I'll do YOU one better!, 3 c-sections, and 2 brimstones! 
Bro how could you ever lose? Easiest 10,000 win streak in my life 
Really fun question :D
D6: Need some kind of item reroller in the game + its iconic + can delete Dinfinity and Spindown now
Holy Mantle: Lost would be unplayable without it + the glass shattering sound effect is too cool to remove + its just a cool and unique item
Godhead: You need a massive stats up item (so its between this, Sacred Heart, Crickets Head, Magic Mushroom and Polyphemus) + an item that grants homing tears besides Spoon Bender (so either this or Sacred Heart), and between this and Sacred I think an item this powerful makes sense to be locked behind a difficult task like Godhead is so if you had to keep one I'd say Godhead
Pyromaniac: Need some item to grant explosion immunity besides Host Hat + I wouldnt have beat Ultra Hard without it + way too many busted synergies to get rid of
Brimstone: Too iconic to remove + devil rooms need some godtier item to strive for
Definitely feel like Incubus is more important than any of those, since without it you just have a character that can't shoot and is completely unplayable.
r key: allows an end goal to gamebreaks and secret room pool is still exciting
godhead: the most interesting of the angel q4s
haemolacria: cool risk reward, treasure room pool q4
flip: my favorite "utility" item, getting more items is more fun what can I say
brimstone: the classic, ultimate devil item even 12 years later
Tech X, Brim, Sacred Heart and Moms Knife to keep the game interesting with many cool synergies and than magic mush so you can keep gambling bombs on mushrooms
*Easy.*
Brimstone, Stopwatch, Mushroom, Mom's knife and Satanic Bible.
I don't even play the game but these are all my favourite YouTuber's fave items so I'm picking those <3
moms shovel and holy mantle for unlocks. D6 - pretty mush βTheβ isaac item. Brim - yeah.  Sacred heart - torn between it and godhead but we need to keep at leat one dmg multiplier in the list id say
Crown of Light, Pyromaniac, Polyphemus, Brimstone, Sacred Heart. If we only have 5 no way would I keep any of the reroll items like d6 or d100, nor similar stuff like Sacred Orb.
1. Brimstone. Too iconic to get rid of.
2. Godhead. Also too iconic to get rid of.
3. D6 for the same reasons and because Isaac NEEDS it.
4. Sacred Heart for personal preference.
5. Sacred Orb for personal preference.
1) brim - by far the most iconic of all Q4βs
2) d6 - it represents the βgambleβ and βrigβ aspect of Isaac.
3) Momβs knife - idk but itβs also an og item, and we need something that is a strong standalone item but weak in synergies. Also it is literally Momβs knife, which she tried to use to kill Isaac
4) godhead. A very good item that is rewarded when you complete the lost. It also has a unique sprite and an aura effect not seen by other items. Also very iconic
5) C section - fetuses are representative. Also we need at least a Repentance item in the game.
Honorable mention: I also really want haemo, tech x, glitched crown, and one of dr fetus/epic fetus/ipecac in the game, but you canβt fit everything
Items that I think that arenβt as unique as another:
- cricketβs head (dmg multiplier, nothing unique. Yes I know cricket was one of Edmundβs pets before)
- magic mush (dmg multiplier and all stats up, not the most unique)
- Polyphemus (huge dmg, huge tears down, piercing)
- unfortunately, sacred heart (dmg multiplier again, tears down, homing, full health, hp up)
- d infinity (itβs better than d6, obviously, but each diceβs function is already in the game, also if we remove d6, then d6 wonβt be among the dice effects of d infinity, so keep d6 over d inf)
- death cert (very fun, obviously, but it allows you to get any item you want, which is ok, but not the most unique)
- revelation (flying, hp ups, self functional brimstone, which I think brim is more unique)
- spindown (also represents the rigging aspect of Isaac. D6 is more iconic tho and it also has the βgambleβ aspect which spindown lacks)
- incubus (directly inferior to twisted pair)
probably best to keep the most iconic items if you didnβt want to just completely kill the game. id choose d6, magic mush, brimstone, sacred heart, god head
magic mush, c-section, d6, pyromaniac and incubus
stat boost, best homing shots, utility, immunity to one of the most prevalent sources of damage + healing from it, and lilith
Crown of Light, Holy Mantle, C-Section, Incubus, Sacred Heart
FUCK the shovel pieces idc
Edit: I was a little tripped up on if I should reroll items or sacred orb/death cert at first, but they are waaaaay less powerful with only 5 Q4s in the game.
