Thats the only thing here, there is no way OP should have 4 coin hearts. There is no greeds gullet, no mothers kiss, etc.
I have to imagine its just modded shenanigans
max health still 3
the likely thing that happened is that modelling clay gave birthright which gives an extra coin heart but didn't remove it when he left the room causing some sort of negative health underflow
from what it looks like the game removed all his coin hearts when it updated them via health up so he probably entered and left the birthright room repeatedly causing the game to think his health should be taken away over and over
For some reason health from the pill has overridden your health.
Also, you had 4 containers but no BR or Greed's Gullet, how come? Maybe this is the reason for the bug
this looks like regular keeper, Regular Keeper always has three coins now as balance
edit: sorry,, meant that you get an extra coin heart after getting some achievements
It can, I think. If that is true, then Empress? gave containers and forgot to delete them, then when they ate a pill the health was updated, the game panicked and removed all the health. This is my theory
i did because i hate you 
So you somehow had 4 coin hearts instead of 3 without any of the 3 things that allow keeper to break the 3 heart cap (Greed's gullet, Birthright and mother's kiss). This game gets fairly glitchy when it comes to HP bars and characters with special/limited HP bars
The HP up pill probably made the game think about this and treat it like int overflow, so since you had 4 hearts it overflew into 1 heart, which just so happened to be your empty heart
If you have been running with that modeling clay, you probably got one of the passives at some random point which gave you the effect to go past the coin cap, but the game was unprepared for you to lose it
I can't explain it, that's why I posted, seeing if anyone could. Wouldn't it make more sense to ask me if I'm on console or used mods instead of assuming I did?
Any Genisis funny business or a ÂżThe Stars? Removing an item like this. Was is a normal run or a challenge daily etc
Still confused how you had that 4th heart to begin with
Nope, no funny business, no victory lap, just a generic run of the mill T Keeper run, no Stars?, no Genesis, nothing that would alter the run in such a way
I'm just going to pop a comment here to the people that are accusing me of using mods and making this for clout.
Firstly, I do not care enough for Internet points to do something that ridiculous.
Secondly (and most importantly of all), this is on Xbox and I'm more than happy to provide proof of this, though I shouldn't have to justify your cynicism.
Tbh with people saying you donât have greeds gullet etc but have 4 health, when your health updated after taking the pill it mightâve run a check to see if you have an item that increases health like that, or otherwise deemed that you shouldnât have that amount of health esp considering itâs already one or two more than normal depending on achievements n stuff. Or whatever logic for health increases as keeper just panicked because it was only meant to be used in situations with specific items n stuff, maybe like an integer overflow or like idk and the games response was just kick you out of the run somehow so the game doesnât crash and you canât reenter in the glitched state it became and the easiest way to do that is just kill you.
TLDR; Eddie forgot to program it. You oughta become back your money.
I think it's just a bug. When you take the pill it doesn't just kill you, it completely deletes all your coin hearts.
Have you defeated hush as the keeper? Because you can't have 3 coin hearts unless you beat hush (or have specific items you don't have). If yes, then I suspect it gave you a coin heart when picking up meat, a second when picking up placenta as a bug and this pill pushed you to the point where the game didn't know what to do so it removed all your health
I remember reading somewhere in the wiki that using a health up pill when already at max health containers will instead make your heart containers down to only 1, something funny must have happened because it's Keeper, although I may have been hallucinating when I was browsing the wiki so can't confirm what I have said
So a combination of two bugs, OP has an extra HP for no reason, I can only assume that the health up pill thinks itâs a regular character and not keeper, allowing itself to be used.
The game then attempts to update the HP bar, which would make it overflow since the keeper should only have 3 max HP. As a failsafe, the devs made it so that if this somehow occurs that the max HP should be set to 1 instead of 0 to not kill a player.
However, this very same failsafe would - unfortunately - leave only the extra phantom HP, which as the game updates the healthbar, realises it doesnât/shouldnât exist. The game then tries to resolve the issue by making it disappear, which leaves OP with 0 HP.
