 1 onion
  • 2 cloves garlic
  • Salt and pepper

Slice the tops off the aubergines, half them lengthways, score the skin and rub with some of the oil. Wrap in foil.

Slice the onion in half too and wrap in foil.

Either cook in a pizza oven (about 250 degrees C) or place in an oven (180 degrees C). The vegetables will take about 15 minutes in the pizza oven. Unwrap from the foil and place in for a few more minutes to char them.

In the oven, allow about 30-40 minutes. You want the aubergines collapsing. Take the foil off for the last five minutes of cooking.

Scrape most of the aubergines from the skin, although you can keep a bit of it for extra smokiness. Place the aubergines, onions and garlic in a food processor with the rest of the oil, the lemon juice and the tahini. Whizz till smooth.

Taste and add salt and pepper as necessary.

The whole dish has about 45g carbs and 18g fibre.

 

Celebrate the NHS 70th birthday with tea and cakes?

On the 5th of July the NHS celebrates its 70th Birthday.  There is a concerted effort to celebrate this with tea parties and people are meant to contribute the proceeds to an NHS charity of their choice. Diabetes UK perhaps?

The trouble could be the cakes, sandwiches, scones and stuff that is likely to be scoffed along with the tea and coffee.

My practice has been gifted a hamper to celebrate the event.

This is what it contains:

plain and fruit scones

Clotted cream

strawberry jam

tea

Fudge oat crunch cookies

strawberries and cream shortbread biscuits

If you are having one of these events at your workplace, there are many low carb alternatives you can bring instead.

It is a pity the event didn’t feature something that emphasised good health promotion instead of bad health promotion. Going for a 30 minute walk for instance.

https://nhsbig7tea.co.uk/

Jovina cooks: A traditional French feast

Madame Saucourt’s Ratatouille
Hotel Mas des Serres in Saint Paul de Vence.
Source: Mediterranean Grains and Greens by Paula Wolfert

Ingredients
5 pounds eggplant
5 pounds zucchini
5 pounds sweet onion, peeled, halved, and thinly sliced
1 quart extra-virgin olive oil
2 tablespoons crushed garlic
2 tablespoons chopped fresh mixed herbs: rosemary, savory, peppermint, thyme, and celery
1 bay leaf
1/2 tablespoon sugar
1 teaspoon salt
1 teaspoon freshly ground black pepper
2 cups dry yet fruity white wine
2 pounds ripe red tomatoes, cored and seeded
5 pounds red bell peppers
A few drops of red wine vinegar
3 tablespoons chopped mixed herbs for garnish: basil, parsley, thyme
Directions
Stem and peel the eggplant. Cut the flesh into 1″ cubes and place them in a deep kettle filled with very salty water. Keep submerged with a non-corrodible plate for at least 1 hour
Stem and peel the zucchini. Cut the flesh into 1″ cubes and place in a deep colander. Toss the zucchini with salt and let stand 1/2 hour.
In a very large heavy skillet or heavy-bottomed roasting pan cook the chopped onions in 1/2 cup water and 1 cup olive oil until the onions are soft and golden, about 30 minutes. Add the garlic, chopped herbs, bay leaf, sugar, salt, pepper, and 1 cup of the wine. Cook over medium heat, stirring often, for 10 minutes.
Coarsely chop the tomatoes with their skins in the work bowl of a food processor. Add to the skillet and continue cooking at a simmer for 11/2 hours. Whenever the onion-tomato mixture starts to stick or burn, “deglaze” with a few tablespoons of water and scrape with a wooden spoon.
Grill the peppers; when cool, peel, stem, seed and cut into small pieces. Set aside.
Rinse and drain the eggplant and zucchini and lightly press dry with toweling.
Slowly heat the remaining 3 cups of olive oil in a wide pan or fryer until medium-hot. Add the zucchini in batches, and fry until golden on all sides. Transfer the zucchini with a slotted spoon to a colander set over a bowl to catch any excess oil. When all the zucchini has been fried, fry the eggplant in the same manner. From time to time return the drained oil in the bowl to the pan.
Spread the zucchini, eggplant, and peppers over the simmering onion-tomato mixture and pour in the remaining wine. Cover and cook at a simmer for 11/2 hours. From time to time remove the cover to help evaporate some of the liquid.
Place a colander over a large bowl and pour the contents of the skillet into it to drain. Stir carefully to avoid crushing the vegetables while trying to encourage any trapped oil and juices to drain. Quickly cool down the captured juices in order to remove as much oil as possible. If there is a lot of juice, boil it down until thick. Reserve all the frying oil and oil from the vegetables for another use. Pour the juices over the vegetables, taste for seasoning, add vinegar, and carefully stir to combine. Serve hot or cold. Sprinkle with fresh herbs.