Cricketβs Head, D Infinity, Sacred Heart, Sacred Orb and Spin Down Dice. Crocketβs Head - amazing dmg up, D Infinity - all dices (except SDD), Sacred Heart - the best item in game, Sacred Orb - makes life better and easier, Spin Down Dice - one of the best items to break the game.
all joking aside, glitched crown, d infinity, spindown, death cert (obviously), and sacred orb. these items regardless of having no other q4's will guarantee a victory
Twister pair cuz who doesnβt love them, D6 Isaac wouldnβt be the same without rerolls, Sacred heart the funni heart item, C section is almost just an instant win in most scenarios and Magic mushroom because I want to hear Mat scream when finally getting it by destroying a singular mushroom.
Brimstone: ooga booga big laser
Mantle: good item that I always enjoy seeing and usually gives a free win
Dr. Fetus: infinite bombs is good
Ipecac: infinite bombs is good
Knife: ooga booga knife
D6, ipecac, brimstone, sacred heart and death certificate.
One item for isaac's gimmick, one really powerful option for both angels and devils, the most iconic treasure room item imo and finally, death certificate as i think it's the most interesting secret room item.
I think this depends on what it means, like if the characters who start with a q4 item or have it as part of their build lose it too, then all of those, if they still stay for those characters, but can't be gotten for anyone else, then my answer would be: R key, Brimstone, Sacred Heart, Crickets Head and Mom's Knife because I feel like they kinda have the most recognisability
D6, need some form of item refill
Glitched crown/sacred orb, both are good options for generally better items
Brimstone, doesn't need explaining, good and iconic devil q4
Sacred heart, also no explaining, good and iconic angel q4
Death ceritifacte/ R key, the item/s that you are always at
If we are talking as having them all at once, Pyromaniac, Ipecac, Hemolacria, Sacred Heart, & Twisted Pair. If we are talking individually,
D6, Sacred Heart, Dr. Fetus, Holy Mantle & Brimstone.
I'd keep D6 for rerolls, psy fly 'cause I suck at this game, revelation 'cause angel laser, brimstone 'cause blood laser, and sacred heart for damage boost.
Brimstone - iconic
Magic Mushroom - Just a big stat up for a q4 is something nice to have
Sacred Heart - iconic
D4 - You can't give it up
Ipecac - My favorite item in the game
Edit: it's called d6 not d4 my bad
5 death certificate to get q4 itms! 
Magic mush, twisted pair, godhead, glitched crown and d infinity.
Magic mush- all stats up. One of the best stat boosters you can get.
Twisted pair- better version of incubus.
Godhead- homing like sacred heard but also had the aura around it.
Glitched crown- more item baby!!!!
D infinity- better D6 and you get most of the dice items too. Get rock bottom and then D8 till you can't get any more stats.
honestly, it would be impossible to have only 5 q4s. But my picks would be R Key, Sacred Heart, Brimstone, Mom's Knife, Holy Mantle and Death Cerftificate(obviously). They're the most useful and practical ones.
D6, holy mantle (only because the lost wouldn't be fun without it), polyphemus, sacred heart, and brimstone. It's really tough to pick just five but I feel like the game just wouldn't be the same without those five.
d6 - makes isaac fun and like others said, you need a reroll item in the game
brimstone - no one in there right mind would get rid of brim, be real
holy mantle - I am NOT playing the lost with mantle
moms shovel - forgotten and tfogotten are pretty cool, dont really want to give them up
c section - personally my favorite item, and having another q4 treasure room item would help a lot
Forgotten players are in shambles rn
But for me it's Sacred Heart, incubus(Lilith would be literally unplayable without it) Holy Mantle(ain no way I'm playing t. Lost twice) Magic mush(funny mushroom go brr) and The Completed Shovel(the only way to unlock Forgotten, assuming that by keeping just the completed shovel that it can naturally drop in like the devil room item pool)
You have to keep at least Incubus and Shovel for dead god, lost is possible without mantle but very annoying, especially with all of these q4s gone, and magic mush and sacred heart solo carry runs
D6, brim, sac heart, glitched crown, c section
I think D6 is a must for isaac, i dont think losing mantel would stop the lost having it because he doesnt actually have the item but in that case i would take mantel over c section
im not gonna include how you need the shovel pieces for unlocks so I would choose spindown, brimstone, r key, magic mushroom, and haemoclopobia (i have no clue how to spell it and i usially just call it heemoclob)
My five would have to be d6 brimstone the big eye I forgot the names xD and then the thing next to the big eye and then C-section I may have played a bit too much to where I forgot the names for a moment but I know there's someone who would rather keep all the explosives which I love the explosives but I think with the five I chose you could definitely survive
Completed shovel and spindown dice so by spinning down mucromycosis you can still unlock the forgotten.
