Hot chocolate, also known as hot cocoa or drinking chocolate, is a heated drink consisting of shaved or melted chocolate or cocoa powder, and heated milk or water. It usually contains a sweetener, such as sugar, and is often garnished with whipped cream or marshmallows. Hot chocolate made with melted chocolate is characterized by less sweetness and a thicker consistency. Cacao was first domesticated at least 5,300 years ago, in the Mayo-Chinchipe culture in what is present-day Ecuador, and cacao beverages were consumed by the period 2,500–3,000 years ago by the Maya. A chocolate drink was an essential part of Aztec culture by 1400 AD. The drink became popular in Europe after being introduced from Mexico in the New World and has undergone multiple changes since then. Until the 19th century, hot chocolate was used medicinally to treat ailments such as liver and stomach diseases. Hot chocolate is consumed throughout the world in versions including the spiced chocolate para mesa of Latin America, the very thick cioccolata calda served in Italy and chocolate a la taza served in Spain, and the thinner hot cocoa consumed in the United States. Prepared hot chocolate can be purchased from a range of establishments, including cafeterias, fast food restaurants, coffeehouses and teahouses. Powdered hot chocolate mixes, which can be added to boiling water or hot milk to make the drink at home, are sold at grocery stores and online.