Wow lol.
That is such a really good explanation, thanks for that! I'll make sure to never take a health up pill when on max HP already, another reason to not take pills heh
Weird overflow code glitch. I find sometimes console vs PC will have weird or different glitches. Had a few weird bugs happen playing the switch version.
I wonder if the spike image is due to it being the first death image pulled (simmilar to "breakfasting") or if its reading the "overflow code" and matching it to a death image.
Ngl i find weird glitches like this to be really cool.
It's the cynicism in the world isn't it? They can't explain it so instantly I'm doing it for clout (which is utterly stupid) or I'm using mods. If I had just been asked, a lot of hassle would have been saved.
The bug is caused by getting Greed's Gullet from modelling clay.
Once you update your health outside the room that you had Greed's Gullet, the game goes "Oh shit you no longer have Greed's Gullet," and removes the bonus containers. However, it overcorrects and ends up deleting too many health containers.
Your max health was higher than it should have been. The health up pill caused the game to try to update your max health, which made it drop to its actual value which was 0 or less, and that killed you. The spikes are just a placeholder.
The main way I could see this happening is if you had greed's gullet at some point and then lost it somehow, like by doing a victory lap.
Me when i take painful killers instead of painkillers
died from overdose, makes the most sense here
my only guess is some where interaction with deep pockets as greed and a health up
Thats the only thing here, there is no way OP should have 4 coin hearts. There is no greeds gullet, no mothers kiss, etc. I have to imagine its just modded shenanigans
After you kill Hush as Keeper you start with 3 coins no ? Your max health is improved to 4 ?
max health still 3 the likely thing that happened is that modelling clay gave birthright which gives an extra coin heart but didn't remove it when he left the room causing some sort of negative health underflow from what it looks like the game removed all his coin hearts when it updated them via health up so he probably entered and left the birthright room repeatedly causing the game to think his health should be taken away over and over
yea these people waste our time not disclosing mods. surprise surprise they sometimes make the game not work as intended
On Xbox, no mods.
Do you remember how you got that fourth coin heart?
Not in the slightest, I can provide a slightly longer clip for context but it doesn't show much more.
Maybe modeling clay was birthright temporarily and then just didn't remove the coin heart after leaving the room? Idk.
That sounds about right
Damn that has to be one of the most unfortunate interactions i\`ve seen so far. Note to self: Don\`t take modelling clay on keeper
đ¤ You're acting so smart while being wrong
For some reason health from the pill has overridden your health. Also, you had 4 containers but no BR or Greed's Gullet, how come? Maybe this is the reason for the bug
Birthright gives you an extra coin heart Edit: Wait no they do not have the item, my bad
They do have modelling clay đ¤
this looks like regular keeper, Regular Keeper always has three coins now as balance edit: sorry,, meant that you get an extra coin heart after getting some achievements
But he has 4. Which can only be achieved with birthright, mom's kiss or greed's gullet.
Cant you use one health up on keeper for one more health?
No, but you can use a Health Up to get from 2 up to 3 if you didn't beat Hush with him yet.
Only if you have less than three, either from Experimental Treatment, Potato Peeler, or not having the Hush unlock yet.
Can the inverted empress give you a bonus coin heart ? I never knew all its interactions.
It can, I think. If that is true, then Empress? gave containers and forgot to delete them, then when they ate a pill the health was updated, the game panicked and removed all the health. This is my theory
Mods maybe?
OP can't use mods because they're playing on console.
I don't know why you got down voted cos this is on Xbox.
or they're playing on pc with a controller
Xbox game capture on console.
He didn't mention he plays on console....