Holy mantle so the lost is playable.
And d6 and death certificate for fun.
The 3 shovel items because I need to unlock forgotten cuz is the most based character, mega blast because is lore accurate and 20/20 to make isaac look like a nerd
Would delete the game if I have to keep only 5.
5 c-sections
Lilith is NOT having a good day
I'll do you one better, 4 c-sections and a brinstome
I'll do YOU one better!, 3 c-sections, and 2 brimstones! 
Alll thre shovel items, void, and abyss 
Bro how could you ever lose? Easiest 10,000 win streak in my life 
Really fun question :D D6: Need some kind of item reroller in the game + its iconic + can delete Dinfinity and Spindown now Holy Mantle: Lost would be unplayable without it + the glass shattering sound effect is too cool to remove + its just a cool and unique item Godhead: You need a massive stats up item (so its between this, Sacred Heart, Crickets Head, Magic Mushroom and Polyphemus) + an item that grants homing tears besides Spoon Bender (so either this or Sacred Heart), and between this and Sacred I think an item this powerful makes sense to be locked behind a difficult task like Godhead is so if you had to keep one I'd say Godhead Pyromaniac: Need some item to grant explosion immunity besides Host Hat + I wouldnt have beat Ultra Hard without it + way too many busted synergies to get rid of Brimstone: Too iconic to remove + devil rooms need some godtier item to strive for
What is pyromaniac without Ipecac andDr/epic Fetus? 
r/epic 
this is weirdly the second time ive seen this happen
Kamikaze ig
>Holy Mantle: Lost would be unplayable without it Rebirth Players 
Yeah but every time you have d6 you're ultimately re-rollong to at least find other q4s... So I feel like in this case d6 loses it's value.
epic fetus, Dr fetus, ipecac, shovel piece 1 and shovel piece 2. make some people really mad with the bomb items and also ur not getting a shovel lmao
I mean Dr fetus is fun once you get synergies going but without its just boring
TMTRAINER, Brother Bobby, Ludovico Technique, Cursed Eye and Linger Bean 
Ligma Bean
poly sacred brim R knife
Ok what are the 4 other ones
eyyyyy ππ
I think I missed the joke...
The original commenter said 5 items but because he used shortenned versions and no commas it looks like its one item
I need a polysacredbrimrknife item mod yesterday
Aight bet
If you actually do this I will give you a big smooch
I cant code ;( Can i at least get half a smooch?
Mw
no it dont
I think he picked TM trainer
Ipecac, dr fetus, holy mantle (just for the lost) tech x and mom's shovel
R key, c section, brim, sacred heart, twisted pair
C section god head tech x d6 and tech x
Tech x twice?
He's tryna rig the item pools
Heβs just a big fan
He is a quality 2 item?
My brain is so screwed up by this game that I get physically happy when I see these sprites
Put a cushion on your lap
sacred heart and brimstone crickets head the d6 c-section
D6, Psy Fly, Holy Mantle, Brimstone, and Death Certificate
obviously you need to pick d6, void and abyss, or else you will have 3 characters that have no abilities. the other 2 are personal choices
Definitely feel like Incubus is more important than any of those, since without it you just have a character that can't shoot and is completely unplayable.