Coquilles St-Jacques

Serves 6
Ingredients
8 oz. button mushrooms, minced
6 tablespoons unsalted butter
3 small shallots, minced
2 tablespoons minced parsley
1 tablespoons minced tarragon, plus 6 whole leaves, to garnish
Kosher salt and freshly ground black pepper, to taste
3/4 cup dry vermouth
1 bay leaf
6 large sea scallops
2 tablespoons flour
1/2 cup heavy cream
2/3 cup grated Gruyère
1/2 teaspoon fresh lemon juice
Directions
Heat mushrooms, 4 tablespoons butter, and 2⁄3 of the shallots in a 4-qt. saucepan over medium heat; cook until the mixture forms a loose paste, about 25 minutes. Stir the parsley and minced tarragon into the mushroom mixture; season with salt and pepper.
Divide mixture among 6 cleaned scallop shells or shallow gratin dishes. Bring remaining shallots, vermouth, bay leaf, salt, and 3⁄4 cup water to a boil in a 4-qt. saucepan over medium heat. Add scallops; cook until barely tender, about 2 minutes.
Remove scallops; place each over mushrooms in shells. Continue boiling cooking liquid until reduced to 1⁄2 cup, about 10 minutes; strain.
Heat broiler to high. Heat remaining butter in a 2-qt. saucepan over medium heat. Add flour; cook until smooth, about 2 minutes. Add reduced cooking liquid and cream; cook until thickened, about 8 minutes. Add cheese, juice, salt, and pepper; divide the sauce over scallops.
Broil until browned on top, about 3 minutes; garnish each with a tarragon leaf.

French Cassoulet
This hearty dish from southwestern France, known as a cassoulet, is a one-pot meal. A slow-simmered mix of beans, pork sausages, pork shoulder, pancetta and duck topped with a bread crumb crust , takes its name from the earthenware casserole in which it was traditionally made. My comment:You don’t need to use the breadcrumb crust.
Serves 6-8
Ingredients
1 lb. dried great northern beans
10 tablespoons duck fat or olive oil
16 cloves garlic, smashed
2 onions, chopped
2 carrots, chopped
2 large ham hocks
1 lb. pork shoulder, cut into 1″cubes
1⁄2 lb. pancetta, cubed
4 sprigs oregano
4 sprigs thyme
3 bay leaves
1 cup whole peeled canned tomatoes
1 cup white wine
2 cups chicken broth
4 duck legs
1 lb. pork sausages
2 cups bread crumbs (preferably not on a low carb diet!)
Directions
Soak the beans in a 4-qt. bowl in 7 1⁄2 cups water overnight.
Heat 2 tablespoons of duck fat in a 6-qt. pot over medium-high heat. Add half the garlic, onions, and carrots and cook until lightly browned, about 10 minutes. Add ham hocks along with beans and their water and boil. Reduce heat and simmer beans until tender, about 1 1⁄2 hours.
Transfer ham hocks to a plate; let cool. Pull off meat; discard skin, bone, and gristle. Chop meat; add to beans. Set aside.
Heat 2 tablespoons duck fat in a 5-qt. dutch oven over medium-high heat. Add pork and brown for 8 minutes. Add pancetta; cook for 5 minutes. Add remaining garlic, onions, and carrots; cook until lightly browned, about 10 minutes.
Tie together oregano, thyme, and bay leaves with twine; add to pan with tomatoes; cook until liquid thickens, 8–10 minutes. Add wine; reduce by half. Add broth; boil. Reduce heat to medium-low; cook, uncovered, until liquid has thickened, about 1 hour. Discard herbs; set dutch oven aside.
Sear the duck legs in 2 tablespoons duck fat in a 12″ skillet over medium-high heat for 8 minutes; transfer to a plate. Brown the sausages in the fat, about 8 minutes. Cut sausages into 1⁄2″ slices. Pull duck meat off bones. Discard fat and bones. Stir duck and sausages into pork stew.
Heat the oven to 300˚F. Mix beans and pork stew in a 4-qt. earthenware casserole. Cover with bread crumbs; drizzle with remaining duck fat.
Bake, uncovered, for 3 hours. Raise oven temperature to 500˚; cook the cassoulet until the crust is golden, about 5 minutes.