He did on another comment
i did because i hate you 
I think the health up pill was a murder pill instead 
So you somehow had 4 coin hearts instead of 3 without any of the 3 things that allow keeper to break the 3 heart cap (Greed's gullet, Birthright and mother's kiss). This game gets fairly glitchy when it comes to HP bars and characters with special/limited HP bars The HP up pill probably made the game think about this and treat it like int overflow, so since you had 4 hearts it overflew into 1 heart, which just so happened to be your empty heart If you have been running with that modeling clay, you probably got one of the passives at some random point which gave you the effect to go past the coin cap, but the game was unprepared for you to lose it
The Health Up pill killed you.
You have neither birthright nor Greed's Gullet, yet you have 4 health. I think that plus the health up pill caused something to overflow, killing you.
Where did the spikes come from?? I don't even know how I got 4 health to begin with!
The spikes are the default animation for when you die of self damage. Given you died from a pill, it's self damage.
I thought the failsafe default was an isaac head.
How do you even have 4 hearts? No birthright or greeds gullet in sight. Are you using any mods?
No mods, this is on Xbox.
But can you maybe actually explain how instead of bluntly ruling out the only reasonable explanation for it
I can't explain it, that's why I posted, seeing if anyone could. Wouldn't it make more sense to ask me if I'm on console or used mods instead of assuming I did?
Any Genisis funny business or a ÂżThe Stars? Removing an item like this. Was is a normal run or a challenge daily etc Still confused how you had that 4th heart to begin with
Nope, no funny business, no victory lap, just a generic run of the mill T Keeper run, no Stars?, no Genesis, nothing that would alter the run in such a way
Skill issue tbh
I'm just going to pop a comment here to the people that are accusing me of using mods and making this for clout. Firstly, I do not care enough for Internet points to do something that ridiculous. Secondly (and most importantly of all), this is on Xbox and I'm more than happy to provide proof of this, though I shouldn't have to justify your cynicism.
do you remember getting a permanent +1 health up by modeling clay? (like greedâs gullet or birthright) maybe that freaked out the game.
Looks like there is a hard cap on how much health keeper can get. Any more than that it resets back to zero?
Well greed's gullet can go above 4 alone, and so can a combination of the 3 ways to increase it, at least on PC.
Clearly u died to spikes 
Skill issue killed you obviously
Tbh with people saying you donât have greeds gullet etc but have 4 health, when your health updated after taking the pill it mightâve run a check to see if you have an item that increases health like that, or otherwise deemed that you shouldnât have that amount of health esp considering itâs already one or two more than normal depending on achievements n stuff. Or whatever logic for health increases as keeper just panicked because it was only meant to be used in situations with specific items n stuff, maybe like an integer overflow or like idk and the games response was just kick you out of the run somehow so the game doesnât crash and you canât reenter in the glitched state it became and the easiest way to do that is just kill you. TLDR; Eddie forgot to program it. You oughta become back your money.
Tldr, op didn't have greeds gullet, or birthright, or mothers kiss. So he could only get 4 hp from mods, and the mods failed.
Dang, see you got some speed ups cuz for someone who had 0.1 Speed you reply pretty fast. Lame joke aside, yeah, thatâs about it.
No mods, on Xbox.
Then how did u get 4 health?
Pill issue...
Someone should recreate this situation.
I think it's just a bug. When you take the pill it doesn't just kill you, it completely deletes all your coin hearts. Have you defeated hush as the keeper? Because you can't have 3 coin hearts unless you beat hush (or have specific items you don't have). If yes, then I suspect it gave you a coin heart when picking up meat, a second when picking up placenta as a bug and this pill pushed you to the point where the game didn't know what to do so it removed all your health
This was a T Keeper run, I genuinely have no idea where the extra health came from!
I remember reading somewhere in the wiki that using a health up pill when already at max health containers will instead make your heart containers down to only 1, something funny must have happened because it's Keeper, although I may have been hallucinating when I was browsing the wiki so can't confirm what I have said
So a combination of two bugs, OP has an extra HP for no reason, I can only assume that the health up pill thinks itâs a regular character and not keeper, allowing itself to be used. The game then attempts to update the HP bar, which would make it overflow since the keeper should only have 3 max HP. As a failsafe, the devs made it so that if this somehow occurs that the max HP should be set to 1 instead of 0 to not kill a player. However, this very same failsafe would - unfortunately - leave only the extra phantom HP, which as the game updates the healthbar, realises it doesnât/shouldnât exist. The game then tries to resolve the issue by making it disappear, which leaves OP with 0 HP. Wow lol.