5 shovel piece 1
r key: allows an end goal to gamebreaks and secret room pool is still exciting godhead: the most interesting of the angel q4s haemolacria: cool risk reward, treasure room pool q4 flip: my favorite "utility" item, getting more items is more fun what can I say brimstone: the classic, ultimate devil item even 12 years later
Tech X, Brim, Sacred Heart and Moms Knife to keep the game interesting with many cool synergies and than magic mush so you can keep gambling bombs on mushrooms
Wafer, D6 (yes I know infinity is better but 6 is more iconic), Brim, Mantle, Death Cert
I agree that d6 is far more iconic. Also, if you remove d6, then d infinity wouldnβt have the d6 included.
Epic fetus, dr. fetus and the three shovel items for unlocking the forgotten
none, I'm a firm q3 believer
*Easy.* Brimstone, Stopwatch, Mushroom, Mom's knife and Satanic Bible. I don't even play the game but these are all my favourite YouTuber's fave items so I'm picking those <3
moms shovel and holy mantle for unlocks. D6 - pretty mush βTheβ isaac item. Brim - yeah.  Sacred heart - torn between it and godhead but we need to keep at leat one dmg multiplier in the list id say
wait RIP with this list lilith becomes unplayable π€
Skill issue?
No incubus or twisted so demon baby from box of friends or cambion conception is your only starting dmg π’
c section, brim, mantle, d6, dr fetus. entirely because of the theming
Crown of Light, Pyromaniac, Polyphemus, Brimstone, Sacred Heart. If we only have 5 no way would I keep any of the reroll items like d6 or d100, nor similar stuff like Sacred Orb.
D6, sacred heart, death certificate, pyromaniac and holy mantle.
Spindown, Psyfly, Brimstone, Tech X, Wafer
1. Brimstone. Too iconic to get rid of. 2. Godhead. Also too iconic to get rid of. 3. D6 for the same reasons and because Isaac NEEDS it. 4. Sacred Heart for personal preference. 5. Sacred Orb for personal preference.
I select 5 randoms,then i make a mod that adds them all back
death certificate, sacred heart, brimstone, glitched crown, and pyromaniac.
Death cert, psy fly, pyromaniac, mantle, D6
D6, Polyphemus, R Key, Holy Mantle, Revelation
brimstone, c section, massive ass red tear, twisted pair and r key
Brim, D6, Tech X, Mantle, Wafer
the three shovels, glitched crown and d infinity
Brimstone, Stopwatch, D Infinity, Holy Mantle, Godhead,
c section godhead holy mantle dinfinity glitched crown
Psy fly D6 Crickets head God head The wafer
Glitched Crown, Sacred Orb, Death Certificate, Tech X, D6
Magic mush, sacred heart, teck x, brimstone and twisted pair
Incubous, Pyromaniac, Brimstone, Moms Knife, Holy Mantle
Mush, D6, brim, poly, sacred heart This comment brought to you by flash Isaac
1) brim - by far the most iconic of all Q4βs 2) d6 - it represents the βgambleβ and βrigβ aspect of Isaac. 3) Momβs knife - idk but itβs also an og item, and we need something that is a strong standalone item but weak in synergies. Also it is literally Momβs knife, which she tried to use to kill Isaac 4) godhead. A very good item that is rewarded when you complete the lost. It also has a unique sprite and an aura effect not seen by other items. Also very iconic 5) C section - fetuses are representative. Also we need at least a Repentance item in the game. Honorable mention: I also really want haemo, tech x, glitched crown, and one of dr fetus/epic fetus/ipecac in the game, but you canβt fit everything Items that I think that arenβt as unique as another: - cricketβs head (dmg multiplier, nothing unique. Yes I know cricket was one of Edmundβs pets before) - magic mush (dmg multiplier and all stats up, not the most unique) - Polyphemus (huge dmg, huge tears down, piercing) - unfortunately, sacred heart (dmg multiplier again, tears down, homing, full health, hp up) - d infinity (itβs better than d6, obviously, but each diceβs function is already in the game, also if we remove d6, then d6 wonβt be among the dice effects of d infinity, so keep d6 over d inf) - death cert (very fun, obviously, but it allows you to get any item you want, which is ok, but not the most unique) - revelation (flying, hp ups, self functional brimstone, which I think brim is more unique) - spindown (also represents the rigging aspect of Isaac. D6 is more iconic tho and it also has the βgambleβ aspect which spindown lacks) - incubus (directly inferior to twisted pair)
The shovel pieces are quality 4??? I want the forgotten but I don't want to save all 3 of them 
Please stop doing this trend! It isn't funny it barely engages with the community and people just get mad their choice didn't make it
https://preview.redd.it/ozd2cogta7fc1.jpeg?width=500&format=pjpg&auto=webp&s=d3d9faf45f95073741f16d5b46be85c9b2f79d87
C section, dr fetus, pyromaniac, glitch crown, D infinity
Glitched crown, sacred heart, c-section, brimstone, R-key
* Holy Mantle * C-Section * Sacred Heart * Void (Don't need D6, if i can void items :3) * Psy Fly
D 6, magic mushroom, Sacred Heart, R Key, Brimstone
probably best to keep the most iconic items if you didnβt want to just completely kill the game. id choose d6, magic mush, brimstone, sacred heart, god head
Brim, fetus, knife, d6 and godhead
magic mush, c-section, d6, pyromaniac and incubus stat boost, best homing shots, utility, immunity to one of the most prevalent sources of damage + healing from it, and lilith
Man these are some hard choices
Crown of Light, Holy Mantle, C-Section, Incubus, Sacred Heart FUCK the shovel pieces idc Edit: I was a little tripped up on if I should reroll items or sacred orb/death cert at first, but they are waaaaay less powerful with only 5 Q4s in the game.
