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The are a few ways around that like Clicker or Spindown Dice
You can find some things you wouldn't expect from the term "offensive", like mapping items and some of the dice items. Things you can't get also include stuff like almost all extra life givers, things that deflect bullets and slow down enemies, some things that possibly negate damage, things that give invincibility but not contact damage (including gnawed leaf unfortunately, or many of the orbitals, especially ones that don't deal damage other than on contact.
Items that are excluded can't be found from death certificate or most other item sources, but some of them can be found in certain fixed ways, like some items found by blowing up skulls and stuff (like dry baby), from using Soul of Lilith, or cube of meat from horsemen bosses (though some similar ones won't appear, like little C.H.A.D.) Excluded items without such a specific exempted source can only be obtained with spindown dice.
Note that the regular Lost with birthright has a different excluded item list that is only things that make sense to exclude due to not being properly useful without health or having innate flight and spectral tears.
Some good defensive options do remain though, like combining panic button with book of shadows and hopefully some battery items (or clear rune plus rune of algiz). Blanket and wooden cross can grant shields, as well as card related stuff to get more use out of holy cards. Birthright gives one same room extra life. The only other extra life available is missing poster revives as yourself instead of regular Lost. You can use void on glowing hour glass, and infinitely activate it upon losing the holy card shield. Some orbitals are possible, like from book of virtues or book of the dead, Block projectiles with ghost pepper plus the luck from perfection or with lost contacts. Tooth and nail (including for curse rooms) and telekinesis can help. You can also safely use curse rooms with flat file. Decreasing your size (like with Pluto) can help. Unicorn stump is gone, but you can get My Little Unicorn or Gamekid. They're not defensive, but remember items with flaws that trigger on taking damage are more valuable with the downside gone, like glass cannon, Damocles, and paschal candle.
Lastly, you can keep prohibited items if you change into tainted Lost by using Clicker with another tainted character (though clicker is itself an item he can't find).