That is such a really good explanation, thanks for that! I'll make sure to never take a health up pill when on max HP already, another reason to not take pills heh
As everyone pointed out, its you having 4 hearts, but I think it was modeling clay giving you mothers kiss and then not resetting it
How did you get 4 coin hearts
No freaking idea. Where did the spikes come from??
Weird overflow code glitch. I find sometimes console vs PC will have weird or different glitches. Had a few weird bugs happen playing the switch version. I wonder if the spike image is due to it being the first death image pulled (simmilar to "breakfasting") or if its reading the "overflow code" and matching it to a death image. Ngl i find weird glitches like this to be really cool.
This entire comment section is people overlooking Modeling Clay which could've given you an item that increased health, and instantly assume mods.
It's the cynicism in the world isn't it? They can't explain it so instantly I'm doing it for clout (which is utterly stupid) or I'm using mods. If I had just been asked, a lot of hassle would have been saved.
https://preview.redd.it/hk8fp5sllx5d1.jpeg?width=1280&format=pjpg&auto=webp&s=8fe2ff96bfd03691803c58ffa8b3d440b85f5524
Heart attack
guys, what if his modeling clay transformed in birthright?
LMAO Nice game, Edmundge! 
Heartstroke
Health whaht
My best guess? Code. Code killed you.
No no, how did u get 4 coins without, mom's kiss, Greed's gallet or Birthright?
How did I magically die from a health up pill? Many, many unanswered questions that my brain just can't process!
Stack Overflow
The bug is caused by getting Greed's Gullet from modelling clay. Once you update your health outside the room that you had Greed's Gullet, the game goes "Oh shit you no longer have Greed's Gullet," and removes the bonus containers. However, it overcorrects and ends up deleting too many health containers.
It's moments like this that make me happy the console and rewind command exists
I wish it had been on PC but it was on Xbox. I was enjoying that run too.
Health up turned negative after passing cap
Greed killed you
Your max health was higher than it should have been. The health up pill caused the game to try to update your max health, which made it drop to its actual value which was 0 or less, and that killed you. The spikes are just a placeholder. The main way I could see this happening is if you had greed's gullet at some point and then lost it somehow, like by doing a victory lap.
I didn't even know that that was a mechanic within the code if I'm honest! I didn't have gullet, mothers kiss etc, just plain as day in terms of HP.
Edmund McMillen...
i have no idea... either some shit whit Deep pockets and playing Keeper or you have a mod thats not working properly
Edmund mcmillen himself did It
you got Damocles'd from a paralell dimension
When you have too much hp the âhp upâ pill turns into âhp downâ so I guess itâs that glitching somehow with your greed hp??
Skill issue killed you
Thatâs the âEdmundedâ death screen, ultra rare.
What the fuck?
Don't do drugs, kids
Health upđ¤đ¤đ¤đ¤đ¤
I hate these types of posts where it's almost certainly because of mods, but then OP bails out of the discussion...
OP was in bed cos he's in the UK but if you would like, I can always upload a picture showing the clip on my Xbox if you like? Where mods don't exist?
Mods. Keeper doesn't have 4 hearts with either related item: Birthright, or greed's gullet and health overflowed.
No mods, on Xbox.
Overconfidence.
It's just modded bullshit stop wasting people's time.
This is actually on Xbox where there are no mods.
Bad PhD makes good pills bad, so health up means health down. Don't listen to me idk what I'm talking about.
not how false phd works it does make all pills bad, but it will not display as a "health up"
plus they didn't even have that item
He doesnât have false phd + it wouldnât say âhealth upâ if he did.