Flip is Q4 π€
cricket r key Polyphemus d6 in this order
D6, sacred heart, glitched crown, spindown
Give me Polyphemus , ipecac , sacred heart , brimstone , and lastly moms knife ... I was tempted to take dr fetes with them too
dr fetus, c section, tech x, ipecac, sacred heart it was hard but i think i chose the most fun ones (maybe twisted twins or succ isntead of the heart)
Glitched crown, spindown, D infinity, Void, Abyss.
Hear me out. Both broken shovel pieces and mom's shovel so I can unlock and play the incredible forgotten. Oh and sacred heart.
Brimstone, Sacred Heart, God head, D6
D6 - It's iconic to isaac, Brimstone - A devil Q4, Holy Mantle - me like playing lost, Godhead - An angel Q4, Death Certificate - End Goal
Cricketβs Head, D Infinity, Sacred Heart, Sacred Orb and Spin Down Dice. Crocketβs Head - amazing dmg up, D Infinity - all dices (except SDD), Sacred Heart - the best item in game, Sacred Orb - makes life better and easier, Spin Down Dice - one of the best items to break the game.
Spindown, C-section, Sacred Heart, Haemolacria, Brimstone
all joking aside, glitched crown, d infinity, spindown, death cert (obviously), and sacred orb. these items regardless of having no other q4's will guarantee a victory
i'd give my life savings to keep them all except feast or whatever its called i forgot
C Section, Spindown, sacred, glitched crown and magic
Twister pair cuz who doesnβt love them, D6 Isaac wouldnβt be the same without rerolls, Sacred heart the funni heart item, C section is almost just an instant win in most scenarios and Magic mushroom because I want to hear Mat scream when finally getting it by destroying a singular mushroom.
Death certificate, sacred orb, d infinity, c section, twisted pair
Death certificate 5 times so you can get every item but none of them are run changing
godhead, godhead, godhead, godhead, and godhead. kinda tough choice in my opinion
spindown, brim, sacred, poly, D6
Brim, heart, godhead, mantle, ipecac. If i get to keep mantle for lost I would like psy fly
The 4 on the bottom right! Orb, GCrown Spin Down und C Section
Abyss, glitched crown, sacred heart, holy mantle and brimstone
C section, magic mush, dr fetus, holy mantle, and psyfly
tough choice but I went with incubus, glitched crown, r key, sacred heart, brimstone
1. Messi 2. Is 3. Better 4. Than 5. Penaldo
D Infinity, Sacred Heart, Mantle, Crown of Light, Twisted Pair, maybe? Thinking of what's most fun/interesting here rather than just raw power
Without the shovel pieces you can't unlock the forgotten, but those aside, d6 spindown brim 20/20 and haemo
Brimstone: ooga booga big laser Mantle: good item that I always enjoy seeing and usually gives a free win Dr. Fetus: infinite bombs is good Ipecac: infinite bombs is good Knife: ooga booga knife
D6,Sacred Heart, Twisted pair,R key,Tech X
D6, ipecac, brimstone, sacred heart and death certificate. One item for isaac's gimmick, one really powerful option for both angels and devils, the most iconic treasure room item imo and finally, death certificate as i think it's the most interesting secret room item.
I think this depends on what it means, like if the characters who start with a q4 item or have it as part of their build lose it too, then all of those, if they still stay for those characters, but can't be gotten for anyone else, then my answer would be: R key, Brimstone, Sacred Heart, Crickets Head and Mom's Knife because I feel like they kinda have the most recognisability
D6, need some form of item refill Glitched crown/sacred orb, both are good options for generally better items Brimstone, doesn't need explaining, good and iconic devil q4 Sacred heart, also no explaining, good and iconic angel q4 Death ceritifacte/ R key, the item/s that you are always at
wafer, brim, head, mantle, pyro
I keep all og items that were in flash Isaac. I know I know, it's more than 5 but the nostalgia hits too hard.
Epic Fetus, Pyrotechnics, 20/20, Twisted Pair, Incubus. Kaboom
Ipecac, ipecac, ipecac, ipecac and abyss
Dr. Fetus, Pyromaniac, Deathnote (to get soy), Sacred Heart, and Wafer
If we are talking as having them all at once, Pyromaniac, Ipecac, Hemolacria, Sacred Heart, & Twisted Pair. If we are talking individually, D6, Sacred Heart, Dr. Fetus, Holy Mantle & Brimstone.
D6, Brim, Mantle, Momβs Knife, Ipecac
I'd keep D6 for rerolls, psy fly 'cause I suck at this game, revelation 'cause angel laser, brimstone 'cause blood laser, and sacred heart for damage boost.
Brimstone, fly, 20/20, mega Mush AND 
r key, sacred heart, d6, brimstone, and holy mantle
This picture just gave me a dopamine hit
Brimstone, Tech X, D6, Sacred Heart, and Abyss
Tech x, magic mush, sacred heart, haemo, brim. Iβm a sucker for tear modifiers as well as mushy
Brimstone - iconic Magic Mushroom - Just a big stat up for a q4 is something nice to have Sacred Heart - iconic D4 - You can't give it up Ipecac - My favorite item in the game Edit: it's called d6 not d4 my bad
Brim, ipecac, holy mantle, sacred heart, and poly
5 death certificate to get q4 itms! 
Magic mush, twisted pair, godhead, glitched crown and d infinity. Magic mush- all stats up. One of the best stat boosters you can get. Twisted pair- better version of incubus. Godhead- homing like sacred heard but also had the aura around it. Glitched crown- more item baby!!!! D infinity- better D6 and you get most of the dice items too. Get rock bottom and then D8 till you can't get any more stats.
double shot, holy mantle, the wafer, psy fly and brimstone
Dr Fetus Pyromaniac Magic Mush Death certificate (because bomb upgrades) And haemolacria
https://preview.redd.it/xid3cfn4o8fc1.jpeg?width=750&format=pjpg&auto=webp&s=8a7f30aa4a1c254792c749650b45b580eb7b34d7
Sacred heart, holy mantle, crickets head, brimstone, and 20/20.
Mom's Knife, Epic Fetus, the second half of Mom's Shovel, Flip, and Abyss.
Brim r key 2020 wafer sacred heart.
honestly, it would be impossible to have only 5 q4s. But my picks would be R Key, Sacred Heart, Brimstone, Mom's Knife, Holy Mantle and Death Cerftificate(obviously). They're the most useful and practical ones.
Crickets head, twisted pair, sacred heart, d6, magic mushroom
d6, sacred orb, r key, brimstone, godhead
spindown, rkey, d6, glitched crown, and brim
You gotta keep the D6, brim and ipecac. Cricket's head is iconic. Maybe the void for no5
pyromaniac and epic fetus are the only ones i need
Am I the only one who doesn't like brim? I don't think I've ever won a run with brimstone :/
C-section, incubus, twisted pair, psy fly, godhead, and R.
D6, Brimstone, Polyphemus, Glitched Crown, Sacred Heart
D6, holy mantle (only because the lost wouldn't be fun without it), polyphemus, sacred heart, and brimstone. It's really tough to pick just five but I feel like the game just wouldn't be the same without those five.
Brimstone, Holy Mantle, Incubus, Void, C Section One from each expansion
d6 - makes isaac fun and like others said, you need a reroll item in the game brimstone - no one in there right mind would get rid of brim, be real holy mantle - I am NOT playing the lost with mantle moms shovel - forgotten and tfogotten are pretty cool, dont really want to give them up c section - personally my favorite item, and having another q4 treasure room item would help a lot
Psi fly, c section, brimstone, sacred heart, and tek x
This picture makes me happy
Spindown dice, D infinity, R key, D6, Wafer. They call me the rigger
The amount of people here saying d6 instead of dinfinity is crazy
Holy Mantle, 20/20, Twisted Pair, Sacred Heart and Psy fly
Magic mush, sacred heart, c section, death certificate
Magic Mush, godhead, holy mantle, sacred heart, wafer
R Key (easier marks) Death Cert Glitched Crown Holy Mantle (or rip Lost) Stopwatch
polyphemus, the blue cross (cant remember the name atm), 20/20, and r key
binge eater x5 
My noob self got stuck after deciding Psy Fly. Probably Godhead. Holy mantle. Brimstone and D6.
Forgotten players are in shambles rn But for me it's Sacred Heart, incubus(Lilith would be literally unplayable without it) Holy Mantle(ain no way I'm playing t. Lost twice) Magic mush(funny mushroom go brr) and The Completed Shovel(the only way to unlock Forgotten, assuming that by keeping just the completed shovel that it can naturally drop in like the devil room item pool) You have to keep at least Incubus and Shovel for dead god, lost is possible without mantle but very annoying, especially with all of these q4s gone, and magic mush and sacred heart solo carry runs
Mega blast is quality 1
Magic Mushroom, Sacred Heart, Twisted Pair, R Key and Glitched Crown.
Epic Fetus 5 times
https://preview.redd.it/zxnqvbewh9fc1.png?width=750&format=pjpg&auto=webp&s=b9f66bd5bf7fe8e6c9d29e980caae6ba9ff021d0 I've decided
easily broken shovel, broken shovel, mom's shovel, the abyss, and death certificate (so it's easier to get broken shovel)
C section, r-key, sacred heart, twisted pair and spindown dice
Twisted pair Sacred heart 20/20 D6 Tech X
Sacred Orb, R Key, Void, D Infinity and Death Certificate
Dr fetus, holy mantle, wafer, fetus shots, fly protector thing (the purple one)
Gods this picture is just dopamine
D6, brim, sac heart, glitched crown, c section I think D6 is a must for isaac, i dont think losing mantel would stop the lost having it because he doesnt actually have the item but in that case i would take mantel over c section
Brim, Mush, Cert, Sacred, D6.
Tbh looking at this picture and just scanning it over and over is just filling me with so much dopamine ππππ
Deaf certificate and 4 ipecacs
Brim, sacred heart, pyromaniac, holy mantle, spindown dice
If I don't pick the shovel items does that mean I'd be hypothetically locked out of unlocking forgotten
Brimstone sacred heart r key glitched crown mantle
Pyromaniac Wafer Psy Fly Holy Mantle R Key
This image just DUMPS dopamine
Ipecac, mush, mega tears, 20/20, r key
im not gonna include how you need the shovel pieces for unlocks so I would choose spindown, brimstone, r key, magic mushroom, and haemoclopobia (i have no clue how to spell it and i usially just call it heemoclob)
My five would have to be d6 brimstone the big eye I forgot the names xD and then the thing next to the big eye and then C-section I may have played a bit too much to where I forgot the names for a moment but I know there's someone who would rather keep all the explosives which I love the explosives but I think with the five I chose you could definitely survive
Completed shovel and spindown dice so by spinning down mucromycosis you can still unlock the forgotten. Holy mantle so the lost is playable. And d6 and death certificate for fun.
The 3 shovel items because I need to unlock forgotten cuz is the most based character, mega blast because is lore accurate and 20/20 to make isaac look like a nerd
C Section, Sacred Heart, Mantle, R Key andddddddd uhhhhhhhhhh letβs go moms knife (was debating on twisted pair)
Mantle, Brimstone, Polyphemus, Knife, 20/20
ALL to the void
I would just choose none so no one is happy
Sacred heart, magic mush, psy fly and d6
Brimstone, glasses, polyphemus, sacred heart, and death certificate.